球囊扩张术治疗老年脑卒中后环咽肌失弛缓症的疗效观察

目的观察球囊扩张术治疗老年脑卒中后环咽肌失弛缓症所致吞咽功能障碍的疗效。方法选择环咽肌失弛缓症患者32例,分为治疗组18例和对照组14例。治疗组给予球囊扩张术及常规吞咽康复治疗,对照组仅给予常规吞咽康复治疗。分别在治疗前后进行吞咽功能洼田饮水试验分级评价及电视X线透视吞咽功能造影检查(VFSS)。结果治疗组和对照组患者吞咽功能洼田饮水试验分级均较治疗前好转,治疗组总有效率明显优于对照组(66.7%vs 35.7%,P<0.05);2组环咽肌开放情况较治疗前改善,且治疗组改善幅度明显优于对照组(P<0.05);治疗组治疗后5ml浓流质吞咽通过时间较治疗前明显缩短[(0.16±0.08)s vs(0.22±0.04)s,P=0.018]。结论球囊扩张术结合常规吞咽康复治疗对老年脑卒中患者环咽肌失弛缓症所致吞咽功能障碍具有显著疗效,可降低误吸等不良并发症的发生。     

导尿管球囊扩张术对脑卒中后环咽肌失弛缓所致吞咽障碍患者的影响

目的探讨导尿管球囊扩张术对脑卒中后环咽肌失弛缓所致吞咽障碍患者的影响。方法选取2013年2月—2015年7月东莞市人民医院收治的脑卒中后环咽肌失弛缓所致吞咽障碍患者88例,采用随机数字表法分为对照组和观察组,每组44例。对照组患者给予常规康复治疗,观察组患者在对照组基础上加用尿导管球囊扩张术;治疗终点为患者经口进食或治疗6周。比较两组患者吞咽功能康复效果、治疗后吞咽进食情况及治疗前后咽通过时间、吞咽造影检查(VFSS)评分,观察两组患者治疗期间并发症发生情况。结果观察组患者吞咽功能康复效果优于对照组(P0.05)。治疗后观察组患者可进水、可进食流质物、可进食糊状物、可进食固体食物者所占比例均高于对照组(P0.05)。治疗前两组患者咽通过时间和VFSS评分比较,差异无统计学意义(P0.05);治疗后观察组患者咽通过时间短于对照组,VFSS评分高于对照组(P0.05)。两组患者治疗期间均未出现严重并发症。结论导尿管球囊扩张术能有效改善脑卒中后环咽肌失弛缓所致吞咽障碍患者吞咽功能,有利于缩短吞咽功能恢复时间,促进患者康复,且安全性较高。     

导管球囊扩张治疗环咽肌功能障碍的机制

环咽肌对咽食管期的吞咽功能至关重要,环咽肌功能障碍涉及多种疾病,是临床上吞咽障碍常见的病因。目前导管球囊扩张技术因其疗效显著、安全可靠无不良并发症等特点成为治疗环咽肌功能障碍的首选干预方法。现综述导管球囊扩张治疗环咽肌功能障碍的生物力学、神经调控以及皮质可塑性机制,为临床实践提供了理论依据。     

