| 罗瑶敏
，候邦强
，许艳林
，席愉
，王敏
，姜鑫
，胡恩浩
，李雯
，王珊
，谢玉磊,.iTBS联合球囊扩张术治疗COVID-19诱发的吞咽障碍：脑梗死后遗症期患者的个案分析[J].神经损伤功能重建,2024,(知网首发): |
| iTBS联合球囊扩张术治疗COVID-19诱发的吞咽障碍：脑梗死后遗症期患者的个案分析 |
| Intermittent Theta Burst Stimulation Combined with Balloon Dilation for COVID-19-InducedDysphagia: A Case Study of a Patient with Post-Stroke Sequela |
| |
| DOI： |
| 中文关键词: 新型冠状病毒 吞咽障碍 间歇性theta节律刺激 球囊扩张术 康复治疗 |
| 英文关键词: Coronavirus disease 2019 dysphagia intermittent theta burst stimulation balloon dilation rehabilitation therapy |
| 基金项目:川北医学院附属医
院2023年科研发展
项目（基于 fNIRS
和神经电生理探究
Theta 节律刺激治
疗不完全性脊髓损
伤 2023JC011；川
北医学院 2022 年
科研发展项目（基
于fNIRS和神经电
生理探究Theta节律
刺激治疗不完全性
脊髓损伤 CBY22-
QNA45） |
|
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| 中文摘要: |
| 目的：探寻新型冠状病毒（Coronavirus disease 2019，COVID-19）诱发脑梗死患者吞咽功能障碍的康
复方案。方法：对1例COVID-19诱发吞咽功能障碍1+
月的脑梗死后遗症期的患者进行两个阶段的全面评
估及治疗。一阶段行双侧大脑吞咽皮质间歇性theta节律刺激（intermittent theta burst stimulation，iTBS）、球
囊扩张治疗和常规吞咽康复训练，每周 5 次，持续 2 周。二阶段在一阶段的基础上增加舌骨上肌群iTBS，
每周 5 次，持续 2 周。分别在治疗前、一阶段治疗后和二阶段治疗后进行评估。评估指标包括标准吞咽功
能评价量表（Standardized Swallowing Assessment，SSA）、基于电子鼻咽喉镜吞咽功能检查（Flexible endoscopic evaluation of swallowing，FEES）的Yale咽部残留严重程度评定量表（Yale Pharyngeal Residue Severity Rating Scale，YPR-SRS）和渗漏误吸评分量表（Penetration-aspiration Scale，PAS）、功能性经口摄食量表
（Functional Oral Intake Scale，FOIS）、舌骨上肌群运动诱发电位（Motor evoked potential，MEP）和功能性近
红外光谱（Functional near-infrared spectroscopy，fNIRS）。结果：与治疗前相比，一阶段治疗结束时吞咽功能
无明显改善，会厌谷和梨状隐窝仍有中度或重度残留，患者仅能最小量尝试进食液体。与一阶段治疗结束
时相比，二阶段治疗结束时患者的吞咽功能明显提高，SSA评分从32分降至22分；YPR-SRS从中度和重度
残留改善为轻度和微量残留；PAS从4分降至1分；FOIS从2分增至6分，患者除不能连续大口饮水外，可完
全经口进食；双侧舌骨上肌群MEP潜伏期缩短，波幅增大；fNIRS结果显示患者吞咽相关的大脑皮质网络
功能连接强度显著增加。结论：舌骨上肌群和双侧大脑吞咽皮质iTBS联合球囊扩张术是治疗脑梗死患者
COVID-19感染后吞咽困难的一种安全、有效的康复方案，它可能通过改善舌骨上肌群的功能以及提高吞
咽相关皮质区域的兴奋性和大脑网络功能连接的强度来实现。 |
| 英文摘要: |
| To explore rehabilitation options for dysphagia induced by Coronavirus disease 2019
(COVID-19) in post-stroke patients. Methods: A patient with post-stroke sequelae who developed
COVID-19-induced dysphagia for more than one month underwent a two-stage comprehensive assessment and
treatment. In the first stage, intermittent theta burst stimulation (iTBS) to the bilateral swallowing cortex, balloon
dilation therapy, and standard swallowing rehabilitation exercise were performed five times per week for two
weeks. In the second stage, iTBS was applied to the suprahyoid muscles for an additional two weeks.
Assessments were performed before treatment (T0), after the first stage (T1) and after the second stage (T2). The
assessment indicators included the Standardized Swallowing Assessment (SSA), Yale Pharyngeal Residue
Severity Rating Scale (YPR-SRS) and Penetration-Aspiration Scale (PAS) based on Flexible Endoscopic
Evaluation of Swallowing (FEES), Functional Oral Intake Scale (FOIS), Motor Evoked Potentials (MEP) of
suprahyoid muscles, and Functional Near-Infrared Spectroscopy (fNIRS). Results: Compared with T0, there
was no significant improvement in swallowing function at the end of T1, with moderate to severe residue
observed in the epiglottic vallecula and pyriform sinus. The patient could only attempt minimal liquid intake.
Compared with the end of T1, the patient's swallowing function was significantly improved at the end of T2,
with the SSA score decreasing from 32 to 22. YPR-SRS improved from moderate/severe residue to mild/trace
residue, the PAS score decreased from 4 to 1, and the FOIS increased from 2 to 6. The patient could consume
food orally with the exception of large gulps. The MEP latency reduced, and the amplitude increased in the bilateral suprahyoid muscles.
The fNIRS results revealed a significant increase in the functional connectivity of the cortical swallowing network. Conclusion: iTBS to
the suprahyoid muscles and bilateral swallowing cortex combined with balloon dilation is a safe and effective rehabilitation therapy for
treating post-COVID-19 dysphagia in post-stroke patients, potentially by improving the function of the supraglottic muscles and
increasing the excitability of swallowing-associated cortical areas and functional connectivity of brain networks. |
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