帕金森病患者吞咽困难的个体化康复治疗
Individualized Rehabilitation of Dysphagia in Patients with Parkinson’s Disease
DOI: 10.12677/jcpm.2024.33162, PDF,   
作者: 张 敏：北华大学附属医院神经内科，吉林 吉林；丁希艳*：北华大学附属医院康复医学科，吉林 吉林
关键词: 帕金森病；吞咽困难；吞咽功能评估；康复治疗；Parkinson’s Disease； Difficulty Swallowing； Swallowing Function Assessment； Treatment of Rehabilitation
摘要: 帕金森病(Parkinson’s disease)是严重影响老年人健康的神经系统变性疾病。吞咽障碍是PD常见的非运动障碍，在临床上具有隐蔽性、进行性发展等特点，是吸入性肺炎致死的重要原因。PD吞咽功能障碍可以通过相关量表、纤维内窥镜吞咽检查(FEES)和电视透视吞咽检查(VFSS)等进行评估。目前尚无证据证实药物治疗能够完全改善患者的吞咽功能。近年来，康复治疗作为针对PD患者吞咽障碍的治疗手段备受关注。故本文围绕PD患者吞咽困难的评估及康复治疗进展予以综述。
Abstract: Parkinson’s disease (PD) is a neurodegenerative disease that seriously affects the health of the elderly. Dysphagia is a common non-motor disorder in PD. It has the characteristics of concealment and progressive development in clinical practice, and is an important cause of death in aspiration pneumonia PD swallowing dysfunction can be related to scale, fiber endoscope (feeds) and TV fluoroscopy swallow check (VFSS) and so on. At present, there is no evidence that drug treatment can completely improve the swallowing function of patients. In recent years, rehabilitation therapy as a treatment for PD patients with swallowing difficulties. Therefore, this article around the assessment of the PD patients with dysphagia and rehabilitation progress were reviewed.
文章引用：张敏, 丁希艳. 帕金森病患者吞咽困难的个体化康复治疗[J]. 临床个性化医学, 2024, 3(3): 1135-1146. https://doi.org/10.12677/jcpm.2024.33162

参考文献

[1] 冷方达, 王雅薇, 刘芳, 等. 帕金森病患者吞咽功能障碍的发病机制及康复治疗进展[J]. 医学综述, 2020, 26(17): 3451-3455.
[2] Ou, Z., Pan, J., Tang, S., et al. (2021) Global Trends in the Incidence, Prevalence, and Years Lived with Disability of Parkinson’s Disease in 204 Countries/Territories from 1990 to 2019. Frontiers in Public Health, 9, Article 776847. [Google Scholar] [CrossRef] [PubMed]
[3] 王崧. 帕金森病患者生存分析——一项十年随访研究[D]:[硕士学位论文]. 大连: 大连医科大学, 2022.
[4] Dorsey, E.R., Sherer, T., Okun, M.S. and Bloem, B.R. (2018) The Emerging Evidence of the Parkinson Pandemic. Journal of Parkinson’s Disease, 8, S3-S8. [Google Scholar] [CrossRef] [PubMed]
[5] 许欣. 帕金森病吞咽障碍非药物疗法的研究进展[J]. 饮食保健, 2023(3): 157-160.
[6] Wang, P., Wang, B., Chen, X., Xiong, B., Xie, F., Wu, S., et al. (2021) Six-year Follow-Up of Dysphagia in Patients with Parkinson’s Disease. Dysphagia, 37, 1271-1278. [Google Scholar] [CrossRef] [PubMed]
[7] Cosentino, G., Avenali, M., Schindler, A., Pizzorni, N., Montomoli, C., Abbruzzese, G., et al. (2021) A Multinational Consensus on Dysphagia in Parkinson’s Disease: Screening, Diagnosis and Prognostic Value. Journal of Neurology, 269, 1335-1352. [Google Scholar] [CrossRef] [PubMed]
[8] Khedr, E.M., Mohamed, K.O., Soliman, R.K., Hassan, A.M.M. and Rothwell, J.C. (2019) The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Advancing Parkinson’s Disease with Dysphagia: Double Blind Randomized Clinical Trial. Neurorehabilitation and Neural Repair, 33, 442-452. [Google Scholar] [CrossRef] [PubMed]
[9] Simons, J.A., Vaillant, M., Hipp, G., Pavelka, L., Stute, L., Pauly, C., et al. (2019) Multilingual Validation of the First French Version of Munich Dysphagia Test—Parkinson’S Disease (MDT-PD) in the Luxembourg Parkinson’s Study. Frontiers in Neurology, 10, Article 1180. [Google Scholar] [CrossRef] [PubMed]
[10] 马宇敏, 陈伟观, 王军. 帕金森病患者吞咽障碍的研究进展[J]. 临床神经病学杂志, 2018, 31(3): 233-235.
