Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong; Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Institute for Biomagnetism and Biosignal Analysis, University of Münster, Münster, Germany; Department of Neurology, University Hospital Münster, Münster, Germany.
Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; Stroke, Nottingham University Hospital NHS Trust, Nottingham, UK.
Neurotherapeutics. 2024 Sep;21(5):e00433. doi: 10.1016/j.neurot.2024.e00433. Epub 2024 Aug 23.
Pharyngeal electrical stimulation (PES) has emerged as a promising intervention for neurogenic dysphagia, with potential benefits in reducing dysphagia severity in stroke patients. PES may facilitate decannulation in tracheotomised stroke patients with dysphagia, yet the predictive factors for treatment success have not been investigated in detail. This study used data from the PHAryngeal electrical stimulation for treatment of neurogenic Dysphagia European Registry (PHADER) study to identify predictive factors for PES treatment success among patients with post stroke dysphagia who required mechanical ventilation and tracheotomy. Multiple linear regression was performed to predict treatment success, as measured in improvement in dysphagia severity rating scale (DSRS), accounting for age, sex, stroke type, lesion location, baseline National Institutes of Health Stroke Scale (NIHSS) score, feeding status, time from stroke onset to PES, PES perceptual threshold and PES stimulation intensity at the first session. Cox regression was conducted to identify the predictors for decannulation for all participants. Ninety-eight participants (mean [SD] age = 66.6 [13.0]; male 73.5%) were included in the analyses. Regression analyses showed that early intervention (p = 0.004) and younger age (p = 0.049) were significant predictors for treatment success. For participants who received PES during tracheotomy (n = 60; mean [SD] age = 66.6 [11.2]; male 73.3%), supratentorial stroke (p = 0.033) and feeding status at baseline (p = 0.025) were predictors of treatment success. Among all participants, early intervention was associated with higher likelihood of decannulation (p = 0.026). These results highlight the importance of timely intervention, age and stroke location in PES treatment success for stroke patients with mechanical ventilation and tracheotomy.
咽部电刺激（PES）已成为治疗神经源性吞咽困难的一种有前途的干预手段，有可能降低脑卒中患者吞咽困难的严重程度。PES 可能有助于使患有吞咽困难的气管切开脑卒中患者拔管，但尚未详细研究治疗成功的预测因素。本研究使用来自欧洲神经源性吞咽困难治疗的咽部电刺激登记研究（PHADER）的数据，确定需要机械通气和气管切开的脑卒中后吞咽困难患者 PES 治疗成功的预测因素。采用多元线性回归预测治疗成功，以吞咽困难严重程度评分量表（DSRS）的改善程度来衡量，同时考虑年龄、性别、脑卒中类型、病变部位、基线国立卫生研究院脑卒中量表（NIHSS）评分、喂养状态、从脑卒中发病到 PES 的时间、PES 感知阈值和第一次就诊时 PES 刺激强度。进行 Cox 回归分析，以确定所有参与者拔管的预测因素。98 名参与者（平均[标准差]年龄 66.6[13.0]；男性 73.5%）纳入分析。回归分析显示，早期干预（p=0.004）和年龄较小（p=0.049）是治疗成功的显著预测因素。对于接受气管切开术期间 PES 治疗的参与者（n=60；平均[标准差]年龄 66.6[11.2]；男性 73.3%），幕上脑卒中（p=0.033）和基线时的喂养状态（p=0.025）是治疗成功的预测因素。在所有参与者中，早期干预与拔管的可能性更高相关（p=0.026）。这些结果强调了及时干预、年龄和脑卒中部位在脑卒中患者机械通气和气管切开术 PES 治疗成功中的重要性。
