神经损伤与功能重建2025，Vol.20Issue(9)：505-510,6.DOI:10.16780/j.cnki.sjssgncj.20240347
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
Intermittent Theta Burst Stimulation Combined with Balloon Dilation for COVID-19-Induced Dysphagia:A Case Study of a Patient with Post-Stroke Sequela
摘要
Abstract
Objective:To explore rehabilitation options for dysphagia induced by Coronavirus disease 2019(COVID-19)in post-stroke patients.Methods:A patient with post-stroke sequelae who developed COVID-19-induced dysphagia for more than one month underwent a two-stage comprehensive assessment and treatment.In the first stage,intermittent theta burst stimulation(iTBS)to the bilateral swallowing cortex,balloon dilation therapy,and standard swallowing rehabilitation exercise were performed five times per week for two weeks.In the second stage,iTBS was applied to the suprahyoid muscles for an additional two weeks.Assessments were performed before treatment(T0),after the first stage(T1)and after the second stage(T2).The assessment indicators included the Standardized Swallowing Assessment(SSA),Yale Pharyngeal Residue Severity Rating Scale(YPR-SRS)and Penetration-Aspiration Scale(PAS)based on Flexible Endoscopic Evaluation of Swallowing(FEES),Functional Oral Intake Scale(FOIS),Motor Evoked Potentials(MEP)of suprahyoid muscles,and Functional Near-Infrared Spectroscopy(fNIRS).Results:Compared with T0,there was no significant improvement in swallowing function at the end of T1,with moderate to severe residue observed in the epiglottic vallecula and pyriform sinus.The patient could only attempt minimal liquid intake.Compared with the end of T1,the patient's swallowing function was significantly improved at the end of T2,with the SSA score decreasing from 32 to 22.YPR-SRS improved from moderate/severe residue to mild/trace residue,the PAS score decreased from 4 to 1,and the FOIS increased from 2 to 6.The patient could consume food orally with the exception of large gulps.The MEP latency reduced,and the amplitude increased in the bilateral suprahyoid muscles.The fNIRS results revealed a significant increase in the functional connectivity of the cortical swallowing network.Conclusion:iTBS to the suprahyoid muscles and bilateral swallowing cortex combined with balloon dilation is a safe and effective rehabilitation therapy for treating post-COVID-19 dysphagia in post-stroke patients,potentially by improving the function of the supraglottic muscles and increasing the excitability of swallowing-associated cortical areas and functional connectivity of brain networks.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Key words
Coronavirus disease 2019/dysphagia/intermittent theta burst stimulation/balloon dilation/rehabilitation therapy分类
医药卫生引用本文复制引用
罗瑶敏,谢玉磊,候邦强,许艳林,席愉,王敏,姜鑫,胡恩浩,李雯,王珊..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[J].神经损伤与功能重建,2025,20(9):505-510,6.基金项目
川北医学院附属医院2023年科研发展项目(基于fNIRS和神经电生理探究Theta节律刺激治疗不完全性脊髓损伤2023JC011 （）
川北医学院2022年科研发展项目(基于fNIRS和神经电生理探究Theta节律刺激治疗不完全性脊髓损伤CBY22-QNA45) （基于fNIRS和神经电生理探究Theta节律刺激治疗不完全性脊髓损伤CBY22-QNA45）