主动球囊扩张术治疗卒中后环咽肌失弛缓所致吞咽障碍的效果

目的探讨主动球囊扩张术对卒中后环咽肌失弛缓所致吞咽障碍的效果。方法前瞻性连续纳入38例诊断明确并经头部CT/MRI证实,经数字化吞咽造影检查(VFSS)证实为环咽肌失弛缓的清醒卒中患者。按照随机数字表法将患者随机分成观察组和对照组各19例。观察组给予主动球囊扩张术及常规吞咽康复治疗,对照组仅给予常规吞咽康复治疗。治疗终点为恢复经口进食或治疗已满4周(每周治疗7次)。于治疗前和治疗4周后采用DSA设备下的数字化VFSS、功能性经口摄食评估(FOIS)及VFSS评估食管上括约肌开放程度及吞咽障碍程度。结果 (1)食管上括约肌完全开放比例比较:经主动球囊扩张术及常规吞咽康复治疗4周后,对照组及观察组患者食管上括约肌完全开放的患者比例分别为10/19、16/19,差异有统计学意义(χ~2=4.39,P=0.04)。(2)FOIS评分比较:对照组和观察组患者治疗后FOIS评分与治疗前比较[分别为4(3,6)分比2(1,3)分,6(5,7)分比2(1,3)分],差异均有统计学意义(Z值分别为3.75、3.85,均P0.01);观察组患者治疗后FOIS评分与对照组治疗后比较,差异有统计学意义(Z=2.19,P=0.03)。治疗效果比较:对照组显效8例,有效11例,观察组显效15例,有效4例,两组治疗后效果差异有统计学意义(χ~2=5.40,P=0.45)。(3)VFSS评分比较:对照组和观察组患者治疗后VFSS评分与治疗前比较[分别为4(3,8)分比2(1,4)分,8(7,9)分比1(0,3)分],差异均有统计学意义(Z值分别为3.65、3.86,均P0.01);两组治疗后比较,差异有统计学意义(Z=3.28,P=0.01)。VFSS各分项比较:对照组和观察组口腔期、咽期、误咽程度治疗后与治疗前比较,差异均有统计学意义(对照组Z值分别为2.64、3.29、3.35,均P0.01;观察组Z值分别为2.44、3.99、3.87,均P0.05);治疗后组间比较,口腔期两组差异无统计学意义(Z=0.14,P=0.89),咽期和误咽程度差异均有统计学意义(Z值分别为4,51、3.29,均P0.01)。治疗效果比较:对照组有效9例,治愈3例;观察组有效8例,治愈10例;治疗后效果差异有统计学意义(χ~2=5.70,P=0.042)。结论主动球囊扩张术对卒中后环咽肌失弛缓所致吞咽障碍疗效显著。     

导管球囊扩张联合表面肌电生物反馈治疗脑外伤后吞咽障碍1例报告

目的探讨导管球囊扩张联合表面肌电生物反馈对1例脑外伤后吞咽障碍患者的治疗作用。方法四川省八一康复中心听力语言治疗科2022年4月收治的1例环咽肌不完全开放的吞咽障碍患者,给予导管球囊扩张联合表面肌电生物反馈治疗。治疗终点定为在拔除鼻饲管经口进食5周后,吞咽造影下显示患者的吞咽障碍症状轻微或基本消失。结果患者前15次治疗为单独使用导管球囊扩张+吞咽常规治疗,后15次治疗为前述治疗方案基础上增加表面肌电生物反馈治疗,对治疗前后环咽肌球囊内注水量进行对比,经独立样本t检验,联合治疗后球囊注水量较之前明显增加(t=-11.501,P<0.001)。结论导管球囊扩张联合表面肌电生物反馈治疗对环咽肌不完全开放有明显疗效。     

球囊扩张联合神经肌肉电刺激治疗80岁以上脑卒中患者吞咽障碍2例护理体会

目的：球囊扩张术联合神经肌肉电刺激治疗高龄患者卒中后吞咽障碍的护理.方法：经电视透视吞咽功能检查（VFSS）后,采用球囊扩张合并神经肌肉电刺激仪（Vitalstim）治疗高龄患者（〉80岁）卒中后吞咽障碍2例,每天一次,疗程8～12天.结果：经治疗护理后,患者球囊扩张由4～5ml增加到8～8.5ml,VFSS显示,钡剂在会厌谷、梨状隐窝的残留量明显减少,无呛咳或误吸,环咽肌开放基本正常,食物可顺利通过环咽肌进入食道,患者可经口安全进食.结论：初步表明,球囊扩张术联合神经肌肉电刺激对于80岁以上高龄患者吞咽障碍的治疗及积极护理是有效而且是安全的.     

