护理学报 ›› 2023, Vol. 30 ›› Issue (1): 37-40.doi: 10.16460/j.issn1008-9969.2023.01.037
口腔感觉训练在脑卒中吞咽障碍患者中的应用进展
苗姣娜1, 王元姣2, 何叶1
- 1.浙江中医药大学 护理学院,浙江 杭州 310051;
2.浙江省人民医院 康复医学科,浙江 杭州 310014
摘要： 目的 对国内外口腔感觉训练技术在脑卒中吞咽障碍患者中的应用研究进行综述,以为临床研究提供参考。方法 检索国内外相关文献,简单阐述脑卒中吞咽障碍的发病机制、口腔感觉训练技术的发展过程,从温度觉刺激、嗅觉刺激、味觉刺激、振动觉刺激和其他刺激等角度进行综述。结果 口腔感觉训练技术在临床的应用中冰刺激、酸刺激和辣椒素刺激等研究较多,研究形式多样,不同感觉训练效果间的对比研究较少。结论 口腔感觉训练技术能有效改善脑卒中吞咽障碍患者吞咽功能,但其应用形式、频率、强度等尚未形成统一标准,研究者可结合患者疾病情况和心理需求进一步开展高质量的相关研究。
中图分类号:
- R493
| [1] Takizawa C, Gemmell E, Kenworthy J, et al.A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s Disease, Alzheimer’s Disease, head injury, and pneumonia[J]. Dysphagia, 2016, 31(3):434-441.DOI:10.1007/s00455-016-9695-9. [2] Savcı C, Acaroglu R.Effects of swallowing training and follow-up on the problems associated with dysphagia in patients with stroke[J]. Florence Nightingale J Nurs, 2021, 29(2):137-149.DOI: 10.5152/FNJN.2021.19007. [3] Gomes F, Emery PW, Weekes CE.Erratum to risk of malnutrition is an independent predictor of mortality, length of hospital stay, and hospitalization costs in stroke patients[J]. J Stroke Cerebrovasc Dis,2016,25(4):799-806.DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.001. [4] 中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍评估与治疗专家共识(2017年版)第二部分治疗与康复管理篇[J].中华物理医学与康复杂志,2018,40(1):1-10.DOI:10.3760/cma.j.issn.0254-1424.2018.01.001. [5] Gatto AR, Cola PC, da Silva RG, et al. Influence of thermal and gustatory stimulus in the initiation of the pharyngeal swallow and bolus location instroke[J]. J Stroke Cerebrovasc Dis, 2021, 30(4):105349.DOI:10.1016/j.jstrokecerebrovasdis.2020.105349. [6] Nascimento W, Tomsen N, Acedo S, et al.Effect of aging, gender and sensory stimulation of TRPV1 receptors with capsaicin on spontaneous swallowing frequency in patients with oropharyngeal dysphagia: a proof-of-concept study[J]. Diagnostics(Basel),2021,11(3):461.DOI:10.3390/diagnostics11030461. [7] Speyer R, Cordier R, Sutt AL, et al.Behavioural interventions in people with oropharyngeal dysphagia: a systematic review and meta-analysis of randomised clinical trials[J]. J Clin Med,2022,11(3):685-716.DOI:10.3390/jcm11030685. [8] Hossain MZ, Ando H, Unno S, et al.Targeting chemosensory ion channels in peripheral swallowing-related regions for the management of oropharyngeal dysphagia[J]. Int J Mol Sci, 2020, 21(17).DOI: 10.3390/ijms21176214. [9] Jones CA, Colletti CM, Ding MC.Post-stroke dysphagia: recent insights and unanswered questions[J]. Curr Neurol Neurosci Rep, 2020, 20(12):61-73. DOI:10.1007/s11910-020-01081-z. [10] Alvarez-Berdugo D,Rofes L, Casamitjana JF, et al.Oropharyngeal and laryngeal sensory innervation in the pathophysiology of swallowing disorders and sensory stimulation treatments[J]. Ann N Y Acad Sci, 2016, 1380(1):104-120.DOI:10.1111/nyas.13150. [11] Nakamura