超声引导下注射A型肉毒毒素治疗脑损伤患者流涎症的临床应用

Botulinum toxin in the treatment of sialorrhea attributable to brain damage ： A preliminary study

目的 观察超声引导下A型肉毒毒素治疗脑损伤患者流涎症的疗效.方法 选择脑损伤患者9例（脑外伤5例,脑梗死3例,缺血缺氧性脑病1例）,在超声引导下将A型肉毒毒素注射入腮腺及下颌下腺,两边腮腺的上下极各取1个点,共4点,每个点注射A型肉毒毒素15 U;两边下颌下腺各取1个点,每点注射20 U.于治疗前和治疗1、4、12周后采用唾液流率、多涎评分系统的多涎严重程度和频率评定量表分别对患者进行评估.结果 治疗1周、治疗4周、治疗12周后,9例患者5 min平均唾液流率分别为（0.24±0.08）g、（0.28±0.12）g、（0.34 ±0.11）g,与治疗前的（0.49 ±0.12）g比较,差异均有统计学意义（P＜0.05）.治疗1周、治疗4周、治疗12周后,9例患者多涎评分系统的多涎严重程度（DSS-severity）评分分别为（1.92±0.37）分、（1.92 ±0.37）分、（2.32±0.64）分,与治疗前的（4.35±0.48）分比较,差异均有统计学意义（P＜0.05）.治疗1周、治疗4周、治疗12周后,9例患者多涎评分系统的多涎频率评分分别为（2.01±0.42）分、（2.01±0.42）分、（2.28±0.63）分,与治疗前的（3.56±0.49）分比较,差异均有统计学意义（P＜0.05）.结论 A型肉毒毒素可显著改善脑损伤患者的唾液分泌和流涎症状.

Objective To evaluate the effect of ultrasound-guided botulinum toxin A injection into the salivary glands in treating patients with sialorrhea attributable to brain damage.Methods Nine subjects with sialorrhea attributable to traumatic brain injury （n =5）,cerebral infarction （n =3） and hypoxic ischemic encephalopathy （n =1） were recruited into the study.With the guidance of ultrasound,15 units （U） of botulinum toxin type A was injected into the highest and lowest points of the two parotid glands,and 20 U was injected into two points of both submandibular glands.The saliva flow rate and the severity and frequency of sialorrhea were recorded before the treatment and 1 week,4 weeks and 12 weeks later using the Drooling Scoring System （DSS）.Results The saliva flow rate before treatment （0.49 ± 0.12 g/min） decreased significantly to 0.24 ± 0.08 g/min after 1 week,but then increased again to 0.28 ±0.12 g/min after 4 weeks and 0.34 ±0.11 g/min after 12 weeks.The average DSS severity score showed the same pattern：4.35 ± 0.48 initially 1.92 ± 0.37 after 1 week,1.92 ± 0.37 after 2 weeks and 2.32 ± 0.64 after 12 weeks.The DSS frequency score,however,remained significantly lower：3.56 ± 0.49 initially,2.01 ± 0.42 after 1 and 4 weeks and 2.28 ± 0.63 after 12 weeks.Conclusion Botulinum toxin type A can effectively improve the salivary secretion and sialorrhea attributable to brain damage.