摘要
目的探讨咽部电刺激(PES)用于脑卒中患者气管切开术后神经源性吞咽困难的安全性和临床疗效。方法应用前瞻性、单盲、随机对照试验设计,选取2019年1月至2021年1月于某三级甲等医院就诊的20例脑卒中气管切开术后神经源性吞咽困难患者作为研究对象,分两阶段研究,第一阶段将20例受试者随机分为PES组和假刺激组(对照组),每组10名。观察在PES治疗后48h拔管情况、不良反应事件、吞咽功能。第二阶段研究对象为延迟治疗受试者(在第一阶段的假刺激后被判定为不准备拔管的受试者)7例和复治受试者(在第一阶段的PES治疗后被判定为不准备拔管的受试者)4例,共11例受试者。在第30天随访期间或出院前(以先到者为准),观察PES延期治疗和PES重复治疗的必要性。结果所有受试者均能耐受咽部电刺激治疗,未发生不良反应事件或严重并发症。PES组中有7例(70.0%),对照组中有3例(30.0%)判断为可拔管,差异无统计学意义。拔管的受试者知觉阈值低于不能拔管受试者,差异有统计学意义(P<0.05)。对PES有反应的受试者电流强度水平低于无反应的受试者,差异有统计学意义(P<0.05)。第二阶段研究拔管率为45.5%。结论对于行气管切开术的脑卒中后吞咽困难受试者,PES在改善气道保护和吞咽功能方面安全有效,拔管率较高,值得临床推广应用。
Objective To explore the safety and clinical efficacy of pharyngeal electrical stimulation(PES)in the treatment of neurogenic dysphagia after tracheotomy in stroke patients.Methods A prospective,single-blind,randomized controlled trial design was used to select 20 patients with neurogenic dysphagia after tracheotomy in tertiary hospital from January 2019 to January 2021 as the research subjects,the study was divided into two stages,in the first stage,20 subjects were randomly divided into PES group and sham stimulation group(control group),with 10 cases in each group.The extubation,adverse events and swallowing function were observed at 48 h after PES treatment.The subjects of the second stage were 7 subjects with delayed treatment(who were judged not to be extubation after the first stage of sham stimulation)and 4 subjects with retreatment(who were judged not to be extubation after the first stage of PES treatment),a total of 11 subjects.The necessity of PES delayed treatment and PES repeated treatment was observed during the 30-day follow-up period or before discharge(whichever comes first).Results All subjects were able to tolerate pharyngeal electrical stimulation without adverse events or serious complications.There were 7 cases(70.0%)in the PES group and 3 cases(30.0%)in the control group were judged to be extubable,and the difference was not statistically significant.The perceptual threshold of subjects who could not extubate was lower than that of subjects who could not extubate,and the difference was statistically significant(P<0.05).The current intensity of the subjects who responded to PES was lower than that of the subjects who did not respond,and the difference was statistically significant(P<0.05).In the second stage,the extubation rate was 45.5%.Conclusion PES is safe and effective in improving airway protection and swallowing function in tracheotomy stroke patients with dysphagia,it is superior to the control group and has higher extubation rate,so it is worthy of clinical application.
作者
孙会艳
周立燕
任丽雪
马力颖
李强
SUN Huiyan;ZHOU Liyan;REN Lixue;MA Liying;LI Qiang(Chifeng College Medical Department,Chifeng,Inner Mongolia,024000,China;Department of Neurology,Affiliated Hospital of Chifeng University,Chifeng,Inner Mongolia,024000,China;Inner Mongolia Key Laboratory of Human Genetic Diseases,Chifeng,Inner Mongolia,024000,China)
出处
《当代医学》
2023年第1期154-156,共3页
Contemporary Medicine
基金
赤峰市自然科学科研课题项目(SZR21049)
内蒙古自治区自然科学基金项目(2021LHMS08024、2021MS08131)。
关键词
咽部电刺激
神经源性吞咽困难
脑卒中
气管切开
前瞻性
Pharyngeal electrical stimulation
Neurogenic dysphagia
Stroke
Tracheotomy
Prospective
