切换至 "中华医学电子期刊资源库"

中华脑科疾病与康复杂志(电子版) ›› 2025, Vol. 15 ›› Issue (05) : 293 -297. doi: 10.3877/cma.j.issn.2095-123X.2025.05.007

综述

咽腔电刺激在重症脑卒中后吞咽障碍治疗中的应用
范慧敏, 王玲()   
  1. 610041 成都,四川大学华西医院康复医学中心
  • 收稿日期:2024-12-27 出版日期:2025-10-15
  • 通信作者: 王玲

Application of pharyngeal electrical stimulation in the treatment of dysphagia after severe stroke

Huimin Fan, Ling Wang()   

  1. Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu 610041, China
  • Received:2024-12-27 Published:2025-10-15
  • Corresponding author: Ling Wang
  • Supported by:
    National Key Research and Development Program of China(2022YFC3601101)
引用本文:

范慧敏, 王玲. 咽腔电刺激在重症脑卒中后吞咽障碍治疗中的应用[J/OL]. 中华脑科疾病与康复杂志(电子版), 2025, 15(05): 293-297.

Huimin Fan, Ling Wang. Application of pharyngeal electrical stimulation in the treatment of dysphagia after severe stroke[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2025, 15(05): 293-297.

重症脑卒中患者常伴有吞咽障碍,严重妨碍患者的康复进程,并对其生活质量产生不良影响。咽腔电刺激(PES)作为一种新型的无创神经调节技术,在治疗重症脑卒中后吞咽障碍方面显示出重要的临床价值,能够改善患者的吞咽功能,缩短住院时间,并降低相关并发症发生率,但是在治疗标准、适用人群及长期效果等方面尚未达成共识。本文围绕PES在重症脑卒中后吞咽障碍中的作用机制和应用进展进行综述,旨在为临床治疗和未来研究提供参考。

Severe stroke patients often suffer from dysphagia, which severely impedes their recovery and affects their quality of life. As a new non-invasive neuromodulation technique, pharyngeal electrical stimulation (PES) has shown significant clinical value in the treatment of post stroke dysphagia, which can improve swallowing function, shorten hospital stay and reduce related complications. However, there are still some controversies about this treatment, such as the standard of care, the population to be treated and the long-term effects. This review summarizes and discusses the mechanism of action and progress in the application of PES in the treatment of dysphagia in severe stroke patients, with the aim of providing a reference for clinical management and future research.