T, Fujishima I.Usefulness of ice massage in triggering the swallow reflex[J]. J Stroke Cerebrovasc Dis, 2013, 22(4):378-382. DOI:10.1016/j.jstrokecerebrovasdis.2011.09.016. [12] Magara J, Watanabe M, Tsujimura T, et al.Cold thermal oral stimulation produces immediate excitability in human pharyngeal motor cortex[J].Neurogastroenterol Motil, 2018, 30(10):e13384.DOI:10.1111/nmo.13384. [13] 朱明芳,王丽,杜红妍,等.咽部冰刺激联合电子生物反馈治疗在脑卒中吞咽障碍患者早期康复中的应用效果[J].国际护理学杂志,2020,39(10):1809-1810.DOI:10.3760/cma.j.cn221370-20190301-00560. [14] Ebihara T, Ebihara S, Maruyama M, et al.A randomized trial of olfactory stimulation using black pepper oil in older people with swallowing dysfunction[J]. J Am Geriatr Soc,2006, 54(9):1401-1406. DOI:10.1111/j.1532-5415.2006.00840.x. [15] Wang Z, Wu L, Fang Q, et al.Effects of capsaicin on swallowing function in stroke patients with dysphagia: a randomized controlled trial[J]. J Stroke Cerebrovasc Dis, 2019, 28(6):1744-1751.DOI:10.1016/j.jstrokecerebrovasdis.2019.02.008. [16] Hägglund P, Hägg M, Levring Jäghagen E, et al.Oral neuromuscular training in patients with dysphagia after stroke: a prospective, randomized, open-label study with blinded evaluators[J]. BMC Neurol, 2020, 20(1):405.DOI: 10.1186/s12883-020-01980-1. [17] 陈欢,胡玲利.冷热交替疗法对脑卒中后口腔期吞咽障碍及流涎的效果观察[J].中国康复,2018, 33(5):480-481.DOI:10.3870/zgkf.2018.05.010. [18] Magara J, Watanabe M, Tsujimura T, et al.Lasting modulation of human cortical swallowing motor pathways following thermal tongue stimulation[J].Neurogastroenterol Motil, 2021, 33(1):e13938.DOI:10.1111/nmo.13938. [19] Tripathi AK, Ray AK, Mishra SK.Molecular and pharmacological aspects of piperine as a potential molecule for disease prevention and management: evidence from clinical trials[J]. Beni Suef Univ J Basic Appl Sci, 2022, 11(1):16.DOI: 10.1186/s43088-022-00196-1. [20] Chakraborty M, Bhattacharjee A, Kamath JV.Cardioprotective effect of curcumin and piperine combination against cyclophosphamide-induced cardiotoxicity[J]. Indian J Pharmacol, 2017, 49(1):65-70.DOI:10.4103/0253-7613.201015. [21] Sacks D, Baxter B, Campbell BCV, et al.Multisociety consensus quality improvement revised consensus statement for endovascular therapy of acute ischemic stroke[J]. Int J Stroke, 2018, 13(6):612-632. DOI:10.1177/1747493018778713. [22] Sedeky AS, Khalil IA, Hefnawy A, et al.Development of core-shell nanocarrier system for augmenting piperine cytotoxic activity against human brain cancer cell line[J]. Eur J Pharm Sci, 2018, 118:103-112.DOI:10.1016/j.ejps.2018.03.030. [23] 王玲,徐惠丽,熊荣荣,等.风油精口腔护理在脑卒中后吞咽困难病人中的应用[J].