Florea Cristina, Bräumann Christine, Mussger Christine, Leis Stefan, Hauer Larissa, Sellner Johann, Golaszewski Stefan M
Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria.
Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria.
Brain Sci. 2020 Apr 28;10(5):256. doi: 10.3390/brainsci10050256.
Dysphagia after stroke impacts quality of life and is a risk factor for respiratory infections. Patients frequently require prophylactic measures including nasogastric tube or percutaneous endoscopic gastrostomy. Until recently, therapy for dysphagia was limited to training with a speech and language specialist. Intraluminal pharyngeal electrical stimulation (PES) is a new technique that stimulates the pharyngeal sensory afferents to the higher swallowing center in cortex. The clinical trials published to date involved stimulation for 10 minutes over three days. We present a case of brainstem infarction with severe dysphagia in a 53-year-old woman with preserved cognitive functions. For airway protection, she had a surgical tracheotomy. The initial swallowing training achieved slight improvements, but stagnated after three months so PES was tried. Under good PES tube tolerance, a prolonged and repeated stimulation protocol was administered, with the main purpose of relieving her of the tracheal tube. Although the swallowing improved, she stayed tube-dependent with minimal attempts with puréed food during therapy, and could not be decannulated. Further studies are required to assess the value of this promising approach for the treatment of dysphagia.
中风后的吞咽困难会影响生活质量，并且是呼吸道感染的一个风险因素。患者经常需要采取预防措施，包括鼻胃管或经皮内镜下胃造口术。直到最近，吞咽困难的治疗还仅限于与言语和语言专家一起进行训练。腔内咽部电刺激（PES）是一种新技术，它刺激咽部感觉传入神经至大脑皮层中的高级吞咽中枢。迄今为止发表的临床试验涉及连续三天每天刺激10分钟。我们报告一例53岁认知功能保留的女性脑干梗死伴严重吞咽困难的病例。为保护气道，她接受了外科气管切开术。最初的吞咽训练取得了轻微改善，但三个月后停滞不前，因此尝试了PES。在对PES管耐受性良好的情况下，实施了延长和重复的刺激方案，主要目的是使她摆脱气管插管。尽管吞咽功能有所改善，但她在治疗期间仍依赖插管，只能少量尝试糊状食物，无法拔管。需要进一步研究来评估这种有前景的方法在治疗吞咽困难方面的价值。