[11] 彭小英, 蔡益玲, 祝晓珍. 洼田饮水试验在105例帕金森患者居家饮食管理中的应用效果评价[J]. 福建医药杂志, 2021, 43(2): 53-55.
[12] Nestlé Nutrition Institute (2023) Swallowing Screening Tool.
[13] 王莹, 王司晔, 孙丽, 等. 洼田饮水试验和EAT-10在帕金森病吞咽障碍中的应用[J]. 交通医学, 2020, 34(3): 289-291.
[14] Järvenpää, P., Kuuskoski, J., Pietarinen, P., Markkanen-Leppänen, M., Freiberg, H., Ruuskanen, M., et al. (2021) Finnish Version of the Eating Assessment Tool (F-EAT-10): A Valid and Reliable Patient-Reported Outcome Measure for Dysphagia Evaluation. Dysphagia, 37, 995-1007. [Google Scholar] [CrossRef] [PubMed]
[15] Schlickewei, O., Nienstedt, J.C., Frank, U., Fründt, O., Pötter-Nerger, M., Gerloff, C., et al. (2020) The Ability of the Eating Assessment Tool-10 to Detect Penetration and Aspiration in Parkinson’s Disease. European Archives of Oto-Rhino-Laryngology, 278, 1661-1668. [Google Scholar] [CrossRef] [PubMed]
[16] Loureiro, F., Caline, A., Sampaio, M., et al. (2013) A Swallowing Clinical Assessment Score (SCAS) to Evaluate Outpatients with Parkinson’s Disease. Pan American Journal of Aging Research, 1, 16-19.
[17] Branco, L.L., Trentin, S., Augustin Schwanke, C.H., Gomes, I. and Loureiro, F. (2019) The Swallowing Clinical Assessment Score in Parkinson’s Disease (SCAS-PD) Is a Valid and Low-Cost Tool for Evaluation of Dysphagia: A Gold-Standard Comparison Study. Journal of Aging Research, 2019, Article ID: 7984635. [Google Scholar] [CrossRef] [PubMed]
[18] 赖小星, 薄琳, 朱宏伟, 等. 老年吞咽障碍患者的生活质量及其影响因素[J]. 中国康复理论与实践, 2020, 26(11): 1263-1268.
[19] Chan, H.F., Ng, M.L., Kim, H. and Kim, D.Y. (2020) Swallowing-Related Quality of Life among Oral-Feeding Chinese Patients with Parkinson’s Disease—A Preliminary Study Using Chinese SWAL-QOL. Disability and Rehabilitation, 44, 1077-1083. [Google Scholar] [CrossRef] [PubMed]
[20] Milewska, M., Grabarczyk, K., Dąbrowska-Bender, M., Jamróz, B., Dziewulska, D., Staniszewska, A., et al. (2020) The Prevalence and Types of Oral-and Pharyngeal-Stage Dysphagia in Patients with Demyelinating Diseases Based on Subjective Assessment by the Study Subjects. Multiple Sclerosis and Related Disorders, 37, Article ID: 101484. [Google Scholar] [CrossRef] [PubMed]
[21] Buhmann, C., Bihler, M., Emich, K., Hidding, U., Pötter-Nerger, M., Gerloff, C., et al. (2019) Pill Swallowing in Parkinson’s Disease: A Prospective Study Based on Flexible Endoscopic Evaluation of Swallowing. Parkinsonism & Related Disorders, 62, 51-56. [Google Scholar] [CrossRef] [PubMed]
[22] Curtis, J.A. and Troche, M.S. (2020) Handheld Cough Testing: A Novel Tool for Cough Assessment and Dysphagia Screening. Dysphagia, 35, 993-1000. [Google Scholar] [CrossRef] [PubMed]
[23] 冯艳艳, 郭琳, 盛井香, 等. 容积-黏度吞咽测试在帕金森病患者吞咽障碍筛查中的应用[J]. 齐鲁护理杂志, 2019, 25(5): 39-42.