综合康复护理干预对老年吞咽障碍病人的影响

目的探索综合康复护理对老年吞咽障碍病人的影响。方法选取我科2015年3月至2017年3月收治的74例老年吞咽障碍病人,按数字表法分为对照组(予以常规护理)和研究组(予以综合康复护理),每组各37例。采用标准吞咽功能量表(SSA)评估病人吞咽功能,采用吞咽障碍生活质量量表(SWAI-QOL)评估病人生活质量改善情况。比较2组病人的SSA评分、相关并发症发生率以及SWAI-QOL评分。结果干预4周后,2组病人的SSA评分均低于治疗前;且研究组显著低于对照组(P<0.05);对照组并发症发生率明显高于研究组(P<0.05); 2组病人的SWAI-QOL评分均显著高于治疗前,且研究组优于对照组(P<0.05)。结论综合康复护理干预可以改善老年吞咽障碍病人的吞咽功能,减少并发症,提高病人生活质量。     

支气管镜下留置微球囊导管治疗结核性支气管狭窄的临床研究

目的探讨支气管镜下行支气管扩张术后留置微球囊导管治疗结核性支气管狭窄患者的疗效。方法将80例结核性支气管狭窄患者随机分成两组,治疗组及对照组各40例,治疗组在支气管镜下采用行支气管扩张术后留置微球囊导管进行扩张治疗,对照组采用传统支气管球囊扩张术进行扩张治疗,观察治疗后两周及2个月两组患者支气管复张愈合及相应肺叶复张、肺功能一秒钟用力呼气容积(FEV1)情况。结果 2周后治疗组有效率94.0%,对照组有效率88.3%,差别无统计学意义(P0.05)。两组患者肺功能FEV1和气促评分均较治疗前有显著性改善(P0.05),但两组比较差异无统计学意义(P0.05)。2个月后治疗组有效率78.8%,对照组有效率55.9%,差异无统计学意义(P0.05)。治疗组肺功能FEV_1和气促评分较治疗前有显著性改善(P0.05),且显著优于对照组(P0.05)。仅部分患者术后管壁出现少量出血,治疗组为27.3%,对照组为35.3%,差别无统计学意义(P0.05)。所有出血经注入止血药并采用氩气刀电凝后出血停止。结论支气管镜下行支气管扩张术后留置微球囊导管治疗结核性支气管狭窄效果良好,提示此法值得推广应用。     

老年鼻咽癌患者放化疗后并发吞咽功能障碍的相关因素

目的 分析老年鼻咽癌(NPC)患者放化疗后吞咽功能障碍及其影响因素。方法 回顾性分析完成放化疗治疗及1 w随访的100例老年NPC患者病历资料,统计其放化疗结束后1 w内吞咽功能障碍发生情况;比较两组基线资料,分析导致老年NPC患者放化疗后并发吞咽功能障碍的相关因素。结果 放化疗结束后1 w内,100例老年NPC患者中37例(37.00%)发生吞咽功能障碍;功能障碍组同步放化疗、有吸烟史、嚼槟榔占比高于无功能障碍组,咽缩肌放疗总剂量高于无功能障碍组,放化疗前营养状况A级占比低于无功能障碍组,差异有统计学意义(P<0.05);经Logistic回归分析显示,咽缩肌放疗总剂量过高、有吸烟史、放化疗前营养状况B及C级均为老年NPC患者放化疗后并发吞咽功能障碍的影响因素(P<0.05)。结论 老年NPC放化疗患者吞咽功能障碍的发生受咽缩肌放疗总剂量、吸烟史、放疗前营养状况的影响。     

