改良球囊扩张治疗对脑干卒中后吞咽障碍患者皮质脑干束兴奋性的影响

The effect of modified catheter balloon dilatation therapy on corticobulbar excitability in dysphagic brainstem stroke patients

目的探讨改良球囊扩张治疗对脑干卒中后吞咽障碍患者颏下肌兴奋性的影响及其与吞咽功能的关系。方法选取单侧脑干卒中后上食管括约肌功能障碍30例，按随机数字表法分为对照组和扩张组，每组患者15例。对照组患者采用常规吞咽治疗，每日2次；扩张组患者在每日1次与对照组相同的常规吞咽治疗的基础上增加球囊扩张治疗。2组患者均于治疗前和治疗终点时记录双侧颏下肌的运动诱发电位（SMEP）、渗漏误吸评分（PAS）、功能性经口进食评分（FOIS）。结果重复方差分析提示，组别、时间以及SMEP记录侧的三个因素存在交互作用（F=3．46，P=0．02），两两比较发现，治疗后，2组的患侧SMEP均较组内治疗前增加，但仅扩张组患侧SMEP波幅较对照组增加（P〈O．05）。治疗后，扩张组的FOIS评分较组内治疗前显著增加（P〈0．01），PAS评分较组内治疗前显著降低（P〈O．05）。相关性分析发现，仅患侧SMEP的波幅变化与PAS评分呈正的强相关（r=0．815，P〈0．001），与FOIS评分弱相关（r=0．43，P=0．02）。结论改良球囊扩张治疗可增强皮质一患侧脑干一吞咽肌通路的兴奋性，并与吞咽安全性的增加有关。

Objective To explore the effect of the modified balloon dilatation on excitability of the submental swallowing muscle and its relationship with swallowing function of dysphagic patients with brainstem stroke. Methods Thirty unilateral brainstem stroke patients with upper esophageal sphincter （UES） dysfunction were recruited and randomly divided into a dilatation group and a control group, each of 15. The control group was given the routine swallowing therapy twice daily, while the dilatation group was provided one routine swallowing treatment plus a modified balloon dilatation daily. The treatment lasted 3 weeks, 30rain per day and 5 days per week. Both groups were evaluated using the bilateral submental motor evoked potentials （SMEPs）, penetration-aspiration scale （PAS） and functional oral intake scale （FOIS） before and after treatment. Results Repeated analysis of variance showed that there was significant interaction effect of group, time on SMEPs. The MEPs of the affected submental muscle in- creased significantly in both groups after treatment （P〈0.01） , but only the amplitude of SMEP of the affected submental muscles in the dilatation group was higher than that of the control group after treatment （P〈0.05）. In the dilatation group, the average FOIS score increased significantly （P〈0.01） , while the average PAS score decreased sig- nificantly after the treatment （P〈0.05）. An increase of amplitude of the affected SMEP was strongly correlated with the improvement in the average PAS score （P〈0.01, r= 0.815） , but weakly correlated with the average FOIS score （P = 0.02,r = 0.43）. Conclusion The modified balloon dilatation therapy can increase the excitability of the cortical-affected lateral brainstem-swallowing muscle pathway in patients with unilateral brainstem stroke, which might be more correlated with improvement in swallowing safety.