[1]
Sasegbon A, Cheng I, Labeit B, et al. New and evolving treatments for neurologic dysphagia[J]. Drugs, 2024, 84(8): 909-932. DOI: 10.1007/s40265-024-02064-x.
[2]
Grube MM, Koennecke HC, Walter G, et al. Influence of acute complications on outcome 3 months after ischemic stroke[J]. PLoS One, 2013, 8(9): e75719. DOI: 10.1371/journal.pone.0075719.
[3]
Suntrup-Krueger S, Minnerup J, Muhle P, et al. The effect of improved dysphagia care on outcome in patients with acute stroke: trends from 8-year data of a large stroke register[J]. Cerebrovasc Dis, 2018, 45(3-4): 101-108. DOI: 10.1159/000487811.
[4]
Arnold M, Liesirova K, Broeg-Morvay A, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome[J]. PLoS One, 2016, 11(2): e0148424. DOI: 10.1371/journal.pone.0148424.
[5]
Macht M, Wimbish T, Clark BJ, et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness[J]. Crit Care, 2011, 15(5): R231. DOI: 10.1186/cc10472.
[6]
Walter U, Knoblich R, Steinhagen V, et al. Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit[J]. J Neurol, 2007, 254(10): 1323-1329. DOI: 10.1007/s00415-007-0520-0.
[7]
Mayer SA, Copeland D, Bernardini GL, et al. Cost and outcome of mechanical ventilation for life-threatening stroke[J]. Stroke, 2000, 31(10): 2346-2353. DOI: 10.1161/01.str.31.10.2346.
[8]
Lais G, Piquilloud L. Tracheostomy: update on why, when and how[J]. Curr Opin Crit Care, 2025, 31(1): 101-107. DOI: 10.1097/mcc.0000000000001224.
[9]
Rabinstein AA, Wijdicks EF. Outcome of survivors of acute stroke who require prolonged ventilatory assistance and tracheostomy[J]. Cerebrovasc Dis, 2004, 18(4): 325-331. DOI: 10.1159/000080771.
[10]
Choate K, Barbetti J, Currey J. Tracheostomy decannulation failure rate following critical illness: a prospective descriptive study[J]. Aust Crit Care, 2009, 22(1): 8-15. DOI: 10.1016/j.aucc.2008.10.002.
[11]
Leung R, MacGregor L, Campbell D, et al. Decannulation and survival following tracheostomy in an intensive care unit[J]. Ann Otol Rhinol Laryngol, 2003, 112(10): 853-858. DOI: 10.1177/000348940311201005.
[12]
Bath PM, Scutt P, Love J, et al. Pharyngeal electrical stimulation for treatment of dysphagia in subacute stroke: a randomized controlled trial[J]. Stroke, 2016, 47(6): 1562-1570. DOI: 10.1161/strokeaha.115.012455.
[13]
Romero CM, Marambio A, Larrondo J, et al. Swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy[J]. Chest, 2010, 137(6): 1278-1282. DOI: 10.1378/chest.09-2792.
[14]
Bertschi D, Rotondo F, Waskowski J, et al. Post-extubation dysphagia in the ICU-a narrative review: epidemiology, mechanisms and clinical management (Update 2025)[J]. Crit Care, 2025, 29(1): 244. DOI: 10.1186/s13054-025-05492-7.
[15]
丁玉菊,刘照勇,张波.获得性脑损伤患者成功拔除气管套管的预测因素研究[J].中华脑科疾病与康复杂志(电子版), 2023, 13(2): 108-112. DOI: 10.3877/cma.j.issn.2095-123X.2023.02.007.
[16]
Suntrup S, Marian T, Schröder JB, et al. Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial[J]. Intensive Care Med, 2015, 41(9): 1629-1637. DOI: 10.1007/s00134-015-3897-8.
[17]
中国残疾人康复协会神经康复专业委员会,中国康复研究中心.神经重症气管切开患者气道功能康复与管理专家共识(2024)[J].中国康复理论与实践, 2024, 30(8): 869-881. DOI: 10.3969/j.issn.1006-9771.2024.08.001.
[18]
Steele CM, Miller AJ. Sensory input pathways and mechanisms in swallowing: a review[J]. Dysphagia, 2010, 25(4): 323-333. DOI: 10.1007/s00455-010-9301-5.
[19]
Williams T, Walkden E, Patel K, et al. Research report: management of dysphagia using pharyngeal electrical stimulation in the general intensive care population-a service development[J]. J Intensive Care Soc, 2024, 25(4): 374-382. DOI: 10.1177/17511437241270244.
[20]
Restivo DA, Hamdy S. Pharyngeal electrical stimulation device for the treatment of neurogenic dysphagia: technology update[J]. Med Devices (Auckl), 2018, 11: 21-26. DOI: 10.2147/mder.S122287.
[21]
Fraser C, Power M, Hamdy S, et al. Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury[J]. Neuron, 2002, 34(5): 831-840. DOI: 10.1016/s0896-6273(02)00705-5.
[22]
Suntrup S, Teismann I, Wollbrink A, et al. Pharyngeal electrical stimulation can modulate swallowing in cortical processing and behavior-magnetoencephalographic evidence[J]. Neuroimage, 2015, 104: 117-124. DOI: 10.1016/j.neuroimage.2014.10.016.