针灸联合神经肌肉电刺激、导管球囊扩张术对脑卒中后吞咽障碍病人舌骨喉复合体动度、营养状况的影响

目的:观察针灸联合神经肌肉电刺激(NMES)、导管球囊扩张术对脑卒中后吞咽障碍病人舌骨喉复合体动度及营养状况的影响。方法:选取2019年10月—2021年10月广安市人民医院收治的脑卒中后吞咽障碍病人142例,按照随机数字表法分为观察组与对照组,各71例。对照组给予导管球囊扩张术、神经肌肉电刺激,观察组在对照组基础上给予针灸治疗,两组均治疗4周。比较两组治疗前后吞咽功能[洼田饮水试验(WST)、标准吞咽功能量表(SSA)、渗漏-误吸评分、残留评分]、舌骨喉复合体动度、表面肌电图指标、营养状况[血清总蛋白(TP)、血清清蛋白(ALB)、血清前蛋白(PA)、肱三头肌皮褶厚度(TSF)、健侧上臂中部肌围(AMC)]。结果:治疗4周后,两组WST、SSA评分、渗漏-误吸评分、残留评分较治疗前下降(P<0.05),且观察组低于对照组(P<0.05);两组舌骨上移、舌骨前移、甲状软骨上移、甲状软骨前移距离较治疗前增大(P<0.05),且观察组大于对照组(P<0.05);两组吞咽时程较治疗前缩短(P<0.05),且观察组短于对照组;两组最大波幅较治疗前增高(P<0...     

针灸加康复训练治疗中风后吞咽障碍33例

目的 探讨早期针灸加康复训练对中风后吞咽障碍患者吞咽功能恢复的影响.方法 将中风住院患者63例随机分为治疗组和对照组.治疗组采用针灸加现代吞咽功能康复训练,对照组采用现代吞咽功能康复训练.以洼田氏饮水实验评价法进行功能评定.结果 治疗后治疗组吞咽功能恢复得更好,且并发症的发生率明显降低,差异有统计学意义(P<0.01).结论 中风后吞咽障碍患者宜早期针灸结合吞咽功能康复训练.     

早期干预对急性脑梗死后吞咽障碍患者营养状况及ADL的影响

目的探讨早期不同干预措施对急性脑梗死所致吞咽障碍患者的吞咽能力、营养状况及日常生活活动能力（ADL）的影响。方法将100例急性脑梗死后吞咽障碍患者随机分为综合治疗组（康复训练联合针灸治疗）、康复训练组、针灸治疗组及常规药物组各25例,于治疗前、治疗2周后分别采用吞咽电视检查（VFSS）评价吞咽障碍程度,检测血清白蛋白、血红蛋白、总淋巴细胞计数,采用Barthel指数分级法评价ADL。结果治疗2周后,综合治疗组吞咽能力改善有效率优于其他3组（P〈0.05）;4组血清白蛋白、血红蛋白、总淋巴细胞计数均较治疗前下降（P〈0.05）,但综合治疗组优于其他3组（P〈0.05）;2周后综合治疗组Barthel指数分级改善均优于其他3组（P〈0.05）。结论急性脑梗死后吞咽障碍经早期康复训练联合针灸治疗,能明显改善吞咽功能,缓解营养不良恶化,促进患者ADL的恢复。     

Botulinum Toxin in the Treatment of Cricopharyngeal Dysphagia

Dysphagia is a common symptom in various neurological disorders affecting pharyngeal functions. Cricopharyngeal dysfunction is one of the major findings in these patients. The most effective treatment for restoring normal swallowing function in persistent cricopharyngeal dysfunction is cricopharyngeal myotomy, especially when mechanical obstruction or a well-localized neuromuscular dysfunction, such as a cricopharyngeal muscle spasm, is present. However, when there is a more diffuse neurological disorder present the results of surgery are more disappointing. In unclear cases, or in patients with temporary problems, no good method other than swallowing training, bougienage, and tube feeding are available. During the past decade, botulinum toxin has been found to be of therapeutic value in the treatment of a variety of neurological disorders associated with inappropriate muscular contractions such as torticollis and spasmodic dysphonia. Recently, injections of botulinum toxin in patients with cricopharyngeal muscle dysfunction have been reported to result in marked relief of dysphagia. In this article we describe our experiences with botulinum toxin injections to treat four patients suffering from deglutition problems and cricopharyngeal dysphagia of different origins. Botulinum toxin was injected into the cricopharyngeus muscle that was identified by endoscopy under general anesthesia. In this study, no major side effects were observed. Three patients obtained a significant improvement of esophageal symptoms after the first injection. The treatment had limited effect in one patient who had reflux disease and only slight cricopharyngeus dysfunction.     