[24] Cosentino, G., Todisco, M., Giudice, C., Tassorelli, C. and Alfonsi, E. (2022) Assessment and Treatment of Neurogenic Dysphagia in Stroke and Parkinson’s Disease. Current Opinion in Neurology, 35, 741-752. [Google Scholar] [CrossRef] [PubMed]
[25] Pflug, C., Bihler, M., Emich, K., Niessen, A., Nienstedt, J.C., Flügel, T., et al. (2017) Critical Dysphagia Is Common in Parkinson Disease and Occurs Even in Early Stages: A Prospective Cohort Study. Dysphagia, 33, 41-50. [Google Scholar] [CrossRef] [PubMed]
[26] Warnecke, T., Hamacher, C., Oelenberg, S. and Dziewas, R. (2014) Off and on State Assessment of Swallowing Function in Parkinson’s Disease. Parkinsonism & Related Disorders, 20, 1033-1034. [Google Scholar] [CrossRef] [PubMed]
[27] Patel, B., Legacy, J., Hegland, K.W., Okun, M.S. and Herndon, N.E. (2020) A Comprehensive Review of the Diagnosis and Treatment of Parkinson’s Disease Dysphagia and Aspiration. Expert Review of Gastroenterology & Hepatology, 14, 411-424. [Google Scholar] [CrossRef] [PubMed]
[28] Jones, C.A., Hoffman, M.R., Lin, L., Abdelhalim, S., Jiang, J.J. and McCulloch, T.M. (2017) Identification of Swallowing Disorders in Early and Mid‐Stage Parkinson’s Disease Using Pattern Recognition of Pharyngeal High‐Resolution Manometry Data. Neurogastroenterology & Motility, 30, e13236. [Google Scholar] [CrossRef] [PubMed]
[29] Taira, K., Fujiwara, K., Fukuhara, T., Koyama, S., Morisaki, T. and Takeuchi, H. (2021) Evaluation of the Pharynx and Upper Esophageal Sphincter Motility Using High-Resolution Pharyngeal Manometry for Parkinson’s Disease. Clinical Neurology and Neurosurgery, 201, Article ID: 106447. [Google Scholar] [CrossRef] [PubMed]
[30] Minagi, Y., Ono, T., Hori, K., Fujiwara, S., Tokuda, Y., Murakami, K., et al. (2018) Relationships between Dysphagia and Tongue Pressure during Swallowing in Parkinson’s Disease Patients. Journal of Oral Rehabilitation, 45, 459-466. [Google Scholar] [CrossRef] [PubMed]
[31] Pitts, L.L., Morales, S. and Stierwalt, J.A.G. (2018) Lingual Pressure as a Clinical Indicator of Swallowing Function in Parkinson’s Disease. Journal of Speech, Language, and Hearing Research, 61, 257-265. [Google Scholar] [CrossRef] [PubMed]
[32] Broadfoot, C.K., Abur, D., Hoffmeister, J.D., Stepp, C.E. and Ciucci, M.R. (2019) Research-based Updates in Swallowing and Communication Dysfunction in Parkinson Disease: Implications for Evaluation and Management. Perspectives of the ASHA Special Interest Groups, 4, 825-841. [Google Scholar] [CrossRef] [PubMed]
[33] Silbergleit, A.K., Schultz, L., Hamilton, K., LeWitt, P.A. and Sidiropoulos, C. (2021) Self-Perception of Voice and Swallowing Handicap in Parkinson’s Disease. Journal of Parkinson’s Disease, 11, 2027-2034. [Google Scholar] [CrossRef] [PubMed]
[34] Hireš, M., Drotár, P., Pah, N.D., Ngo, Q.C. and Kumar, D.K. (2023) On the Inter-Dataset Generalization of Machine Learning Approaches to Parkinson’s Disease Detection from Voice. International Journal of Medical Informatics, 179, Article ID: 105237. [Google Scholar] [CrossRef] [PubMed]
[35] Illner, V., Tykalova, T., Skrabal, D., Klempir, J. and Rusz, J. (2023) Automated Vowel Articulation Analysis in Connected Speech among Progressive Neurological Diseases, Dysarthria Types, and Dysarthria Severities. Journal of Speech, Language, and Hearing Research, 66, 2600-2621. [Google Scholar] [CrossRef] [PubMed]
[36] Pitts, L.L., Cox, A., Morales, S. and Tiffany, H. (2021) A Systematic Review and Meta-Analysis of Iowa Oral Performance Instrument Measures in Persons with Parkinson’s Disease Compared to Healthy Adults. Dysphagia, 37, 99-115. [Google Scholar] [CrossRef] [PubMed]
[37] Kim, J.Y. and Kim, H. (2022) Effects of Behavioural Swallowing Therapy in Patients with Parkinson’s Disease: A Systematic Review. International Journal of Speech-Language Pathology, 25, 269-280. [Google Scholar] [CrossRef] [PubMed]
[38] Sayaca, C., Serel-Arslan, S., Sayaca, N., Demir, N., Somay, G., Kaya, D., et al. (2019) Is the Proprioceptive Neuromuscular Facilitation Technique Superior to Shaker Exercises in Swallowing Rehabilitation? European Archives of Oto-Rhino-Laryngology, 277, 497-504. [Google Scholar] [CrossRef] [PubMed]
[39] 朱美红, 时美芳, 郑叶平, 等. 姿势控制训练对脑卒中后吞咽障碍患者相关性肺炎的影响[J]. 中华物理医学与康复杂志, 2020, 42(8): 701-704.