[23]
Koestenberger M, Neuwersch S, Hoefner E, et al. A pilot study of pharyngeal electrical stimulation for orally intubated ICU patients with dysphagia[J]. Neurocrit Care, 2020, 32(2): 532-538. DOI: 10.1007/s12028-019-00780-x.
[24]
Niimi M, Hashimoto G, Hara T, et al. Relationship between frequency of spontaneous swallowing and salivary substance P level in patients with acute stroke[J]. Dysphagia, 2018, 33(4): 414-418. DOI: 10.1007/s00455-017-9867-2.
[25]
Arai T, Yoshimi N, Fujiwara H, et al. Serum substance P concentrations and silent aspiration in elderly patients with stroke[J]. Neurology, 2003, 61(11): 1625-1626. DOI: 10.1212/01.wnl.0000096395.80826.23.
[26]
Muhle P, Suntrup-Krueger S, Bittner S, et al. Increase of substance P concentration in saliva after pharyngeal electrical stimulation in severely dysphagic stroke patients-an indicator of decannulation success?[J]. Neurosignals, 2017, 25(1): 74-87. DOI: 10.1159/000482002.
[27]
Muhle P, Labeit B, Wollbrink A, et al. Targeting the sensory feedback within the swallowing network-reversing artificially induced pharyngolaryngeal hypesthesia by central and peripheral stimulation strategies[J]. Hum Brain Mapp, 2021, 42(2): 427-438. DOI: 10.1002/hbm.25233.
[28]
Muhle P, Claus I, Labeit B, et al. Pharyngeal electrical stimulation prior to extubation-reduction of extubation failure rate in acute stroke patients?[J]. J Crit Care, 2024, 82: 154808. DOI: 10.1016/j.jcrc.2024.154808.
[29]
Fraser C, Rothwell J, Power M, et al. Differential changes in human pharyngoesophageal motor excitability induced by swallowing, pharyngeal stimulation, and anesthesia[J]. Am J Physiol Gastrointest Liver Physiol, 2003, 285(1): G137-G144. DOI: 10.1152/ajpgi.00399.2002.
[30]
Jayasekeran V, Singh S, Tyrrell P, et al. Adjunctive functional pharyngeal electrical stimulation reverses swallowing disability after brain lesions[J]. Gastroenterology, 2010, 138(5): 1737-1746. DOI: 10.1053/j.gastro.2010.01.052.
[31]
Wang Q, Hu J, Tian Y, et al. An experimental study on the optimal timing of modified pharyngeal electrical stimulation for the treatment of dysphagia after stroke in rats[J]. Brain Res Bull, 2025, 227: 111390. DOI: 10.1016/j.brainresbull.2025.111390.
[32]
Maffiuletti NA, Gondin J, Place N, et al. Clinical use of neuromuscular electrical stimulation for neuromuscular rehabilitation: what are we overlooking?[J]. Arch Phys Med Rehabil, 2018, 99(4): 806-812. DOI: 10.1016/j.apmr.2017.10.028.
[33]
Pieber K, Herceg M, Paternostro-Sluga T, et al. Optimizing stimulation parameters in functional electrical stimulation of denervated muscles: a cross-sectional study[J]. J Neuroeng Rehabil, 2015, 12: 51. DOI: 10.1186/s12984-015-0046-0.
[34]
Chandrasekaran S, Davis J, Bersch I, et al. Electrical stimulation and denervated muscles after spinal cord injury[J]. Neural Regen Res, 2020, 15(8): 1397-1407. DOI: 10.4103/1673-5374.274326.
[35]
Zhang X, Wang X, Liang Y, et al. Neuroplasticity elicited by modified pharyngeal electrical stimulation: a pilot study[J]. Brain Sci, 2023, 13(1): 119. DOI: 10.3390/brainsci13010119.
[36]
Hu J, Wang Q, Dai Y, et al. Screening for optimal parameters for modified pharyngeal electrical stimulation for the treatment of dysphagia after stroke in rats[J]. Exp Neurol, 2024, 379: 114878. DOI: 10.1016/j.expneurol.2024.114878.
[37]
Zhang X, Xie H, Wang X, et al. Modulating swallowing-related functional connectivity and behavior via modified pharyngeal electrical stimulation: a functional near-infrared spectroscopy evidence[J]. Front Neurol, 2022, 13: 1006013. DOI: 10.3389/fneur.2022.1006013.
[38]
Zhang X, Liang Y, Wang X, et al. Effect of modified pharyngeal electrical stimulation on patients with severe chronic neurogenic dysphagia: a single-arm prospective study[J]. Dysphagia, 2023, 38(4): 1128-1137. DOI: 10.1007/s00455-022-10536-z.
[39]