Application of transcranial direct current stimulation in cricopharyngeal dysfunction with swallowing apraxia caused by stroke: A case report

Rationale:Dysphagia is a common complication after stroke. The 2 types of dysphagia with cricopharyngeal dysfunction and swallowing apraxia after stroke are relatively rare and difficult to treat; however, there are few clinical case reports of cricopharyngeal dysfunction and swallowing apraxia after stroke.Patient concerns:A case of cricopharyngeal dysfunction and swallowing apraxia due to cerebral infarction caused by atrial fibrillation in a 63-year-old woman who was followed up for 1 year.Diagnoses:The patient was diagnosed with cricopharyngeal dysfunction and swallowing apraxia caused by stroke based on the clinical course and imaging findings.Interventions:Pharmacotherapy and rehabilitation therapy.Outcome:The patient''s swallowing function returned to normal, and her nasal feeding tubes were removed, and oral feeding was resumed.Lessons:The 2 types of dysphagia with cricopharyngeal dysfunction and swallowing apraxia after stroke are relatively rare and difficult to treat after stroke. Only by improving swallowing apraxia can patients perform mandatory swallowing and balloon dilatation treatment. However, transcranial direct current stimulation has a good therapeutic effect on the primary motor and sensory cortex of the tongue in patients with cricopharyngeal dysfunction and swallowing apraxia.     

虚拟现实技术结合综合疗养康复对脑卒中患者上肢功能恢复的临床研究

目的观察虚拟现实(VR)技术结合综合疗养康复对脑卒中后上肢功能障碍的患者运动功能恢复的影响。方法将40例脑卒中后上肢功能障碍的患者随机分为2组,治疗组患者给予常规作业训练并进行VR技术结合综合疗养康复,对照组患者仅给予常规作业训练。观察两组患者治疗前后运动功能Fugl-Meyer评分、日常生活能力改良Barthel指数、患侧上肢肌力评分的变化情况。结果与治疗前相比,两组患者在治疗10周时Fugl-Meyer评分、改良Barthel指数、患侧上肢肌力评分均高于治疗前(P0.05),且治疗10周时,治疗组上述指标均明显高于对照组(P0.05)。结论 VR技术结合综合疗养康复可以显著改善脑卒中后上肢功能障碍患者的上肢运动功能、日常生活能力和上肢肌力,值得临床推广应用。     

Assessment of swallowing function in pediatric patients with Wilson’s disease: Results of a videofluoroscopic swallowing study

Background and study aimsWilson’s disease (WD) is a complex disorder related to copper metabolism and neurological involvement may lead to swallowing disorders. The purpose of this study was to evaluate swallowing function in pediatric patients with WD by using videofluoroscopic swallowing study (VFSS).Patients and methodsA total of 21 patients were included in the study, prospectively. The VFSS was conducted to evaluate swallowing function of the patients. The penetration-aspiration scale (PAS) was used to assess penetration-aspiration severity.ResultsAccording to the VFSS, abnormal results were detected in nine patients (42.9%) with WD. Of these nine patients, oral phase dysfunction was present in one patient, laryngeal penetration was present in one patient and moreover, abnormal esophageal body function was detected in all nine patients. Of these nine patients, five had neurological presentation at the time of diagnosis, and remaining four patients had hepatic presentation. Mean PAS score of the patients was 1.ConclusionThe current study results suggest that subclinical swallowing dysfunction may be observed in patients with either neurological or hepatic WD. Further studies are necessary to reveal the real incidence of esophageal phase problems of swallowing function in pediatric patients with WD.     

Endoscopic botulinum toxin injection for treatment of pharyngeal dysphagia in patients with cricopharyngeal dysfunction

Background: Dysphagia associated with neurologic disorders is a problem worldwide. However, few studies have assessed the efficacy of endoscopic botulinum toxin injections into the cricopharyngeal muscle using a pharyngoscope.