护理研究,2021,35(10):1854-1857.DOI:10.12102/j.issn.1009-6493.2021.10.032. [24] Alvarez-berdugo D, Rofes L, Arreola V, et al. A comparative study on the therapeutic effect of TRPV1, TRPA1, and TRPM8 agonists on swallowing dysfunction associated with aging and neurological diseases[J]. Neurogastroenterol Motil, 2018, 30(2).DOI:10.1111/nmo.13185. [25] Nakato R, Manabe N, Shimizu S, et al.Effects of capsaicin on older patients with oropharyngeal dysphagia: a double-blind, placebo-controlled, crossover study[J]. Digestion, 2017, 95(3):210-220.DOI:10.1159/000463382. [26] Ortega O, Rofes L, Martin A, et al.A comparative study between two sensory stimulation strategies after two weeks treatment on older patients with oropharyngeal dysphagia[J]. Dysphagia,2016, 31:706-716. DOI:10.1007/s00455-016-9736-4. [27] Cui F, Yin Q, Wu C, et al.Capsaicin combined with ice stimulation improves swallowing function in patients with dysphagia after stroke: a randomised controlled trial[J]. J Oral Rehabil, 2020, 47(10):1297-1303.DOI:10.1111/joor.13068. [28] 万桂芳,窦祖林,谢纯青,等.口腔感觉运动训练技术在吞咽康复中的应用[J].中华物理医学与康复杂志,2013,35(12):955-957.DOI:10.3760/cma.j.issn.0254-1424.2013.12.010. [29] 李芮,刘帅,宋丽敏,等.口腔护理技术联合电动口腔振动按摩刺激棒予K点刺激及冰刺激在脑卒中吞咽障碍患者中的应用效果分析[J].世界最新医学信息文摘,2021,21(79):225-227.DOI:10.3969/j.issn.1671-3141.2021.79.067. [30] Kamarunas E, Wong SM, Ludlow CL.Laryngeal vibration increases spontaneous swallowing rates in chronic oropharyngeal dysphagia: a proof-of-principle pilot study[J]. Dysphagia, 2019,34(5):640-653.DOI:10.1007/s00455-018-9962-z. [31] 吴金香,王元姣,熊冰,等.冰酸K点刺激在脑卒中口腔期吞咽障碍患者中的应用效果[J]. 中华现代护理杂志,2017,23(27):3503-3506. DOI:10.3760/cma.j.issn.1674-2907.2017.27.016. [32] 张芳,童一峰,孔朱明,等.K点刺激对最小意识状态患者吞咽障碍的影响[J].中华物理医学与康复杂志,2017,39(1):25-26. DOI:10.3760/cma.j.issn.0254-1424.2017.01.006. [33] Yamamura K, Kurose M, Okamoto K.Guide to enhancing swallowing initiation: insights from findings in healthy subjects and dysphagic patients[J].Curr Phys Med Rehabil Rep, 2018, 6(3):178-185.DOI:10.1007/s40141-018-0192-y. [34] Theurer JA, Johnston JL, Fisher J, et al.Proof-of-principle pilot study of oropharyngeal air-pulse application in individuals with dysphagia after hemispheric stroke[J]. Arch Phys Med Rehabil, 2013, 94(6):1088-1094.DOI: 10.1016/j.apmr.2012.11.033. [35] Mcginnis CM, Homan K, Solomon M, et al.Dysphagia: interprofessional management, impact, and patient-centered care[J]. Nutr Clin Pract, 2019, 34(1):80-95.DOI:10.1002/ncp.10239. [36] Kojima K, Ikuno K, Morii Y, et al.Feasibility study of a combined treatment of electromyography-triggered neuromuscular stimulation and mirror therapy in stroke patients: a randomized crossover trial[J]. Neuro Rehabilit, 2014, 34(2):235-244.DOI:10.3233/NRE-131038. [37] Selles RW, Michielsen ME, Bussmann JB, et al.Effects of a mirror-induced visual illusion on a reaching task in stroke patients: implications for mirror therapy training[J]. Neurorehabil Neural Repair, 2014, 28(7):652-659.DOI:10.1177/1545968314521005. |
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