多模态超声技术在脑卒中后吞咽障碍咽期评估中的研究与进展

Research and Advances in Multimodal Ultrasound Technology for Pharyngeal Phase Assessment in Post-Stroke Dysphagia

摘要: 脑卒中后吞咽障碍(Post-Stroke Dysphagia, PSD)是卒中后常见且严重的并发症，显著增加患者误吸性肺炎、营养不良及死亡的风险，并严重影响其生活质量与康复进程。根据中国吞咽障碍康复管理指南(2023版)，传统的“金标准”评估方法有视频荧光吞咽造影(Videofluoroscopic Swallowing Study, VFSS)和电子鼻咽喉镜检查(Flexible Endoscopic Evaluation of Swallowing, FEES)，虽精准，但存在辐射、侵入性、操作复杂等局限，难以实现床旁动态监测。近年来，多模态超声技术整合了B型、M型、剪切波弹性成像等多种模式，为PSD的评估提供了无创、实时、定量、可重复的全新视角。该技术能够一体化评估吞咽相关肌肉的形态、运动及生物力学特性，在早期筛查、精准诊断、康复疗效监测及介入治疗中展现出巨大潜力。本文系统综述了B/M型超声、弹性成像及多普勒模式在PSD咽期评估中的应用现状与核心价值。

Abstract: Post-Stroke Dysphagia (PSD) is a common and severe complication following stroke, significantly increasing patients’ risk of aspiration pneumonia, malnutrition, and mortality while severely impacting their quality of life and rehabilitation progress. According to the Chinese Dysphagia Rehabilitation Management Guidelines (2023 Edition), traditional “gold standard” assessment methods include Videofluoroscopic Swallowing Study (VFSS) and Flexible Endoscopic Evaluation of Swallowing (FEES). While precise, these methods have limitations, including radiation exposure, invasiveness, and operational complexity, which make bedside dynamic monitoring challenging. In recent years, multimodal ultrasound technology—integrating B-mode, M-mode, shear wave elastography, and other modalities—has provided a novel, noninvasive, real-time, quantitative, and reproducible perspective for PSD assessment. This technology enables the integrated evaluation of the morphology, movement, and biomechanical properties of swallowing-related muscles, demonstrating significant potential in early screening, precise diagnosis, monitoring rehabilitation efficacy, and interventional therapy. This paper systematically reviews the current applications and core value of B/M-mode ultrasound, elastography, and Doppler modes in evaluating the pharyngeal phase of PSD.