Methods: Fourteen patients who received an endoscopic botulinum toxin injection due to cricopharyngeal muscle dysfunction and a neurological disorder from 2006 to 2017 were retrospectively reviewed at a single tertiary medical center. The toxin was injected at a 100 international unit (IU) total dose under direct endoscopic vision. The success of the procedure was evaluated comprehensively using the following: clinical resolution of the previous symptoms, functional oral intake scale (FOIS) for the clinical evaluation of swallowing, and videofluoroscopic swallowing study (VFSS) to check decreased retention of barium at the pyriform sinus and the epiglottic vallecula.

Results: The study included 12 males and 2 females (mean age, 58 years old; range, 37–82 years). Three patients (21.4%) were confirmed clinically and eleven were confirmed by VFSS. Eleven patients (78.6%) were managed successfully with the injection. Three patients (21.4%) did not improve despite the injection.

Conclusion: An endoscopic botulinum toxin injection may be a good treatment option for patients with dysphagia and cricopharyngeal dysfunction due to a neurological disorder. Large, prospective, long-term follow-up studies are needed in the future.     

A novel balloon angioplasty catheter impregnated with beta-particle emitting radioisotopes for vascular brachytherapy to prevent restenosis; first in vivo results.

BACKGROUND: According to early clinical trials, vascular brachytherapy performed prior to or shortly after angioplasty is very effective in reducing restenosis rates. The purpose of this study was to investigate the effects of a novel radioactive catheter that allows simultaneous balloon angioplasty and beta-particle irradiation in the prevention of restenosis. MATERIAL AND METHODS: The balloon surface of an angioplasty catheter was impregnated with the radioisotope(32)P. Dosimetry calculations using a Monte Carlo method were performed at a radial distance of 0.2 mm from the balloon surface. Rabbit iliac arteries were dilated and simultaneously irradiated with a dose of 20 Gy delivered to the adventitia. Control arteries were only dilated and not irradiated. Neointimal areas, cell numbers and the perimeter of the arteries were measured by histomorphometry after 6 weeks. RESULTS: Neointima formation was reduced after balloon dilatation and simultaneous beta-particle irradiation using the(32)P impregnated angioplasty catheter as compared to balloon dilatation alone with a non-impregnated catheter (0.09+/-0.06 vs 0.27+/-0.09 mm(2)neointimal area and 168+/-45 vs 360+/-133 cells/0.05 mm(2)neointima, P<0.001 vs control, respectively). In addition, balloon dilatation with the(32)P impregnated angioplasty catheter increased the vessel perimeter as compared to balloon dilatation with a non-impregnated catheter (4. 7+/-0.2 vs 3.9+/-0.3 mm, P<0.001 vs control). CONCLUSIONS: Simultaneous balloon dilatation and vascular brachytherapy with a novel(32)P impregnated angioplasty catheter markedly reduces restenosis in vivo by preventing neointimal hyperplasia and constrictive vascular remodelling.     

Analysis of Video Fluoroscopic Swallowing Study in Patients with Vocal Cord Paralysis

We reviewed the findings of a video fluoroscopic swallowing study (VFSS) of 28 patients with vocal cord paralysis (VCP) who complained of swallowing difficulties. VFSSs were performed with thick and thin liquid using modified Logemann methods. The patients were grouped according to whether their VCP was of central or peripheral origin, and the VFSS findings of the groups were compared. The patients showed oral phase dysfunction and pharyngeal dysfunction, especially when the cause was of central origin. Oral phase abnormalities were found in 13 patients and pharyngeal phase abnormalities were found in all patients, including penetration in 20 patients and aspiration in 14 patients. Improper lip closure (LC) and bolus formation (BF) and a delay in triggering pharyngeal swallow (TPS) and upper esophageal sphincter release (UESR) were significantly more frequent in patients with central VCP. With thin-liquid swallowing, pharyngeal transit time (PTT) and pharyngeal delay time (PDT) were significantly more prolonged in central VCP. The results suggest that the delay in triggering and poor coordination of swallowing were profound in patients with central VCP, but dysfunction in peripheral VCP may originate from poor pharyngeal movement.