电子纤维喉镜联合吞咽造影评估脑卒中后吞咽障碍患者经吞咽神经电刺激治疗后的康复效果研究

Assessment of swallowing rehabilitation using combined fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study after pharyngeal electrical stimulation in patients with post-stroke dysphagia

摘要:

目的 探讨电子纤维喉镜联合吞咽造影评估脑卒中后吞咽障碍患者经吞咽神经电刺激治疗后的康复效果。方法 选取2021年3月—2024年1月南京医科大学附属淮安第一医院收治的92例脑卒中后吞咽障碍患者为研究对象，随机分为观察组和对照组，各46例，对照组给予舌压抗阻反馈训练治疗，观察组在对照组基础上联合吞咽神经电刺激治疗。治疗3周后，比较两组的舌肌力量、舌骨喉复合体动度、疗效标准吞咽功能评定量表（SSA）评分、功能性经口摄食评价量表（FOIS）评分、吞咽障碍特异性生活质量问卷（SWAL-QOL）评分。结果 观察组治疗前后舌压均值、舌压峰值及舌压持续时间的差值均高于对照组（P <0.05）。观察组治疗前后舌骨上移、舌骨前移、甲状软骨上移及甲状软骨前移的差值均高于对照组（P <0.05）。观察组治疗前后咽运送时间和上食道括约肌开放时间的差值均高于对照组（P <0.05）。观察组会厌谷残留率、梨状窝残留率及呛咳发生率均低于对照组（P <0.05）。观察组治疗总有效率高于对照组（P <0.05）。观察组治疗前后SSA、FOIS及SWAL-QOL评分的差值均高于对照组（P <0.05）。结论 吞咽神经电刺激应用于脑卒中后吞咽障碍的治疗中，能够提升患者的舌肌力量，促进吞咽功能的恢复。无创性电子纤维喉镜检查能够评估患者的食物残留及误吸风险。

Abstract:

Objective To explore the therapeutic effects of pharyngeal electrical stimulation on post-stroke dysphagia as assessed by combined fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study.Methods A total of 92 patients diagnosed with post-stroke dysphagia admitted to our hospital between March 2021 and January 2024 were included in the study. These patients were randomly assigned into the observation group and the control group, each consisting of 46 individuals. The control group received tongue-pressure resistance training, while the observation group received additional pharyngeal electrical stimulation. After 3 weeks of treatment, the tongue strength, hyolaryngeal movements, Standardized Swallowing Assessment (SSA) scores, Functional Oral Intake Scale (FOIS) scores, and Swallowing Quality-of-Life Questionnaire (SWAL-QOL) scores were compared between the two groups.Results The differences of mean tongue pressure, peak tongue pressure, and duration of tongue pressure before and after treatment in the observation group were all greater than those in the control group (P < 0.05). The differences of hyoid upward displacement, hyoid forward displacement, thyroid cartilage elevation, and thyroid cartilage anterior displacement before and after treatment in the observation group were all higher than those in the control group (P < 0.05). The differences of pharyngeal transit time and upper esophageal sphincter opening duration before and after treatment in the observation group were both higher than those in the control group (P < 0.05). The rates of vallecular residue, pyriform sinus residue, and coughing episodes in the observation group were lower than those in the control group (P < 0.05). The effective rate in the observation group was higher than that in the control group (P < 0.05). The differences of SSA, FOIS, and SWAL-QOL scores before and after treatment in the observation group were all higher than those in the control group (P < 0.05).Conclusion In the treatment of post-stroke dysphagia, pharyngeal electrical stimulation can improve tongue strength and promote the recovery of swallowing function. Non-invasive fiberoptic endoscopic evaluation of swallowing enables the assessment of pharyngeal residue and the risk of aspiration in patients.