导尿管球囊扩张术对脑卒中后环咽肌失驰缓症的疗效及随访研究  

Effects of Catheter Balloon Dilatation Therapy on Cricopharyngeal Achalasia in Stroke Patients and Follow-up Study

作　　者：袁春兰 彭化生 

机构地区：[1]菏泽市第三人民医院康复中心,山东菏泽市274031 [2]菏泽市第三人民医院神经内科,山东菏泽市274031

出　　处：《中国康复理论与实践》2012年第10期976-979,共4页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的探讨导尿管球囊扩张术在脑卒中后环咽肌失弛缓症所致吞咽障碍中的治疗作用及随访情况。方法共选取28例经电视透视下吞咽功能检查(VFSS)诊断为脑卒中后环咽肌失弛缓症的吞咽障碍患者,应用14号导尿管球囊,采用注水方式使球囊充盈以扩张环咽肌,同时辅以神经肌肉电刺激、常规吞咽康复训练。治疗终点为恢复经口进食或治疗已满6周。分别于治疗前、治疗终点时进行吞咽功能评估及吞咽造影检查,1年后随访。结果在导尿管球囊扩张治疗终点,28例患者中有22例恢复经口进食普通饮食,包括固体食物、流质物及水,24例可进食糊状食物,与治疗前比较有显著性差异(P<0.01)。吞咽造影中,治疗后咽通过时间缩短(P<0.05);VFSS吞咽障碍程度评分明显高于治疗前(P<0.01)。治疗终点时VFSS疗效评价显示总有效率达89.28%。1年后随访发现,23例(82.14%)患者均能从口进食普通食物;12例患者咽通过时间、吞咽障碍程度评分已接近正常。结论导尿管球囊扩张术能显著改善脑卒中后环咽肌失弛缓导致的吞咽功能障碍,且具有远期疗效。Objective To explore the effects of catheter balloon dilatation therapy on cricopharyngeal achaiasia in patients with stroke and 1 year follow-up study.Methods 28 cases of dysphagia caused by stroke were diagnosed as cricopharyngeal achalasia through videofluoroscopic swallowing study（VFSS）.A l4# urethral catheter was used to insert into the esophagus and an amount of water was injected into the balloon of urethral catheter to make it turgid.Then the catheter was pulled upwards and passed through the stricture of esophagus to dilatate the cricopharygeus muscle.At the same time,vitalstim low frequency electrical stimulation was used and combined with routine dysphagia rehabilitation training once daily.The treatment end point was either the patient resuming an oral diet or after 6 weeks of treatment.All cases were evaluated by swallowing function and VFSS before and after treatment and followed after 1 year of treatment.Results After catheter balloon dilatations therapy,22 patients regained the ability to take solid food and water orally,24 of them could take pasty food.There was significant difference between pre-treatment and post-treatment（P〈0.01）.The time of bolus passing the pharynx significantly shortened from 0.22 s to 0.14 s after treatment.The scores of VFSS significantly increased after treatment（P〈0.01）.VFSS showed that the total effective rate was 89.28%.1 year after treatment,23 patients could take solid food and water orally,and 12 patients approach to normal in the time passing the pharynx and VFSS score.Conclusion Catheter balloon dilatation has long-term effect on cricopharyngeal achalasia caused by stroke.

关 键 词：导尿管球囊扩张术 脑卒中 环咽肌失弛缓症 吞咽障碍 电视透视下吞咽能力检查 随访 

分 类 号：R743.3[医药卫生—神经病学与精神病学]