吞咽肌不同强度电刺激对急性缺血性卒中吞咽障碍患者脑血流灌注参数的影响

Influence of Different Intensities of Electric Stimulation to Swallowing Muscle on the Parameters of Cerebral Blood Flow of Acute Ischemic Stroke Patients With Dysphagia

目的通过观察吞咽肌低频电刺激对脑血流的影响,探讨吞咽肌低频电刺激治疗急性缺血性卒中吞咽障碍的机制。方法选取2012年1月—2013年5月于首都医科大学附属北京世纪坛医院治疗的由真性球麻痹所致吞咽障碍的急性缺血性卒中患者35例为研究对象。分别以0、3、5、7、9 m A的刺激强度刺激吞咽肌,2 h后记录患侧颅内外血管〔大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)、眼动脉(OA)、颈内动脉虹吸部(CS)、椎动脉(VA)、基底动脉(BA)、小脑后下动脉(PICA)、颈总动脉(CCA)、颈内动脉(ICA)、颈外动脉(ECA)〕血流动力学参数,包括收缩期峰值血流速(Vs)、舒张期低值血流速(Vd)及平均血流速(Vm)。结果吞咽肌不同刺激强度下,MCA、VA及PICA Vs比较,差异有统计学意义(P<0.05)。吞咽肌不同刺激强度下,VA及PICA Vd比较,差异有统计学意义(P<0.05)。吞咽肌不同刺激强度下,MCA、VA、BA及PICA Vm比较,差异有统计学意义(P<0.05)。MCA、VA、PICA Vs与刺激强度呈正相关(rs=0.324、0.363、0.415,P<0.05)。颅内外血管Vd与刺激强度均无直线相关性(P>0.05)。MCA、VA、BA、PICA Vm与刺激强度呈正相关(rs=0.316、0.358、0.259、0.407,P<0.05)。结论吞咽肌低频电刺激可能增强延髓及部分高级中枢的脑血流,从而达到神经中枢对吞咽动作的控制和吞咽功能改善的治疗作用。

Objective To study the mechanism of low -frequency electric stimulation to swallowing muscle treating dysphagia in acute ischemic stroke patients through observing the influence of low - frequency electric stimulation to swallowing muscle on cerebral flow. Methods We enrolled 35 acute ischemic stroke patients with dysphagia induced by true bulbar paralysis who received treatment in Beijing Shijitan Hospital, Capital Medical University from January 2012 to May 2013. The swallowing muscles of the patients were stimulated with intensities of 0, 3, 5, 7 and 9 mA, and 2 hours later, hemodynamie parameters, including Vs, Vd and Vm of ACA, MCA, PCA, OA, CS, VA, BA, PICA, CCA, ICA and ECA were recorded. Results Vs of MCA, VA and PICA varied significantly with different intensities of electric stimulation to swallowing muscle （ P 〈 0. 05 ）. Vd of VA and PICA varied significantly with different intensities of electric stimulation to swallow muscle （ P 〈 0. 05 ）. Vm of MCA, VA, BA and PICA varied significantly with different intensities of electric stimulation （P 〈 0. 05 ）. Vs of MCA, VA and PICA were positively correlated with stimulation intensity （rs = 0. 324, 0. 363, 0. 415 ; P 〈 0. 05）. Vd of intracranial and extracranial vessels had no correlation with stimulation intensity （ P 〉 0. 05 ）. Vm of MCA, VA, BA and PICA had positive correlation with stimulation intensity （ r, = 0. 316, 0. 358, 0. 259 , 0. 407, P 〈 0. 05 ）. Conclusion Low - frequency electric stimulation to swallowing muscle may accelerate the cerebral flow of medulla oblongata and some advanced nerve centers, thus improving swallowing muscle control and swallowing function.