护理学报 ›› 2023, Vol. 30 ›› Issue (22): 40-43.doi: 10.16460/j.issn1008-9969.2023.22.040
化学刺激治疗脑卒中后吞咽障碍的研究现状
徐倩1, 穆艳2
- 1.福建中医药大学,福建 福州 350122;
2.福建中医药大学教学医院（福建省立医院）,福建 福州 350001
摘要： 目的 对脑卒中后吞咽障碍的化学刺激治疗方法进行综述,为临床选择康复治疗方案提供参考依据。方法 检索国内外相关文献,从各个化学刺激治疗方法的机制及应用展开叙述,指出不足和展望。结果 目前尚无治疗脑卒中后吞咽障碍的特效药,通过化学刺激可能可以改善脑卒中后吞咽障碍患者的吞咽功能,常用的化学刺激方法是酸刺激、TRP激动剂及碳酸刺激等。结论 化学刺激能改善脑卒中后吞咽障碍,但它们的针对性优势、最佳浓度及维持时间等问题还有待进一步研究。
中图分类号:
- R473.74
| [1] 中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍康复评估与治疗专家共识(2013年版)[J]. 中华物理医学与康复杂志, 2013,35(12):916-929. [2] Martin RE.Neuroplasticity and swallowing[J]. Dysphagia, 2009,24(2):218-229.DOI:10.1007/s00455-008-9193-9. [3] Yamamura K, Kurose M, Okamoto K.Guide to enhancing swallowing initiation: insights from findings in healthy subjects and dysphagic patients[J]. Current Physical Medicine and Rehabilitation Reports,2018,6(3):178-185.DOI:10.1007/s40141-018-0192-y. [4] 罗红玲,张杰,周欢霞,等.气脉冲训练联合冰柠檬刺激治疗脑干卒中后吞咽障碍的疗效观察[J].老年医学与保健, 2018,24(4):386-388. [5] 宁婷玉. 咽部柠檬冰刺激联合针刺疗法治疗脑卒中后吞咽障碍的临床研究[D]. 济南:山东第一医科大学, 2019. [6] Pelletier CA, Lawless HT.Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia[J]. Dysphagia, 2003,18(4):231-241.DOI:10.1007/s00455-003-0013-y. [7] 黄进瑜, 毛珍芳, 华锋凯, 等.神经肌肉电刺激联合柠檬冰棉签咽部刺激法治疗老年脑卒中后吞咽困难[J]. 中国老年学杂志, 2013,33(3):686-687. [8] Mulheren RW, Kamarunas E, Ludlow CL.Sour taste increases swallowing and prolongs hemodynamic responses in the cortical swallowing network[J]. J Neurophysiol, 2016,116(5):2033-2042.DOI:10.1152/jn.00130.2016. [9] 张兰香,朱振杰,季红娟,等.不同冰刺激方案治疗脑卒中患者吞咽障碍的效果研究[J].交通医学,2018,32(2):141-142. [10] Bautista DM, Movahed P, Hinman A, et al.Pungent products from garlic activate the sensory ion channel TRPA1[J]. Proceedings of the National Academy of Sciences, 2005,102(34):12248-12252.DOI:10.1073/pnas.0505356102. [11] Tomsen N, Alvarez-Berdugo D, Rofes L, et al.A randomized clinical trial on the acute therapeutic effect of TRPA1 and TRPM8 agonists in patients with oropharyngeal dysphagia[J]. Neurogastroenterol Motil,2020,32(6):e13821. DOI:10.1111/nmo.13821. [12] Jin Y, Sekizawa K, Fukushima T, et al.Capsaicin desensitization inhibits swallowing reflex in guinea pigs[J]. Am J Respir Crit Care Med,1994,149(1):261-263. DOI:10.1164/ajrccm.149.1.7509247. [13] Ujiie Y, Sekizawa K, Aikawa T, et al.Evidence for substance P as an endogenous substance causing cough in guinea pigs[J].Am Rev Respir Dis,1993,148(6 Pt 1):1628-1632. DOI:10.1164/ajrccm/148.6_Pt_1.1628. [14] 曹猛. 天然辣椒素食团在急性缺血性脑卒中后吞咽障碍患者中的应用效果研究[D]. 广州:南方医科大学, 2020. [15] 马甜, 张淑坤, 吴世政. 辣椒素受体在卒中及其危险因素中的研究进展[J]. 中国脑血管病杂志, 2016,13(1):51-54. [16] 吴玲玲. 辣椒素刺激对脑卒中患者口咽期吞咽障碍影响的临床研究[D]. 苏州:苏州大学, 2018. [17] 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. [18] 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. [19] 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. [20] 刘萌, 王晨, 尹玲. 辣椒素治疗脑卒中后吞咽障碍的Meta分析[J]. 中国老年保健医学, 2022,20(3):25-30. [21] Tomsen N, Ortega O, Rofes L, et al.Acute and subacute effects of oropharyngeal sensory stimulation with TRPV1 agonists in older patients with oropharyngeal dysphagia: a biomechanical and neurophysiological randomized pilot study[J]. Therap Adv Gastroenterol, 2019,12:321936389.DOI:10.1177/1756284819842043. [22] Dedov VN, Tran VH, Duke CC, et al.Gingerols: a novel class of vanilloid receptor (VR1) agonists[J]. Br J Pharmacol, 2002,137(6):793-798.DOI:10.1038/sj.bjp.0704925. [23] Hirata A, Funato H, Nakai M, et al.Ginger orally disintegrating tablets to improve swallowing in older people[J]. Biologic Pharmaceut Bulletin, 2016,39(7):1107-1111.DOI:10.1248/bpb.b15-01045. [24] 郝文杰,李冰洁,吴晓蕾. 通咽喷雾剂对缺血性中风吞咽困难患者舌骨运动的影响及安全性[J]. 