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研究生:江東樺
研究生(外文):Tung-Hua Chiang
論文名稱:體表肌電圖在診斷腦性麻痺病人併有吞嚥困難的應用
論文名稱(外文):Application of Surface Electromyography in Patients with Cerebral Palsy and Dysphagia
指導教授:郭寶錚郭寶錚引用關係
指導教授(外文):Bo-Jein Kuo
口試委員:劉祥仁劉秋松
口試日期:2011-06-25
學位類別:碩士
校院名稱:國立中興大學
系所名稱:生命科學院碩士在職專班
學門:生命科學學門
學類:生物學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:69
中文關鍵詞:吞嚥困難體表肌電圖最大一口量
外文關鍵詞:dysphagiasurface electromyographymaximum swallowing volume
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中 文 摘 要
吞嚥困難是健康的重大威脅。吞嚥困難會引起營養不足,免疫力降低,引起各種併發症,對年幼的病人會造成發育遲緩不良,而幾乎所有吞嚥困難的病人都面臨著嗆咳引起急性呼吸道阻塞的生命威脅。處理吞嚥困難最好的方法就是儘早篩檢出有危險的個案,給予適當的治療;然而目前現有的吞嚥檢查及流程並不是很理想,造成篩檢率偏低。本次研究我們嘗試以安全、非侵入性的體表肌電圖檢查找出更方便、快速的檢查方法,來檢查有吞嚥障礙的潛在個案,提早進行治療的時間,減少併發症的出現。
我們以20位年齡在5歲到30歲之間、已經在復健科門診追蹤的腦性麻痺併有吞嚥困難的病人為對象,並另外徵求了60位以年齡配對的健康志願者,以2頻道體表肌電圖儀的2組偵測電極分別黏貼於下頜下肌群及舌骨下肌群的皮膚表面,然後執行測量一口能喝下的最大水量(最大一口量)的程序,最後分析整個過程的肌電波紀錄。
在我們設定的檢定項目上,分別是“最大一口量”,以及喝下3 mL和最大一口水量的肌電圖數據,包括“下頜下肌群最大肌電波振幅”、“舌骨下肌群最大肌電波振幅”、“下頜下肌群與舌骨下肌群肌電波時間差”、“ 下頜下肌群與舌骨下肌群肌電波最大電位振幅差”,實驗組與對照組之間存在著顯著的差異。我們由本次研究訂出了新的吞嚥困難的篩檢方法,敏感度可達90 %,特異性可達83.3 %,對於臨床的實用性有很大幫助。
體表肌電圖應用於吞嚥困難的檢查,比起以往的篩檢檢查有更優異的敏感度、特異性,又比較安全、而且客觀,如果能廣泛使用於基層醫療機構,對於吞嚥困難的早期篩檢與後續的治療,會有很大的幫助。


Abstract
Dysphagia is a great threaten to peoples’ health. It would cause malnutrition and impairment of immunity thus brings about a variety of complication. For younger patients dysphagia results in significant growth retardation. Moreover, the patients with dysphagia are all at risk of suffocation, which may cause death. Early identification of dysphagia patients and providing proper treatment is the best solution. The present screening tests are not efficiency for identifying the dysphagia patients. In this study we were trying to set up an easier and faster test for examination of dysphagia patient compared with previous tests, with safe and non-invasive surface electromyography (sEMG).
We enrolled 20 patients with cerebral palsy and dysphagia who had been followed up at out patient department of rehabilitation, aged between 5 to 30 years old. 60 age-matched healthy volunteers were also recruited in this study. 2 electrodes were attached on the surface of suprahyoid muscle group and infrahyoid muscle group. Then we proceeded a procedure of determination of maximum swallowing volume followed by off-line analysis of these electromyographic data.
There were significant differences between dysphagia and normal patients in the following items of data: maximum swallowing volume, maximum sEMG amplitude of suprahyoid muscle group, maximum sEMG amplitude of infrahyoid muscle group, time-difference between 2 muscle groups, and amplitude-difference between 2 muscle groups. A new screening test of dysphagia came from them.
With this sEMG we have developed a new screening test of dyphagia patient. It is a safer, quicker, and more effective test compared with present other tests with sensitivity of 90 % and specificity of 83.3 %. It would be very helpful for screening and treating dysphagia patients if our newly developed test could be available at most of the basic local clinics.


目 錄
頁次
中文摘要---------------------------------------------------I
英文摘要--------------------------------------------------III
表目錄-----------------------------------------------------i
圖目錄-----------------------------------------------------ii
第一章 緒論-------------------------------------------------1
一、 研究背景------------------------------------------------1
二、 研究目的------------------------------------------------4
三、 研究重要性----------------------------------------------5
第二章 文獻探討----------------------------------------------7
一、吞嚥的正常生理與神經支配------------------------------------7
二、吞嚥障礙的分類-------------------------------------------11
三、吞嚥障礙所產生的併發症及基本處理原則-------------------------14
四、吞嚥障礙的評估-------------------------------------------15
五、體表肌電圖在吞嚥障礙檢查的可能應用---------------------------21
第三章 研究方法---------------------------------------------25
一、研究對象------------------------------------------------25
二、體表肌電圖檢查-------------------------------------------25
三、最大一口量----------------------------------------------27
四、資料分析與統計-------------------------------------------27
第四章 研究結果---------------------------------------------29
一、研究對象基本資料之描述性統計--------------------------------29
二、最大一口量----------------------------------------------30
三、體表肌電圖數據分析----------------------------------------31
四、臨界值的訂定---------------------------------------------34
五、參考值之決定---------------------------------------------48
第五章 綜合討論---------------------------------------------50
參考書目---------------------------------------------------62
附錄------------------------------------------------------68



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