Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
Neurogastroenterol Motil. 2013 Nov;25(11):888-e701. doi: 10.1111/nmo.12211. Epub 2013 Aug 12.
Chronic poststroke oropharyngeal dysfunction (OD) is a common condition, leading to severe complications, including death. Treatments for chronic poststroke OD are scarce. The aim of our study was to assess and compare the efficacy and safety of treatment with surface electrical stimulation (e-stim) at sensory and motor intensities in patients with chronic poststroke OD.
Twenty chronic poststroke patients with OD were randomly assigned to (i) sensory e-stim (treatment intensity: 75% of motor threshold) or (ii) motor e-stim (treatment intensity: motor threshold). Patients were treated during 10 days, 1 h/day. Videofluoroscopy was performed at the beginning and end of the study to assess signs of impaired efficacy and safety of swallow and timing of swallow response.
Patients presented advanced age (74.95 ± 2.18), 75% were men. The mean days poststroke was 336.26 ± 89.6. After sensory stimulation, the number of unsafe swallows was reduced by 66.7% (p < 0.001), the laryngeal vestibule closure time by 22.94% (p = 0.027) and maximal vertical hyoid extension time by 18.6% (p = 0.036). After motor stimulation, the number of unsafe swallows was reduced by 62.5% (p = 0.002), the laryngeal vestibule closure time by 38.26% (p = 0.009) and maximal vertical hyoid extension time by 24.8% (p = 0.008). Moreover, the motor stimulus reduced the pharyngeal residue by 66.7% (p = 0.002), the upper esophageal sphincter opening time by 39.39% (p = 0.009), and increased bolus propulsion force by 211.1% (p = 0.008). No serious adverse events were detected during the treatment.
CONCLUSIONS & INFERENCES: Surface e-stim is a safe and effective treatment for chronic poststroke dysphagic patients.
慢性卒中后口咽功能障碍（OD）是一种常见病症，可导致严重并发症，包括死亡。目前针对慢性卒中后 OD 的治疗方法十分匮乏。本研究旨在评估和比较感觉和运动强度表面电刺激（e-stim）治疗慢性卒中后 OD 的疗效和安全性。
20 例慢性卒中后 OD 患者被随机分为（i）感觉 e-stim（治疗强度：运动阈的 75%）或（ii）运动 e-stim（治疗强度：运动阈）。患者每天治疗 1 小时，共 10 天。在研究开始和结束时进行视频透视检查，以评估吞咽有效性和安全性受损的迹象以及吞咽反应的时间。
患者年龄较大（74.95±2.18 岁），75%为男性。卒中后平均天数为 336.26±89.6 天。感觉刺激后，不安全吞咽的次数减少了 66.7%（p<0.001），声门裂关闭时间减少了 22.94%（p=0.027），最大垂直甲状软骨伸展时间减少了 18.6%（p=0.036）。运动刺激后，不安全吞咽的次数减少了 62.5%（p=0.002），声门裂关闭时间减少了 38.26%（p=0.009），最大垂直甲状软骨伸展时间减少了 24.8%（p=0.008）。此外，运动刺激减少了咽部残留 66.7%（p=0.002），食管上括约肌开放时间减少了 39.39%（p=0.009），并且增加了食团推进力 211.1%（p=0.008）。在治疗过程中未发现严重不良事件。
表面 e-stim 是治疗慢性卒中后吞咽困难患者的一种安全有效的方法。
