双球囊导管扩张术对脑干病变后吞咽障碍患者咽缩肌功能影响的对照研究

关键词：双球囊导管扩张术  脑干病变  咽缩肌收缩

Keywords:double balloon catheter dilatation  brainstem lesions  pharyngeal contraction

摘要：

      摘要 目的：探讨双球囊导管扩张术对脑干病变后吞咽障碍患者吞咽功能和咽缩肌功能的影响。 方法：选取脑干病变后吞咽障碍患者22例，按照随机数表法随机分为两组，每组各11例，干预组患者在常规吞咽障碍康复治疗（口腔感觉训练、口腔运动训练、神经肌肉电刺激等项目）之上，增加双球囊导管扩张术。对照组接受常规吞咽障碍康复治疗和单球囊导管扩张术。在治疗开始前及完成4周治疗后，对两组患者的吞咽能力进行评估，包括功能性经口摄食量表分级（functional oral intake scale，FOIS）、上咽部与下咽部压力峰值、环咽肌松弛持续时间，以及通过吞咽造影检查得到的咽部残留评分。 结果：在治疗开始前，两组患者的功能性经口摄食分级（FOIS）、上咽部压力峰值及咽部残留评分之间，差异均不具有显著性意义（P>0.05）。治疗后，两组患者的这些指标相较于治疗前均有所改善（P<0.05），且治疗后干预组上咽部压力峰值（65.83±34.27mmHg）、咽部残留评分优于对照组（P<0.05）。下咽部压力峰值与环咽肌松弛持续时间治疗前基线存在显著性差异（P<0.05），干预组数值较低，治疗后干预组的下咽部压力峰值（30.59±25.23mmHg）与环咽肌松弛持续时间（690.55±359.69ms）的改善幅度明显优于对照组（P<0.05）。两组患者治疗后FOIS分级比较差异无显著性意义（P>0.05）。 结论：双球囊导管扩张术可显著改善脑干病变后吞咽障碍患者的吞咽功能及咽部收缩功能。

Abstract:

      Abstract Objective： To investigate the effects of double balloon catheter dilation on swallowing function and pharyngeal contraction function in patients with dysphagia following brainstem lesions. Method： A total of 22 patients with swallowing disorders after brainstem lesions were selected and randomly divided into two groups using a random number table method，with 11 cases included in each group. The intervention group received routine dysphagia rehabilitation treatment, including oral sensory training，oral motor training， and neuromuscular electrical stimulation，combined with double balloon catheter dilation. The control group received routine dysphagia rehabilitation treatment and single balloon catheter dilation. Before the start of treatment and after completing 4 weeks of treatment， the swallowing function of both groups was evaluated， including functional oral intake scale （FOIS）， peak pressure in the upper and lower pharynx， duration of relaxation of the cricopharyngeal muscle， and residual pharyngeal score obtained by swallowing angiography. Result： Before the start of treatment， there was no statistically significant difference （P>0.05） in functional oral feeding classification， peak upper pharyngeal pressure， or pharyngeal residual score between the two groups. After treatment， both groups showed improvement in these indicators compared to baseline （P<0.05）. The intervention group had better peak pharyngeal pressure （65.83±34.27mmHg） and residual pharyngeal score than the control group after treatment （P<0.05）. There was a statistically significant difference （P<0.05） in the peak pressure of the lower pharynx and the duration of relaxation of the cricopharyngeal muscle at baseline， with lower values in the intervention group. After treatment， the improvement in the peak pressure of the lower pharynx （30.59±25.23mmHg） and the duration of relaxation of the cricopharyngeal muscle （690.55±359.69ms） in the intervention group was significantly better than that in the control group （P<0.05）.There was no statistically significant difference in FOIS grading between the two groups after treatment （P>0.05）. Conclusion： Double balloon catheter dilation can significantly improve the swallowing function and pharyngeal contraction function in patients with dysphagia due to brainstem lesions.