文章摘要
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
iTBS combined with balloon dilatation for COVID-19-induced dysphagia: a case study of a patient in the sequela stage of cerebral infarction
投稿时间:2024-06-03  修订日期:2024-06-03
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: COVID-19, Dysphagia, Intermittent theta burst stimulation, Balloon dilatation therapy, Rehabilitation
基金项目:
作者单位邮编
罗瑶敏 川北医学院附属医院 637000
候邦强 川北医学院附属医院 
许艳林 川北医学院 
席愉 南充市中医院 
王敏 南充市中心医院 
姜鑫 高坪区人民医院 
胡恩浩 川北医学院附属医院 
李雯 川北医学院附属医院 
王珊 成都新华医院 
谢玉磊 川北医学院附属医院 637000
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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层间歇性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层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层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层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:
      Objective: To explore rehabilitation options for Coronavirus disease 2019 (COVID-19) induced dysphagia in stroke patients. Methods: A 2-stage comprehensive evaluation and treatment of a patient with COVID-19-induced dysphagia for 1+ months in the post-infarction phase of cerebral infarction. Intermittent theta burst stimulation (iTBS) of the bilateral cerebral swallowing cortex, balloon dilatation therapy, and conventional swallowing therapy were performed in the first phase, 5 times/week for 2 weeks. The second phase added iTBS of the Suphyoid muscles to the first phase, 5 times/week for 2 weeks. Evaluation was performed before (T0), after the first phase of treatment (T1) and after the second phase of treatment (T2), respectively. Assessment metrics included the Standardised Swallowing Assessment (SSA), the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS) and Penetration-aspiration Scale (PAS) based on Flexible endoscopic evaluation of swallowing (FEES), the Functional Oral Intake Scale (FOIS), the Motor Evoked Potentials of Suphyoid muscles (MEP), and the Functional Near Infrared Spectroscopy (fNIRS). Results: Compared to T0, there was no significant improvement in swallowing function at T1. The epiglottic valley and pearly crypts remained moderately or severely residual, the patient able to only minimally attempt to ingest liquids. Compared with T1, the patient's swallowing function was significantly improved at T2. SSA score decreased from 32 to 22; YPR-SRS improved from moderate and severe residuals to mild and trace residuals; PAS decreased from 4 to 1; FOIS increased from 2 to 6, and the patient was able to feed completely orally, except for the inability to drink continuously in large gulps; The MEP latency of bilateral Suphyoid muscles was shortened and the wave amplitude was increased, and the fNIRS results showed a significant increase in the strength of the functional connectivity of the patient's swallowing-related cortical brain networks. Conclusion: Suphyoid muscles iTBS, bilateral cerebral swallowing cortex iTBS combined with balloon dilatation is a safe and effective rehabilitation option for the treatment of dysphagia after COVID-19 infection in patients with cerebral infarction, which may be achieved by improving the function of the supraglottic muscle group as well as by increasing the excitability of swallowing-associated cortical areas and the strength of functional connectivity of brain networks.
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