Suntrup-Krueger Sonja, Labeit Bendix, von Itter Jonas, Jung Anne, Claus Inga, Ahring Sigrid, Warnecke Tobias, Dziewas Rainer, Muhle Paul
Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149 Muenster, Germany.
Department of Neurology, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
Neurotherapeutics. 2025 Jul;22(4):e00613. doi: 10.1016/j.neurot.2025.e00613. Epub 2025 May 17.
Postextubation dysphagia is a major risk factor for extubation failure in acute stroke. Pharyngeal electrical stimulation (PES) is a novel neurostimulation technique for neurogenic dysphagia rehabilitation. We conducted a randomized controlled pilot trial evaluating PES early after extubation in acute stroke (N = 60) focusing on dysphagia recovery trajectories and related outcomes until discharge. Patients with severe postextubation dysphagia, defined as Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) score >4, received daily PES (real or sham, 10 min/day) for 3 consecutive days. By day 3, significantly fewer patients in the PES group exhibited persistent absence of spontaneous swallows (8 vs. 41 %) or pharyngeal sensory loss (4 vs. 55 %) compared to the sham group, indicating enhanced airway safety. Functional Oral Intake Scale (FOIS) score at day 3 was significantly higher in the PES group (4.1 vs 2.1 pts). FEDSS at days 5-7 and 8-10 showed a sustained treatment effect over time (2.4 vs. 3.7 pts. and 2.2 vs. 3.4 pts), resulting in better FOIS at discharge (4.7 vs. 3.5 pts.). PES shortened LOS in the intensive care unit (ICU) (3.1 vs. 8.5 days, p = 0.008) and total hospital stay (13.8 vs. 21.9 days, p = 0.004) from study inclusion. Tracheotomy rates were 13 vs. 33 % (p < 0.067). The proportion of patients still cannulated at discharge (7 vs. 10 %) and the modified Rankin Scale at discharge (3.9 vs. 4.0) were comparable. PES enhanced recovery of postextubation dysphagia, improved airway safety and shortened length of ICU and hospital stay in acute stroke.
拔管后吞咽困难是急性卒中患者拔管失败的主要危险因素。咽部电刺激（PES）是一种用于神经源性吞咽困难康复的新型神经刺激技术。我们开展了一项随机对照试验，对急性卒中患者拔管后早期（N = 60）进行PES治疗，重点关注吞咽困难的恢复轨迹及直至出院的相关结局。将拔管后严重吞咽困难定义为纤维内镜吞咽困难严重程度量表（FEDSS）评分>4的患者，连续3天每天接受PES治疗（真实或假刺激，10分钟/天）。到第3天，与假刺激组相比，PES组中表现为持续无自主吞咽（8%对41%）或咽部感觉丧失（4%对55%）的患者显著减少，表明气道安全性增强。第3天，PES组的功能性经口进食量表（FOIS）评分显著更高（4.1分对2.1分）。第5 - 7天和第8 - 10天的FEDSS评分随时间显示出持续的治疗效果（2.4分对3.7分以及2.2分对3.4分），出院时FOIS评分更高（4.7分对3.5分）。从纳入研究开始，PES缩短了重症监护病房（ICU）住院时间（3.1天对8.5天，p = 0.008）和总住院时间（13.8天对21.9天，p = 0.004）。气管切开率分别为13%对33%（p < 0.067）。出院时仍留置插管患者的比例（7%对10%）以及出院时的改良Rankin量表评分（3.9对4.0）相当。PES可促进急性卒中患者拔管后吞咽困难的恢复，改善气道安全性，并缩短ICU住院时间和总住院时间。
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