《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (7): 776-787.doi: 10.3969/j.issn.1006-9771.2026.07.005

• 专题 脑卒中并发症康复 • 上一篇    下一篇

超声引导联合改良导管球囊定位下不同剂量A型肉毒毒素治疗脑卒中后环咽肌功能障碍的效果

樊留博1(), 单婷婷1, 刘宝华2, 罗咪咪1, 张露丁1, 王明慧1   

  1. 1 温州医科大学附属台州医院康复医学科, 浙江台州市 317000
    2 温州医科大学附属第一医院康复医学科, 浙江温州市 325035
  • 收稿日期:2025-09-28 修回日期:2026-02-14 接受日期:2026-03-14 出版日期:2026-07-25 发布日期:2026-07-30
  • 通讯作者: 樊留博,E-mail: flb0072002@163.com
  • 作者简介:樊留博(1975-),男,汉族,陕西丹凤县人,硕士,副教授,主任医师,硕士研究生导师,主要研究方向:神经系统疾病早期康复的临床与基础研究。
  • 基金资助:
    浙江省自然科学基金项目(LSY19H170001);浙江省医药卫生科技计划项目(2022KY434);浙江省医药卫生科技计划项目(2024KY524);台州市科技计划项目(23ywa46)

Effect of different doses of Botulinum toxin type A injected under ultrasound guidance combined with modified catheter-balloon localization for post-stroke cricopharyngeal dysfunction: a randomized controlled trial

Fan Liubo1(), Shan Tingting1, Liu Baohua2, Luo Mimi1, Zhang Luding1, Wang Minghui1   

  1. 1 Department of Rehabilitation Medicine, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, Zhejiang 317000, China
    2 Department of Rehabilitation Medicine, Affiliated First Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
  • Received:2025-09-28 Revised:2026-02-14 Accepted:2026-03-14 Published:2026-07-25 Online:2026-07-30
  • Contact: Fan Liubo, E-mail: flb0072002@163.com
  • Supported by:
    Natural Science Foundation of Zhejiang Province(LSY19H170001);Medical and Health Science and Technology Project of Zhejiang Province(2022KY434);Medical and Health Science and Technology Project of Zhejiang Province(2024KY524);Taizhou Science and Technology Plan Project(23ywa46)

摘要:

目的 比较超声引导联合改良导管球囊定位下注射不同剂量A型肉毒毒素(BTX-A)治疗脑卒中后环咽肌功能障碍的短期疗效与安全性,探索适宜的注射剂量。

方法 选取2023年12月至2026年2月浙江省台州医院收治的脑卒中后环咽肌功能障碍患者136例,随机分为对照组、50 U组、70 U组和100 U组,每组34例。对照组采用常规康复治疗方法,各观察组在常规治疗的基础上采用超声引导联合改良导管球囊定位下注射相应剂量BTX-A,比较治疗前和注射后2周的吞咽造影检查(VFSS)评分、功能性经口摄食量表(FOIS)评分、咽部食物残留分级(YPR-SRS)和分泌物严重程度分级(MSS),并分析超声评估参数的差异。

结果 治疗后,各组FOIS均明显改善(|Z| > 2.843, P < 0.01),各观察组YPR-SRS和MSS等级均显著改善(|Z| > 4.147, P < 0.001);两两比较显示,FOIS、YPR-SRS和MSS等级从优到劣依次为100 U组、70 U组和50 U组(P < 0.05)。VFSS评分时间、组别和交互效应均显著(F > 9.68, P < 0.001);两两比较显示,100 U组最优(P < 0.001)。颏舌骨肌活动度和活动速度的时间、组别和交互效应显著(F > 7.34, P < 0.001);两两比较显示,100 U组活动度和活动速度显著优于其他各组(P < 0.001)。舌骨活动距离和距离缩短率的时间和交互效应均显著(F > 3.07, P < 0.05),活动时间和活动速度时间主效应显著(P < 0.01);两两比较显示,100 U组活动距离和距离缩短率优于其他各组(P < 0.05)。治疗及随访期间,各组均未发生严重不良事件。

结论 超声引导联合改良导管球囊定位下BTX-A注射可能进一步改善脑卒中后环咽肌功能障碍患者的短期吞咽功能,有效剂量为100 U。

关键词: 脑卒中, 吞咽障碍, 环咽肌功能障碍, A型肉毒毒素, 超声引导, 剂量-疗效关系

Abstract:

Objective To investigate the short-term efficacy and safety of different doses of Botulinum toxin type A (BTX-A) injected under ultrasound guidance combined with modified catheter-balloon localization for post-stroke cricopharyngeal dysfunction (CPD), and to explore a relatively appropriate dose.

Methods A total of 136 patients with post-stroke CPD admitted to Taizhou Hospital of Zhejiang Province from December, 2023 to February, 2026 were randomly assigned into control group, 50 U group, 70 U group and 100 U group, with 34 patients in each group. The control group received conventional rehabilitation, whereas the three BTX-A groups received conventional rehabilitation plus the corresponding dose of BTX-A injected under ultrasound guidance combined with modified catheter-balloon localization. Videofluoroscopic Swallowing Study (VFSS) scores, Functional Oral Intake Scale (FOIS) scores, Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS) grades, Murray Secretion Severity Scale (MSS) grades and ultrasonographic parameters were compared before and two weeks after intervention.

Results After intervention, FOIS scores improved significantly in all groups (|Z| > 2.843, P < 0.01), and YPR-SRS and MSS grades also showed significant improvements in all BTX-A groups (|Z| > 4.147, P < 0.001). Pairwise comparisons revealed that the order of improvement from best to worst for FOIS, YPR-SRS and MSS grades was the 100 U group, followed by 70 U group, and then 50 U group (P < 0.05). For VFSS scores, the effect of time, group and interaction were all significant (F > 9.68, P < 0.001); pairwise comparisons showed that 100 U group achieved the best outcomes (P < 0.001). Regarding the activity and velocity of the geniohyoid muscle, the effects of time, group and interaction were also significant (F > 7.34, P < 0.001); pairwise comparisons indicated that 100 U group outperformed the other groups in both activity and velocity (P < 0.001). For hyoid bone displacement distance and shortening rate, the effects of time and interaction were significant (F > 3.07, P < 0.05), and the main effects of time on duration and velocity were significant (P < 0.01); pairwise comparisons showed that the 100 U group had superior displacement distance and shortening rate compared to the other groups (P < 0.05). During the treatment and follow-up periods, no serious adverse event occurred in any group.

Conclusion Ultrasound-guided BTX-A injection assisted by modified catheter-balloon localization may further improve short-term swallowing function in patients with post-stroke CPD, with a dosage of 100 U.

Key words: stroke, dysphagia, cricopharyngeal dysfunction, Botulinum toxin type A, ultrasound guidance, dose-efficacy relationship

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