ObjectiveTo systematically evaluate the effectiveness of acupuncture combined with rehabilitation training compared with simple rehabilitation training or acupuncture treatment of dysphagia after stroke, and make clear whether the effect of acupuncture combined with rehabilitation training is better than simple rehabilitation training or acupuncture treatment.MethodsSix databases including China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP, PubMed, Cochrance Library, and Embase were searched by computer for the randomized controlled trials on acupuncture combined with rehabilitation training treatment of post-stroke dysphagia, which were published from January 1st, 2010 to December 31st, 2018. After literature including, excluding, and screening, RevMan 5.3 software was used to conduct a meta-analysis.ResultsA total of 22 studies were included, including 1 987 patients. All the included studies took simple rehabilitation training or rehabilitation training combined with sham acupuncture as the control. Meta-analysis of efficiency and outcome measures for relevant studies showed that: compared with simple rehabilitation training, the effectiveness of acupuncture combined with rehabilitation training on post-stroke dysphagia was higher [17 studies included; odds ratio=3.66, 95% confidence interval (CI) (2.66, 5.05), P<0.000 01], the video fluoroscopy swallowing study score of acupuncture combined with rehabilitation training after treatment was higher [8 studies included; mean difference (MD)=2.31, 95%CI (1.75, 2.87), P<0.000 01], and the StandardizedSwallowing Assessment score of acupuncture combined with rehabilitation training after treatment was lower [6 studies included; MD=−3.20, 95%CI (−3.78, −2.61), P<0.000 01]; at the same time the Watian Drinking Water Test score of acupuncture combined with rehabilitation training after treatment was lower [6 studies included; MD=−0.65, 95%CI (−0.91, −0.39), P<0.000 01].ConclusionsAcupuncture combined with rehabilitation training is effective in dysphagia after stroke, and the combined effect is better than simple rehabilitation training. However, due to the limitations of quality of included literature and sample size, the above results and conclusions still require high quality and large sample studies to testify.
ObjevtiveThe morbidity of intensive care unit-acquired swallowing disorder (ICU-ASD) was clarified through meta-analysis by synthesizing previous evidence, in order to provide an evidence-based basis for early identification and intervention of ICU-ASD. Methods A computerized search of PubMed, Embase, Web of Science, The Cochrane Library, CHINAL, China Knowledge Network, Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal Database was conducted to retrieve the relevant literature on the morbidity of ICU-ASD published in China and abroad from the database establiment to December 2022. Considering the quality of the included literature, the Chinese database excluded master's theses and non-core journals. Meta-analysis of morbidity was performed using Stata 12.0. Results A total of 19 papers, including 4291 patients, were included. Meta-analysis showed that the overall morbidity of ICU-ASD was 36% [95% confidential interval (CI) 26% - 46%; I2=97.62%, P<0.01]. Subgroup analyses showed that the morbidity of ICU-ASD in Asian, European, South American, and North American was 39% (95%CI 28% - 50%), 23% (95%CI 8% - 44%), 52% (95%CI 46% - 57%), and 39% (95%CI 20% - 61%), respectively; and that the morbidity of male and female ICU-ASD was 36% (95%CI 24% - 48%) and 33% (95%CI 22% - 45%), respectively; the morbidity of ICU-ASD was 41% (95%CI 30% - 52%) and 31% (95%CI 18% - 44%) in the patients with and without hypertension, respectively; the morbidity of ICU-ASD was 58% (95%CI 42% - 73%) and 51% (95%CI 36% - 66%) in the patients with and without respiratory disease respectively; the morbidity of ICU-ASD in the patients with and without diabetes mellitus was 37% (95%CI 24% - 51%) and 39% (95%CI 28% - 51%), respectively; the morbidity of ICU-ASD in the patients with and without renal disease was 40% (95%CI 23% - 59%) and 35% (95%CI 24% - 46%), respectively; the morbidity of ICU-ASD in the patients with intubation caliber ≤7.5 mm and >7.5 mm was 31% (95%CI 19% - 45%) and 37% (95%CI 22% - 54%), respectively; the morbidity of ICU-ASD in the patients with and without heart failure was 58% (95%CI 30% - 84%) and 36% (95%CI 23% - 51%), respectively; and the morbidity of ICU-ASD in patients with and without arrhythmia was 36% (95%CI 11% - 65%) and 31% (95%CI 21% - 42%), respectively; the morbidity of ICU-ASD in the patients with and without neurologic disease was 48% (95%CI 24% - 72%) and 34% (95%CI 15% - 57%), respectively. Begg's test P<0.05, Egger's test P<0.05, suggesting publication bias in the study, and the cut-and-patch method corrected for an overall incidence result of 27% (95%CI 18% - 36%). Conclusions Meta-analysis reveals an overall morbidity of 36% for ICU-ASD and 27% for the cut-and-patch correction. Subgroup analysis reveals that the morbidity of ICU-ASD is significantly higher in patients with hypertension, heart failure, and neurological disorders than in patients without these disorders. Current evidence suggests that the prevalence of ICU-ASD is high and needs to be taken seriously. Timely screening and assessment of swallowing disorders is recommended for intensive care unit patients, especially those with hypertension, heart failure, and neurological disorders.