中国中西医结合杂志,2021,27(5):369-374.DOI:10.1007/s11655-020-3325-y. [25] McKemy DD, Neuhausser WM, Julius D. Identification of a cold receptor reveals a general role for TRP channels in thermosensation[J]. Nature, 2002,416(6876):52-58.DOI:10.1038/nature719. [26] Lei WY, Liang SW, Hung JS, et al.Effects of menthol on esophageal motility in humans: studies using high-resolution manometry[J]. Neurogastroenterol Motil, 2022,34(5):e14267.DOI:10.1111/nmo.14267. [27] Meotti FC, Lemos DAE, Calixto JB.TRP modulation by natural compounds[J]. Handb Exp Pharmacol, 2014,223(null):1177-1238.DOI:10.1007/978-3-319-05161-1_19. [28] Namer B, Seifert F, Handwerker HO, et al.TRPA1 and TRPM8 activation in humans: effects of cinnamaldehyde and menthol[J]. Neuro Report, 2005,16(9):955-959.DOI:10.1097/00001756-200506210-00015. [29] 杨峰, 李坤颖, 王茉莉, 等. 自制薄荷冰棒冷热交替刺激辅助治疗脑卒中患者吞咽障碍[J]. 护理学杂志, 2016,31(15):73-75. [30] Ebihara T, Ebihara S, Watando A, et al.Effects of menthol on the triggering of the swallowing reflex in elderly patients with dysphagia[J]. Br J Clin Pharmacol, 2006,62(3):369-371.DOI:10.1111/j.1365-2125.2006.02666.x. [31] Dessirier JM, Simons CT, Carstens MI,et al.Psychophysical and neurobiological evidence that the oral sensation elicited by carbonated water is of chemogenic origin[J]. Chem Senses,2000, 25(3):277-284.DOI:10.1093/chemse/25.3.277. [32] Michou E, Hamdy S.Reversal of the effects of focal suppression on pharyngeal corticobulbar tracts by chemesthesis coupled with repeated swallowing[J]. Neurogastroenterol Motil, 2022,34(6):e14286.DOI:10.1111/nmo.14286. [33] Tsuji K, Tsujimura T, Sakai S, et al.Involvement of capsaicin-sensitive nerves in the initiation of swallowing evoked by carbonated water in anesthetized rats[J]. Am J Physiol-Gastrointest Liver Physiol,2020, 319(5):G564-G572.DOI:10.1152/ajpgi.00233.2020. [34] Sdravou K, Walshe M, Dagdilelis L.Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia[J]. Dysphagia, 2012, 27(2):240-250.DOI:10.1007/s00455-011-9359-8. [35] Shapira-Galitz Y, Levy A, Madgar O, et al.Effects of carbonation of liquids on penetration-aspiration and residue management[J]. Eur Arch Oto-rhino-l, 2021, 278(12):4871-4881.DOI:10.1007/s00405-021-06987-z. [36] Min HS, Shin H, Yoon CH, et al.Effects of carbonated water concentration on swallowing function in healthy adults[J].Dysphagia,2022, 37(6):1550-1559.DOI:10.1007/s00455-022-10420-w. [37] Kim H, Lee SA, Kim K, et al.Submental muscle activity is delayed and shortened during swallowing following stroke[J]. PM R, 2015,7(9):938-945.DOI:10.1016/j.pmrj.2015.05.018. [38] Morishita M, Mori S, Yamagami S, et al.Effect of carbonated beverages on pharyngeal swallowing in young individuals and elderly inpatients[J]. Dysphagia, 2014,29(2):213-222.DOI:10.1007/s00455-013-9493-6. [39] Michou E, Mastan A, Ahmed S, et al.Examining the role of carbonation and temperature on water swallowing performance: a swallowing reaction-time study[J]. Chemical Senses,2012,37(9):799-807.DOI:10.1093/chemse/bjs061. [40] Szallasi A.Piperine: researchers discover new flavor in an ancient spice[J]. Trends Pharmacol Sci, 2005,26(9):437-439.DOI:10.1016/j.tips.2005.07.001. [41] Okamura N, Maruyama M, Ebihara T, et al.Aspiration pneumonia and insular hypoperfusion in patients with cerebrovascular disease[J]. J Am Geriatr Soc, 2004,52(4):645-646.DOI:10.1111/j.1532-5415.2004.52178_4.x. [42] McNamara FN, Randall A, Gunthorpe MJ. Effects of piperine, the pungent component of black pepper, at the human vanilloid receptor (TRPV1)[J]. Br J Pharmacol, 2005,144(6):781-790.DOI:10.1038/sj.bjp.0706040. [43] Vriens J, Appendino G, Nilius B.Pharmacology of vanilloid transient receptor potential cation channels[J]. Molecular Pharmacol, 2009,75(6):1262-1279.DOI:10.1007/978-981-10-7757-9_6. [44] Ebihara T, Ebihara S, Yamazaki M, et al.Intensive stepwise method for oral intake using a combination of transient receptor potential stimulation and olfactory stimulation inhibits the incidence of pneumonia in dysphagic older adults[J]. J Am Geriatr Soc, 2010,58(1):196-198.DOI:10.1111/j.1532-5415.2009.02648.x. [45] Ebihara S, Kohzuki M, Sumi Y, et al.Sensory stimulation to improve swallowing reflex and prevent aspiration pneumonia in elderly dysphagic people[Z]. 2011:115, 99-104.DOI:10.1254/jphs.10R05CP. |
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