Huang Kun-Ling, Liu Ting-Yuan, Huang Yu-Chi, Leong Chau-Peng, Lin Wei-Che, Pong Ya-Ping
Department of Otolaryngology-Head and Neck surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2547-2553. doi: 10.1016/j.jstrokecerebrovasdis.2014.05.031. Epub 2014 Sep 20.
Dysphagia after stroke is associated with mortality and increased pulmonary complications. Swallowing therapies may decrease pulmonary complications and improve patients' quality of life after stroke. This study used clinical swallowing assessments and videofluoroscopy (VFS) to assess the functional recovery of acute stroke patients with dysphagia after different swallowing therapies. We enrolled 29 acute stroke patients with dysphagia and randomly divided them into 3 therapy groups: traditional swallowing (TS), oropharyngeal neuromuscular electrical stimulation (NMES), and combined NMES/TS. All patients were assessed using the clinical functional oral intake scale (FOIS), 8-point penetration-aspiration scale (PAS), and functional dysphagia scale (FDS) of VFS before and after treatment. There were no differences in the clinical parameters and swallowing results of the FOIS and VFS before swallowing treatment among the 3 groups (P > .05). TS therapy and combined therapy both had significant swallowing improvement after therapy according to the FOIS and 8-point PAS (P < .05). When comparing the results of the VFS among the 3 groups, we found significant improvements in patients eating cookies and thick liquid after combined NMES/TS therapy (P < .05). In acute stroke patients with dysphagia, combined NMES/TS therapy is the most effective swallowing therapy in taking solid diets and thick liquids.
中风后吞咽困难与死亡率及肺部并发症增加相关。吞咽治疗可能会减少肺部并发症并改善中风患者的生活质量。本研究采用临床吞咽评估和电视荧光吞咽造影检查（VFS）来评估不同吞咽治疗后急性中风吞咽困难患者的功能恢复情况。我们纳入了29例急性中风吞咽困难患者，并将他们随机分为3个治疗组：传统吞咽治疗（TS）组、口咽部神经肌肉电刺激（NMES）组和NMES/TS联合治疗组。所有患者在治疗前后均使用临床功能性经口进食量表（FOIS）、8分制渗透-误吸量表（PAS）以及VFS功能性吞咽困难量表进行评估。3组患者在吞咽治疗前的FOIS和VFS临床参数及吞咽结果方面无差异（P>.05）。根据FOIS和8分制PAS评估，TS治疗和联合治疗在治疗后吞咽功能均有显著改善（P<.05）。比较3组患者的VFS结果时，我们发现NMES/TS联合治疗组患者在进食饼干和浓稠液体方面有显著改善（P<.05）。在急性中风吞咽困难患者中，NMES/TS联合治疗是摄取固体食物和浓稠液体时最有效的吞咽治疗方法。
