实时电刺激并球囊扩张治疗脑干卒中致环咽肌失弛缓的疗效观察

The effects of real-time electrical stimulation and balloon dilatation on cricopharyngeai achalasia after a brainstem stroke

目的观察吞咽时实时神经肌肉电刺激（NMES）联合球囊扩张治疗脑干卒中致环咽肌失弛缓的疗效。方法采用随机数字表法将30例脑干卒中致环咽肌失弛缓患者分为实验组和对照组，每组15例。实验组患者给予吞咽时实时NMES＋球囊扩张治疗，对照组患者给予常规NMES＋球囊扩张治疗。结果经治疗后，两组共有26例患者恢复正常经口进食，视频吞咽造影检查（VFSS）显示患者吞咽食物时环咽肌正常开放，食物能顺利通过环咽肌，误吸消失。两组患者吞咽功能改善情况组间差异无统计学意义（P〉0．05），但两组恢复正常进食患者其平均治疗次数（Z=2．423，P=0．0201）、平均治疗天数（Z=2．116，P=0．0352）、平均治疗费用（Z=2．296，P=0．0263）组间差异均具有统计学意义（P〈0．05），且上述指标均以实验组患者相对较优。结论吞咽时实时NMES＋球囊扩张及常规NMES＋球囊扩张治疗对脑干卒中致环咽肌失弛缓均具有较好疗效，并且吞咽时实时NMES＋球囊扩张治疗能进一步缩短疗程、降低治疗费用。

Objective To observe the therapeutic efficacy of electrical stimulation and balloon dilatation in treating crieopharyngeal achalasia after a brainstem stroke. Methods Thirty dysphagia patients with cricopharyn- geal achalasia after a brainstem stroke were randomly divided into an experimental group and a control group, each of 15. The experimental group was given real-time electrical stimulation and balloon dilatation, while the control group was treated using common electrical stimulation and balloon dilatation. Results Twenty-six patients in the 2 groups returned to oral feeding after treatment. Videofluoroscopy revealed that the crieopharyngeal sphincter had relaxed and the food passed successfully when swallowing. No aspiration was observed. There was no significant difference in swallowing between the two groups, but the average treatment time, days of treatment and cost of therapy in the exper- imental group were significantly less than in the control group. Conclusions Either real-time electrical stimulation or common electrical stimulation combined with balloon dilatation can treat dysphagia effectively, but the former can shorten the course of treatment and lower its cost.