脑卒中后吞咽障碍患者接受感应电刺激联合舌压抗阻反馈训练的短期吞咽结局

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中文摘要

目的： 探讨视频透视引导下感应电刺激联合舌压抗阻反馈训练对脑卒中后吞咽障碍患者短期吞咽结局的影响。
方法： 这项非随机、单中心前瞻性研究于2024年1月至2025年12月期间纳入238例脑卒中后吞咽障碍患者。患者根据偏好被分配接受常规吞咽康复或时间匹配的综合方案，后者将感应电刺激和舌压抗阻反馈训练纳入同一30分钟康复训练中。主要结局为从基线至治疗后穿透-误吸量表（PAS）评分的变化。次要结局包括功能性经口摄食量表（FOIS）、吞咽生活质量问卷、标准化吞咽评估、视频透视运动学参数、表面肌电图参数、最大等长舌压以及治疗后吞咽状态改善率。采用校正的ANCOVA或logistic回归模型估计治疗相关差异。
结果： 观察到若干基线不平衡，包括卒中类型、改良Rankin量表评分、基线FOIS、基线SWAL-QOL和基线舌压。在校正基线值和临床相关协变量后，干预组PAS评分下降幅度大于对照组，校正差异为-0.21分；95% CI，-0.37至-0.05；P = 0.012。干预组在FOIS、SWAL-QOL、SSA、舌压、甲状软骨和舌骨位移以及吞咽时间方面也显示出更大改善。干预组治疗后吞咽状态改善率为89.9%，对照组为73.1%，对应的绝对率差为16.8%，95% CI，7.2%-26.4%。在校正logistic回归中，干预与更高的临床应答几率相关，校正OR为1.71，95% CI，1.15-2.59。针对治疗后PAS和FOIS的序数logistic敏感性分析得出一致结果。未报告严重不良事件。
结论： 与常规康复相比，视频透视引导下感应电刺激联合舌压抗阻反馈训练与吞咽相关临床、运动学和舌压结局的更大短期改善相关。鉴于基于偏好的分配和干预的多组分性质，这些发现应解释为相关性证据，而非因果关联的确定性证据。

英文摘要

OBJECTIVE: To investigate the short-term swallowing outcomes associated with videofluoroscopy-guided inductive electrical stimulation combined with tongue pressure resistance feedback training in patients with post-stroke dysphagia.
METHODS: This non-randomized, single-center prospective study enrolled 238 patients with post-stroke dysphagia between January 2024 and December 2025. Patients were allocated according to preference to receive conventional swallowing rehabilitation or a a time-matched integrated program in which inductive electrical stimulation and tongue pressure resistance feedback training were incorporated within the same 30-minute rehabilitation session. The primary outcome was the change in Penetration-Aspiration Scale (PAS) score from baseline to post-treatment. Secondary outcomes included Functional Oral Intake Scale (FOIS), Swallowing Quality of Life questionnaire, Standardized Swallowing Assessment, videofluoroscopic kinematic parameters, surface electromyography parameters, maximum isometric tongue pressure, and post-treatment swallowing status improvement rate. Adjusted ANCOVA or logistic regression models were used to estimate treatment-associated differences.
RESULTS: Several baseline imbalances were observed, including stroke type, modified Rankin Scale score, baseline FOIS, baseline SWAL-QOL, and baseline tongue pressure. After adjustment for baseline values and clinically relevant covariates, the intervention group showed a greater reduction in PAS score than the control group, with an adjusted difference of -0.21 points; 95% CI, -0.37--0.05; P = 0.012. The intervention group also showed greater improvements in FOIS, SWAL-QOL, SSA, tongue pressure, thyroid cartilage and hyoid bone displacement, and swallowing time. The post-treatment swallowing status improvement rate was 89.9% in the intervention group and 73.1% in the control group, corresponding to an absolute rate difference of 16.8%, 95% CI, 7.2%-26.4%. In adjusted logistic regression, the intervention was associated with higher odds of clinical response, with an adjusted OR of 1.71, 95% CI, 1.15-2.59. Ordinal logistic sensitivity analyses for post-treatment PAS and FOIS yielded consistent findings. No serious adverse events were reported.
CONCLUSION: Videofluoroscopy-guided inductive electrical stimulation combined with tongue pressure resistance feedback training was associated with greater short-term improvements in swallowing-related clinical, kinematic, and tongue pressure outcomes compared with conventional rehabilitation. Given the preference-based allocation and the multicomponent nature of the intervention, these findings should be interpreted as associative rather than definitive evidence of causal association.