Zhang Xue, Liang Yunxiao, Wang Xiaolu, Shan Yilong, Xie Mengshu, Li Chao, Hong Jiena, Chen Jiemei, Wan Guifang, Zhang Yaowen, Lin Yiqiu, Zhao Fei, He Zitong, Dou Zulin, Wen Hongmei
Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
Dysphagia. 2023 Aug;38(4):1128-1137. doi: 10.1007/s00455-022-10536-z. Epub 2022 Nov 21.
Current treatments for severe chronic neurogenic dysphagia (SCND) are limited. Modified pharyngeal electrical stimulation (mPES) was modified from pharyngeal electrical stimulation (PES). This prospective study aimed to explore the efficacy and safety of mPES on SCND. 30 patients with severe chronic neurogenic dysphagia were recruited. mPES was administered to patients once daily until the functional oral intake scale score (FOIS) reach 3. Videofluoroscopic swallow study (VFSS), flexible endoscopic evaluation of swallowing (FEES), and high-resolution manometry (HRM) were utilized for evaluating the swallowing function. After mPES, 24 of 30 patients (80%) reached the endpoint (FOIS = 3) (P < 0.001). 3 of 6 tracheotomized patients (50%) removed the tracheal tube. The median number of mPES sessions for the 24 patients who met the criteria was 28 (17, 38) and the median period was 43 (29, 63) days. Moreover, a significant increase was observed in hypopharyngeal peak pressure (P = 0.015), hypopharyngeal contraction duration (P = 0.023), velopharyngeal peak pressure (P = 0.044), and velopharyngeal contraction duration (P = 0.031). A reduction was observed in PAS (P < 0.001), secretion (P = 0.001), vallecular residue (P < 0.001), left (P = 0.001), and right (P < 0.001) pyriform sinus residue. The median FOIS of 30 patients at 3-month follow-up was 5 (3, 6). No serious side effects were reported. mPES is a promising effective and safe therapeutic approach that is simple to use in patients with SCND.
目前针对严重慢性神经源性吞咽困难（SCND）的治疗方法有限。改良咽部电刺激（mPES）是由咽部电刺激（PES）改良而来。这项前瞻性研究旨在探讨mPES治疗SCND的疗效和安全性。招募了30例严重慢性神经源性吞咽困难患者。每天对患者进行一次mPES治疗，直至功能性经口进食量表评分（FOIS）达到3分。采用电视荧光吞咽造影检查（VFSS）、吞咽功能的软性内镜评估（FEES）和高分辨率测压法（HRM）来评估吞咽功能。mPES治疗后，30例患者中有24例（80%）达到终点（FOIS = 3）（P < 0.001）。6例气管切开患者中有3例（50%）拔除了气管导管。符合标准的24例患者接受mPES治疗的疗程中位数为28（17，38）次，治疗周期中位数为43（29，63）天。此外，下咽峰值压力（P = 0.015）、下咽收缩持续时间（P = 0.023）、腭咽峰值压力（P = 0.044）和腭咽收缩持续时间（P = 0.031）均显著增加。咽部穿透评分（PAS）（P < 0.001）、分泌物（P = 0.001）、会厌谷残留（P < 0.001）、左侧（P = 0.001）和右侧（P < 0.001）梨状窦残留均有所减少。30例患者在3个月随访时的FOIS中位数为5（3，6）。未报告严重副作用。mPES是一种有前景的有效且安全的治疗方法，对于SCND患者易于使用。
