Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening
Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening
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DOI：
10.1053/gast.2002.32999
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发表时间：
2002-05-01
期刊：
影响因子：
29.4
通讯作者：
Dikeman, K
中科院分区：
文献类型：
--
作者：
Shaker, R;Easterling, C;Dikeman, K
背景和目的：我们评估了一种新型康复运动对一组因上食管括约肌（UES）开口异常导致吞咽失败的患者恢复吞咽功能的效果，这些患者表现为吞咽后残留物和误吸，需要经皮管饲。方法：我们对 27 名患者进行了 6 周的抬头运动计划前后的电视透视检查和吞咽功能评分的功能评估。 27 名患者中的 7 名被随机分配，在进入测试锻炼计划之前参加了假锻炼。 27 人中的 11 人被随机分配到真正的锻炼计划中。结果：虽然假运动后吞咽功能和生物力学没有变化，但经过 6 周的真实运动后，所有 11 名患者的 UES 开口、喉前偏移（P < 0.01）以及吞咽后误吸的解决均表现出显着改善，并能够恢复经口喂养。当假手术组的 7 名患者交叉到真正的运动组时，也发现了类似的结果。全组27例患者运动前后UES开口（P < 0.01）和喉前移（P < 0.05）以及吞咽功能结果评估（P < 0.05）的运动前后比较也显示出显着改善。吞咽困难的病因和持续时间不影响结果。结论：所提出的舌骨上肌强化锻炼计划对于一些因 UES 开口异常而导致吞咽失败的患者恢复经口进食是有效的。
Background & Aims: We evaluated the effect of a novel rehabilitative exercise on restoration of deglutition in a group of patients with deglutitive failure caused by abnormal upper esophageal sphincter (UES) opening manifested by postswallow residue and aspiration necessitating percutaneous tube feeding. Methods: We studied a total of 27 patients by videofluoroscopy and functional assessment of swallowing scores before and after 6 weeks of a head-raising exercise program. Seven of 27 patients, assigned randomly, participated in a sham exercise before entering the tested exercise program. Eleven of 27 were randomized to the real exercise program. Results: Although there was no change in swallow function and biomechanics after the sham exercise, following 6 weeks of real exercise, all 11 patients exhibited a significant improvement in their UES opening, anterior laryngeal excursion (P < 0.01), as well as resolution of postdeglutitive aspiration and were able to resume oral feeding. Similar results were found when the 7 patients in the sham group were crossed over to the real exercise group. Comparison of before and after exercise values for anteroposterior UES opening (P < 0.01) and laryngeal anterior excursion (P < 0.05), as well as functional outcome assessment of swallowing (P < 0.05) in the entire group of 27 patients also showed significant improvement. Etiology and duration of dysphagia did not affect the outcome. Conclusions: The proposed suprahyoid muscle strengthening exercise program is effective in restoring oral feeding in some patients with deglutitive failure because of abnormal UES opening.