Objective To investigate the risk factors of stroke associated pneumonia in stroke patients.Methods A case-control study was conducted. 114 patients who were diagnosed stroke associated pneumonia between January 2008 and December 2010 were recruited as a patient group. 205 patients who were diagnosed stroke without pneumoniawere recruited as a control group. General conditions, accompanied disease, vital sign, hematologic marker, severity of stroke, and bulbar paralysis were compared between two groups. Multifactor Logistic regression was used to screen associated factors.Results Age gt; 65 years ( OR=3. 310, 95% CI 2. 016-7. 549) , accompanied with COPD ( OR = 3. 624, 95% CI 1. 574-9. 236) , diabetes ( OR= 3. 781, 95% CI 1. 305-6. 842) , failed water swallowing test ( OR = 3. 625, 95% CI 1. 604- 8. 386) , big volume of stroke ( OR=14. 784, 95% CI 3. 737-38. 588) , NIH stroke scale ( NIHSS) score gt;6 ( OR=2. 913, 95% CI 1. 029-7. 985) , abbreviated mental test ( AMT) score lt; 8 ( OR = 4. 229, 95% CI 2. 215-9. 368) were associated with stroke associated pneumonia. Conclusion The risk factors for stroke associated pneumonia in stroke patients were age gt;65 years, accompanied with COPD, diabetes, failed WST, big volume of stroke, NIHSS score gt;6, and AMT score lt;8.
Dysphagia is a common non-motor symptom in Parkinson’s disease (PD), with a high incidence and insidious progression. It can lead to complications such as dehydration, malnutrition, aspiration pneumonia, and even death, seriously affecting the quality of life and prognosis of patients. Therefore, early screening, assessment, and intervention are crucial for improving the quality of life and prognosis of PD patients with dysphagia. This article mainly reviews the risk factors and management strategies of dysphagia in PD, with the aim of providing a reference for healthcare professionals to conduct subsequent evaluations and develop targeted interventions.
Post-stroke cricopharyngeal achalasia is a common swallowing disorder that significantly impacts patients’ quality of life. Traditional treatments have limited efficacy, and in recent years, botulinum toxin injections have gained widespread application due to their therapeutic effects. This method involves local injection to relax the cricopharyngeal muscle, improving swallowing function while enhancing safety and comfort, with relatively long-lasting efficacy. However, current practices lack standardised procedures and precise targeting. Future efforts should focus on optimising treatment protocols to enhance efficacy and reduce adverse reactions. This article reviews the current state of research on botulinum toxin treatment for post-stroke cricopharyngeal achalasia, with the aim of providing a basis for standardised treatment in the future.
Objective To explore the clinical effect of occipital-cervical fusion and its impact on cervical curvature, and preliminarily study the causes of postoperative dysphagia. Methods The data of 24 patients who underwent occipito-cervical fusion in the Fourth People’s Hospital of Zigong between January 2014 and December 2018 were retrospectively analyzed, including 13 males and 11 females, aged 33-82 years, with an average age of (58.3±13.3) years. Among them, there were 14 cases of atlas fractures, 6 cases of atlantoaxial fractures, 1 case of intraspinal canal space-occupying lesion, 2 cases of chronic atlantoaxial dislocation with spinal cord compression, and 1 case of instability caused by inflammatory diseases. Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) score were used to evaluate neurological function and pain of patients preoperatively and postoperatively. Occipito-cervical angle (O-C2) and lower cervical angle (C2-C7) were measured to evaluate the preoperative and postoperative angle changes in patients. The causes of postoperative dysphagia were analyzed. Results All the 24 patients were followed up for 8-50 months (26.3 months on average). The mean JOA score increased from 11.6±1.5 before surgery to 15.4±1.2 at the last follow-up, and the mean VAS score decreased from 6.4±1.1 before surgery to 2.0±0.6 at the last follow-up; the differences between the two time points were statistically significant (P<0.001). The bone graft fusion rate was 95.8% (23/24). The mean O-C2 angle decreased from (16.5±7.6)° before surgery to (14.7±4.5)° at the last follow-up, with no statistical significance (P=0.395). The mean angle of C2-C7 increased from (9.4±5.5)° before surgery to (16.3±3.5)° at the last follow-up, and the difference was statistically significant (P<0.001). Two patients developed postoperative dysphagia, possibly due to fusion in a flexion position. Conclusion Occipito-cervical fusion has reliable efficacy in treating occipito-cervical instability, with a high fusion rate and a low incidence of complications, but it will change the physiological curvature of upper and lower cervical vertebra, and fusion in a flexion position may cause postoperative dysphagia.
Objective To investigate the clinical characteristics of facial palsy after stroke (FPS) in order to enhance the understanding of FPS. Methods Patients with stroke and admitted to hospital from March to June 2015 were selected in this study. They were evaluated by Modified House-Braekmann (MHBN), Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS), Standardized Swallowing Assessment and Patient Health Questionnaire-9 (PHQ-9) within 48 hours after admitting. According to the MHBN scores, the patients were divided into FPS group and non-FPS group, and the incidences of dysphagia and depression, and the scores of BI, NIHSS, and PHQ-9 were compared between the two group. Six months later, the patients’ prognosis of stroke was assessed by the Modified Rankin Scale. Results A total of 129 patients were enrolled in this study, including 81 (62.8%) with FPS, and 48 (37.2%) without FPS. The incidences of dysphagia and depression in the FPS group (64.2%, 59.3%) were higher than those in the non-FPS group (22.9%, 18.8%), and the differences were statistically significant (P<0.05). The BI, NIHSS, PHQ-9 scores in the FPS group were 41.79±14.19, 11.23±4.62, 11.54±3.43, respectively, while the scores in the non-FPS group were 66.39±19.96, 7.54±3.69, 7.67±2.89, respectively; the differences in the scores between the two groups were statistically significant (P<0.05). Six months later, the patients’ prognosis in the non-FPS group was better than that in the FPS group (67.4%vs. 32.9%, P<0.001). Conclusions There is a high incidence of FPS, and there are high incidences of dysphagia and depression in the FPS patients with stroke. FPS influences the patients’ prognosis, so the understanding and treatment of FPS should be enhanced.