Arreola Viridiana, Ortega Omar, Álvarez-Berdugo Daniel, Rofes Laia, Tomsen Noemí, Cabib Christopher, Muriana Desiree, Palomera Elisabet, Clavé Pere
Gastrointestinal Physiology Laboratory, 16380Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
Neurorehabil Neural Repair. 2021 Sep;35(9):778-789. doi: 10.1177/15459683211023187. Epub 2021 Jun 17.
. Chronic poststroke oropharyngeal dysphagia (CPSOD) is associated with impaired oropharyngeal sensory/motor function. We aimed to assess effect of sensory (SES) and motor (NMES) transcutaneous electrical stimulation (TES) on safety of swallow and clinical outcomes in patients with CPSOD in a one-year follow-up randomized controlled trial. . Ninety patients (74.1 ± 11.5 y, modified Rankin score 2.6 ± 1.7) with CPSOD and impaired safety of swallow were randomized to (a) compensatory treatment (CT), (b) CT + SES, and (c) CT + NMES. Patients were treated with up to two cycles (6 months apart) of 15 × 1 hour TES sessions over two weeks and followed up with 4-5 clinical and videofluoroscopic assessments during one year. . Baseline penetration-aspiration scale (PAS) was 4.61 ± 1.75, delayed time to laryngeal vestibule closure (LVC) 396.4 ± 108.7 ms, and impaired efficacy signs 94.25%. Swallowing parameters significantly improved between baseline and 1-year follow-up in SES and NMES groups for prevalence of patients with a safe swallow ( < .001), mean PAS ( < .001), time to LVC ( < .01), and need for thickening agents ( < .001). Patients in the CT presented a less intense improvement of signs of impaired safety of swallow without significant changes in time to LVC. No differences between groups were observed for 1-year mortality (6.1%), respiratory infections (9.6%), nutritional and functional status, QoL, and hospital readmission rates (27.6%). No significant adverse events related to TES were observed. . Transcutaneous electrical stimulation is a safe and effective therapy for older patients with CPSOD. After 1-year follow-up, TES greatly improved the safety of swallow and reduced the need for fluid thickening in these patients.
慢性卒中后口咽吞咽困难（CPSOD）与口咽感觉/运动功能受损有关。在一项为期一年的随访随机对照试验中，我们旨在评估感觉（SES）和运动（NMES）经皮电刺激（TES）对CPSOD患者吞咽安全性和临床结局的影响。90例CPSOD且吞咽安全性受损的患者（74.1±11.5岁，改良Rankin评分2.6±1.7）被随机分为：（a）代偿性治疗（CT）组，（b）CT + SES组，以及（c）CT + NMES组。患者接受为期两周的多达两个周期（间隔6个月）、每次15×1小时的TES治疗，并在一年中进行4 - 5次临床和视频透视评估。基线时的渗透-误吸量表（PAS）为4.61±1.75，喉前庭关闭延迟时间（LVC）为396.4±108.7毫秒，无效征象发生率为94.25%。SES组和NMES组在基线和1年随访之间，吞咽安全患者的患病率（<0.001）、平均PAS（<0.001）、LVC时间（<0.01）以及增稠剂需求（<0.001）等吞咽参数有显著改善。CT组患者吞咽安全性受损征象的改善程度较小，LVC时间无显著变化。1年死亡率（6.1%）、呼吸道感染（9.6%）、营养和功能状态、生活质量以及再次入院率（27.6%）在各组之间未观察到差异。未观察到与TES相关的显著不良事件。经皮电刺激是治疗老年CPSOD患者的一种安全有效的疗法。经过1年随访，TES显著提高了这些患者的吞咽安全性，并减少了液体增稠的需求。