Cheng I, Sasegbon A, Hamdy S. Effects of neurostimulation on poststroke dysphagia: a synthesis of current evidence from randomized controlled trials[J]. Neuromodulation, 2021, 24(8): 1388-1401. DOI: 10.1111/ner.13327.
[40]
Bath PM, Woodhouse LJ, Suntrup-Krueger S, et al. Pharyngeal electrical stimulation for neurogenic dysphagia following stroke, traumatic brain injury or other causes: main results from the PHADER cohort study[J]. EClinicalMedicine, 2020, 28: 100608. DOI: 10.1016/j.eclinm.2020.100608.
[41]
Dziewas R, Stellato R, van der Tweel I, et al. Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial[J]. Lancet Neurol, 2018, 17(10): 849-859. DOI: 10.1016/s1474-4422(18)30255-2.
[42]
Suntrup-Krueger S, Labeit B, von Itter J, et al. Treating postextubation dysphagia after stroke with pharyngeal electrical stimulation -insights from a randomized controlled pilot trial[J]. Neurotherapeutics, 2025, 22(4): e00613. DOI: 10.1016/j.neurot.2025.e00613.
[43]
Dziewas R, Mistry S, Hamdy S, et al. Design and implementation of Pharyngeal electrical Stimulation for early de-cannulation in TRACheotomized (PHAST-TRAC) stroke patients with neurogenic dysphagia: a prospective randomized single-blinded interventional study[J]. Int J Stroke, 2017, 12(4): 430-437. DOI: 10.1177/1747493016676618.
[44]
Cheng I, Bath PM, Hamdy S, et al. Predictors of pharyngeal electrical stimulation treatment success in tracheotomised stroke patients with dysphagia: secondary analysis from PHADER cohort study[J]. Neurotherapeutics, 2024, 21(5): e00433. DOI: 10.1016/j.neurot.2024.e00433.
[45]
潘冬生,梁国标.颅脑创伤治疗的最新进展与未来趋势[J].中华神经创伤外科电子杂志, 2024, 10(4): 193-197. DOI: 10.3877/cma.j.issn.2095-9141.2024.04.001.
[46]
盛超,周斌.低频电刺激喉部肌肉治疗脑卒中后吞咽障碍的疗效及对患者生活质量的影响[J].中华脑科疾病与康复杂志(电子版), 2022, 12(5): 279-284. DOI: 10.3877/cma.j.issn.2095-123X.2022.05.005.
[47]
Liu Z, Cheng J, Tan C, et al. Pharyngeal cavity electrical stimulation-assisted swallowing for post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled studies[J]. Dysphagia, 2024, 39(4): 541-551. DOI: 10.1007/s00455-023-10644-4.
[48]
Sun FT, Morrell MJ. Closed-loop neurostimulation: the clinical experience[J]. Neurotherapeutics, 2014, 11(3): 553-563. DOI: 10.1007/s13311-014-0280-3.
[49]
Belkacem AN, Jamil N, Khalid S, et al. On closed-loop brain stimulation systems for improving the quality of life of patients with neurological disorders[J]. Front Hum Neurosci, 2023, 17: 1085173. DOI: 10.3389/fnhum.2023.1085173.
[1] 孙剑玥, 黄瑾, 沈逸冕, 周超群, 程记伟. 重症脑卒中后呼吸机相关肺炎临床及病原学特点[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(01): 11-18.
[2] 黎倩, 何静, 李燕玲, 罗业涛, 徐婷, 吴敏, 王羚入. 卒中后吞咽障碍患者卒中相关性肺炎预测模型的构建[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(06): 793-798.
[3] 于帆, 迟冰玉, 朱紫嫣, 许光旭. 经皮耳迷走神经刺激治疗脑卒中后吞咽障碍的疗效分析[J/OL]. 中华脑科疾病与康复杂志(电子版), 2025, 15(04): 214-219.
[4] 昝兴淳, 许季祥, 何鹏, 齐胤良, 周小妹. 通督调神针刺联合吞咽治疗仪治疗脑卒中后吞咽障碍的临床观察[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(06): 346-352.
[5] 徐金, 龙耀斌, 郑继青. 头针联合辣椒素治疗脑卒中后慢性期吞咽障碍的临床疗效分析[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 80-85.
[6] 尤素伟. 老年脑卒中后吞咽障碍与卒中相关性肺炎的相关性研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2023, 13(03): 150-155.
[7] 郭晋朝, 张新杰, 杨璐, 王贵玲. 间歇经口至食管管饲联合吞咽训练对脑卒中吞咽障碍患者营养状态和预后的影响[J/OL]. 中华脑科疾病与康复杂志(电子版), 2023, 13(02): 102-107.
[8] 张建萍, 邓海鹏, 焦黛妍, 赵洁. 高频重复经颅磁刺激联合肌电生物反馈治疗脑卒中后吞咽障碍的临床研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2022, 12(05): 285-290.
[9] 盛超, 周斌. 低频电刺激喉部肌肉治疗脑卒中后吞咽障碍的疗效及对患者生活质量的影响[J/OL]. 中华脑科疾病与康复杂志(电子版), 2022, 12(05): 279-284.
[10] 张轶, 杜宇征, 聂鹏坤. 杜宇征教授应用“通关利窍”针刺法发微[J/OL]. 中华针灸电子杂志, 2025, 14(01): 37-40.
[11] 刘丹, 郭庆伟, 孙小洁, 樊小农, 刘继华, 冀来喜. "通关利窍"针刺法治疗卒中后吞咽障碍的主穴定位解剖学研究[J/OL]. 中华针灸电子杂志, 2024, 13(03): 102-106.
[12] 王增龙, 顾梅, 杭宇, 刘圣, 施海彬, 包建英. 急性大血管闭塞性脑卒中患者血管内治疗后吞咽障碍发生的危险因素分析[J/OL]. 中华介入放射学电子杂志, 2024, 12(01): 10-14.
[13] 陈娜娜, 韩莹, 胥青芝. 基于文献计量学的脑卒中吞咽障碍康复护理研究进展与临床热点趋势分析[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(02): 100-108.
[14] 王晖, 李丽, 周宝华, 杨琼, 李葆华, 罗永梅. 间歇管饲在脑卒中吞咽障碍患者康复中的应用进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(02): 177-180.
[15] 程培丽, 李霞, 王亚丽. 孤立性脑桥梗死合并吞咽障碍的临床影响因素分析[J/OL]. 中华脑血管病杂志(电子版), 2023, 17(05): 440-444.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?