肉毒毒素注射治疗神经源性环咽肌功能障碍的前瞻性临床研究

关键词：吞咽障碍  肉毒毒素  环咽肌功能障碍  康复

Keywords:dysphagia  botulinum toxin  cricopharyngeal dysfunction  rehabilitation

摘要：

      摘要 目的：探讨超声、球囊联合肌电引导肉毒毒素注射对神经源性环咽肌功能障碍的作用及安全性。 方法：本研究纳入18例经常规吞咽康复治疗无明显改善的神经源性环咽肌功能障碍患者，对其进行超声、球囊联合肌电引导环咽肌肉毒毒素注射，于注射前、末次注射后采用功能性经口摄食量表（functional oral intake scale， FOIS）评估进食功能，采用吞咽造影评估环咽肌开放程度，采用渗漏误吸量表（penetration aspiration scale， PAS）评估渗漏误吸程度，采用高分辨率咽腔测压评估食管上括约肌（upper esophageal sphincter， UES）松弛残余压、UES静息压、腭咽收缩压力峰值和下咽收缩压力峰值等。 结果：注射后15例（83.3%）患者的FOIS分级提高，3例患者的FOIS分级无变化。患者注射前、后FOIS分别为1（1，2）和3（2，4.25）（P＜0.001），环咽肌开放程度分别为2（2，3）和2（1，2.5）（P＜0.05），PAS分别为6（5，6.5）和6（2.5，6）（P＜0.05）。注射前、后UES静息压分别为（37.4±14.0）mmHg和（36.2±23.9）mmHg，UES松弛残余压分别为39.9（4.9，103.9）mmHg和18（4.4，67.9）mmHg，腭咽收缩压力峰值分别为（116.2±46.0）mmHg和（105.0±65.2）mmHg，下咽收缩压力峰值分别为（46.3±26.9）mmHg和（67.3±44.1）mmHg，上述指标注射前后差异均无显著性意义（P＞0.05）。患者未出现不良反应。 结论：超声、球囊联合肌电引导环咽肌肉毒毒素注射可有效干预常规治疗无效的神经源性环咽肌功能障碍。

Abstract:

      Abstract Objective: To explore the effect and safety of botulinum toxin injection guided by ultrasound， balloon and electromyography on neurogenic cricopharyngeal dysfunction. Method: Eighteen patients with neurogenic cricopharyngeal dysfunction who failed to improve after traditional swallowing therapy were included in this study. The etiology included stroke， brain tumor， brain injury and multiple cranial neuritis. They received botulinum toxin injection to the cricopharyngeal muscle guided by ultra-sound， balloon and electromyography. Prior to and post the injection， patients’ ability of eating was evaluated by functional oral intake scale (FOIS). Cricopharyngeal opening and penetration aspiration scale (PAS) were evaluated by videofluroscopic swallowing study (VFSS). Upper esophageal sphincter (UES) relaxation pressure， UES resting pressure， velopharyngeal peak pressure and tongue base peak pressure were evaluated by high resolution manometry (HRM). Result: After the injection， FOIS was increased in 15 patients (83.3%)， while 3 patients did not improve. Prior to and post injection， FOIS was 1(1， 2) and 3(2， 4.25) (P<0.001); cricopharyngeal opening was 2(2， 3) and 2(1， 2.5) (P<0.05) and PAS was 6(5， 6.5) and 6(2.5， 6) (P<0.05). No significant improvement was seen after injection in UES relaxation pressure (37.4±14.0 mmHg and 36.2±23.9 mmHg)， UES resting pressure [39.9 (4.9，103.9) mmHg and 18(4.4，67.9) mmHg]， velopharyngeal peak pressure (116.2±46.0 mmHg and 105.0±65.2 mmHg) and tongue base peak pressure (46.3±26.9 mmHg and 67.3±44.1 mmHg). None of the patients showed side effects. Conclusion: Botulinum toxin injection guided by ultrasound， balloon and electromyography can effectively treat neurogenic cricopharyngeal dysfunction that failed the traditional dysphagia rehabilitation with no apparent side effects.