Balcerak Philipp, Corbiere Sydney, Zubal Richard, Kägi Georg
Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Front Neurol. 2022 Apr 25;13:823189. doi: 10.3389/fneur.2022.823189. eCollection 2022.
Post-stroke dysphagia is an underdiagnosed but relevant complication, associated with worse outcome, dependency and quality of life of stroke survivors. Detailed mechanisms of post-stroke dysphagia are not very well understood, but established therapeutic concepts are needed. Different interventional studies have been published dealing with post-stroke dysphagia. This systematic review wants to collect and give an overview over the published evidence.
PubMed, Embase, Cochrane, CINAHL were searched for relevant interventional studies on post-stroke dysphagia in the (sub-)acute setting (within 3 months of stroke onset). The search has been filtered for randomized trials with an inactive control and the relevant data extracted.
After initially finding 2,863 trials, finally 41 trials have been included. Seven different therapeutic concepts have been evaluated (Acupuncture, behavioral/physical therapy, drug therapy, neuromuscular electrical stimulation, pharyngeal electrical stimulation, transcranial direct current stimulation and repetitive transcranial magnetic stimulation). Studies of all modalities have shown some effect on post-stroke dysphagia with several studies raising concerns about the potential bias.
The amount and quality of studies are not enough to suggest certain therapies. Some therapeutical concepts (intensive physical therapy, transcranial magnetic stimulation, drug therapy) seem to be good potential therapeutic options, but further research is needed.
卒中后吞咽困难是一种诊断不足但相关的并发症，与卒中幸存者更差的预后、依赖程度及生活质量相关。卒中后吞咽困难的详细机制尚未完全明确，但需要确立治疗理念。已发表了不同的关于卒中后吞咽困难的干预性研究。本系统评价旨在收集并概述已发表的相关证据。
检索PubMed、Embase、Cochrane、CINAHL数据库，查找有关（亚）急性期（卒中发作后3个月内）卒中后吞咽困难的相关干预性研究。检索结果经筛选，纳入了设有无活性对照的随机试验，并提取了相关数据。
最初检索到2863项试验，最终纳入41项试验。评估了七种不同的治疗理念（针灸、行为/物理治疗、药物治疗、神经肌肉电刺激、咽部电刺激、经颅直流电刺激和重复经颅磁刺激）。所有方式的研究均显示对卒中后吞咽困难有一定效果，但多项研究对潜在偏倚表示担忧。
研究的数量和质量不足以推荐特定疗法。一些治疗理念（强化物理治疗、经颅磁刺激、药物治疗）似乎是潜在的良好治疗选择，但仍需进一步研究。
