马姝玥,于帆,孙婉婷,等.经皮耳迷走神经刺激对脑卒中后吞咽障碍患者吞咽功能的影响[J].中华物理医学与康复杂志,2026,48(1):28-33
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| 经皮耳迷走神经刺激对脑卒中后吞咽障碍患者吞咽功能的影响 |
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| DOI：10.3760/cma.j.cn421666-20250924-00826 |
| 中文关键词: 脑卒中 吞咽障碍 迷走神经刺激 吞咽造影检查 |
| 英文关键词: Stroke Dysphagia Vagus nerve stimulation Videofluoroscopy Swallowing |
| 基金项目:江苏省卫生健康发展研究中心开放课题（JSHD2021003） |
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| 中文摘要: |
| 目的 探讨经皮耳迷走神经刺激（taVNS）对脑卒中后吞咽障碍（PSD）患者吞咽功能的影响。 方法 采用随机数字表法将20例PSD患者分为对照组和实验组，每组10例。2组患者均接受常规吞咽康复治疗，在此基础上，实验组进行taVNS耳甲刺激，对照组进行taVNS耳垂假刺激，每日20 min，每周7 d，共4周。干预前、干预4周后（干预后），采用吞咽造影检查（VFSS）、渗漏-误吸量表（PAS）评估2组患者的吞咽功能。 结果 与组内干预前比较，实验组干预后的VFSS 17项半定量参数、PAS分级均显著改善（P＜0.05），对照组干预后仅在舌对食团的控制、食团的运送和舌运动、口腔残留、咽期吞咽启动、软腭抬升、喉上抬、舌骨位移、会厌运动、咽蠕动、咽收缩（前后位）、上食管括约肌（UES）开放、舌根收缩、咽部残留、食道清除14项半定量参数及PAS分级上有所改善（P＜0.05）。实验组干预后的VFSS 17项半定量参数及PAS分级［1.00（1.00，2.50）级］改善均显著优于对照组（P＜0.05）。 结论 在常规吞咽康复基础上辅以taVNS，可有效改善PSD患者的吞咽功能。 |
| 英文摘要: |
| Objective To evaluate the utility of transcutaneously stimulating the auricular vagus nerve for improving the swallowing of persons with post-stroke dysphagia (PSD). Methods Twenty PSD patients were randomized into an experimental group (n=10) and a control group (n=10) using a random number table. In addition to conventional swallowing rehabilitation, the experimental group received transcutaneous auricular vagus nerve stimulation (taVNS) targeting the cymba conchae of the auricle, while the control group received sham taVNS applied to the earlobe. Stimulation was administered 20 minutes per day, 7 days per week, for 4 weeks. Before and after the treatment, both groups′ swallowing was evaluated using videofluoroscopy and the Penetration-Aspiration Scale (PAS). Results The experimental group showed significant improvement in all 17 of the semi-quantitative indicators assessed through videofluoroscopy and in its PAS scores. In the control group, apart from improvement in the average PAS score, only 14 of the semi-quantitative indicators had improved significantly-tongue control of a bolus, bolus transport and tongue movement, oral residue, initiation of the pharyngeal swallow, soft-palate elevation, larynx elevation, hyoid displacement, epiglottis movement, pharyngeal peristalsis, pharyngeal contraction (in the anteroposterior view), opening of the upper esophageal sphincter (UES), tongue-base retraction, pharyngeal residue, and esophageal clearance. Even on those measures the experimental group exhibited significantly greater improvement than the control group ［median (IQR) 1.00(1.00, 2.50)］(P≤0.05). Conclusions When administered as an adjunct to conventional swallowing rehabilitation, transcutaneous stimulation of the auricular vagus nerve effectively improves the swallowing of persons with PSD. |
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