[40] 曹艳菊, 曾源, 马文敏, 等. 增稠剂对老年吞咽障碍患者肺炎发生率和生活质量的影响[J]. 中华保健医学杂志, 2020, 22(2): 113-115.
[41] Bolivar-Prados, M., Hayakawa, Y., Tomsen, N., Arreola, V., Nascimento, W., Riera, S., et al. (2023) Shear-Viscosity-Dependent Effect of a Gum-Based Thickening Product on the Safety of Swallowing in Older Patients with Severe Oropharyngeal Dysphagia. Nutrients, 15, Article 3279. [Google Scholar] [CrossRef] [PubMed]
[42] 王多多, 郭洁, 全玉丽, 等. 门德尔松手法及摄食训练对老年帕金森病合并吞咽功能障碍患者的影响[J]. 中华老年多器官疾病杂志, 2019, 18(9): 646-650.
[43] 王丽, 李东升, 朱明芳, 等. 低频冲电脉刺激联合门德尔松手法治疗帕金森病吞咽障碍的疗效观察[J]. 中华物理医学与康复杂志, 2020, 42(8): 698-700.
[44] 王莹, 孙丽, 王司晔, 等. Shaker训练法联合摄食训练治疗帕金森病吞咽障碍效果观察[J]. 南通大学学报(医学版), 2020, 40(3): 239-241.
[45] Printza, A., Goutsikas, C., Triaridis, S., Kyrgidis, A., Haidopoulou, K., Constantinidis, J., et al. (2019) Dysphagia Diagnosis with Questionnaire, Tongue Strength Measurement, and FEES in Patients with Childhood-Onset Muscular Dystrophy. International Journal of Pediatric Otorhinolaryngology, 117, 198-203. [Google Scholar] [CrossRef] [PubMed]
[46] Troche, M.S., Curtis, J.A., Sevitz, J.S., Dakin, A.E., Perry, S.E., Borders, J.C., et al. (2022) Rehabilitating Cough Dysfunction in Parkinson’s Disease: A Randomized Controlled Trial. Movement Disorders, 38, 201-211. [Google Scholar] [CrossRef] [PubMed]
[47] López-Liria, R., Parra-Egeda, J., Vega-Ramírez, F.A., Aguilar-Parra, J.M., Trigueros-Ramos, R., Morales-Gázquez, M.J., et al. (2020) Treatment of Dysphagia in Parkinson’s Disease: A Systematic Review. International Journal of Environmental Research and Public Health, 17, Article 4104. [Google Scholar] [CrossRef] [PubMed]
[48] Claus, I., Muhle, P., Czechowski, J., Ahring, S., Labeit, B., Suntrup‐Krueger, S., et al. (2021) Expiratory Muscle Strength Training for Therapy of Pharyngeal Dysphagia in Parkinson’s Disease. Movement Disorders, 36, 1815-1824. [Google Scholar] [CrossRef] [PubMed]
[49] 张肖, 项洁, 吴婷, 等. 呼吸训练治疗帕金森病吞咽障碍的疗效[J]. 医学综述, 2020, 26(2): 386-390
[50] 叶沙, 程津, 刘梦洁. 床边深度呼吸训练对帕金森病病人躯干稳定性及吸气肌肌力的影响[J]. 全科护理, 2022, 20(26): 3679-3681.
[51] Schiffer, B.L. and Kendall, K. (2018) Changes in Timing of Swallow Events in Parkinson’s Disease. Annals of Otology, Rhinology & Laryngology, 128, 22-27. [Google Scholar] [CrossRef] [PubMed]
[52] Rangwala, R., Saadi, R., Lee, J.J., et al. (2023) Respiratory-Swallow Coordination in Individuals with Parkinson’s Disease: A Systematic Review and Meta-Analysis. Journal of Parkinson’s Disease, 13, 681-698.
[53] Doruk, C., Curtis, J.A., Dakin, A.E. and Troche, M.S. (2023) Cough and Swallowing Therapy and Their Effects on Vocal Fold Bowing and Laryngeal Lesions. The Laryngoscope, 134, 1127-1132. [Google Scholar] [CrossRef] [PubMed]
[54] 王红艳, 左冠超, 刘静, 等. 针刺配合口腔感觉运动训练治疗帕金森病吞咽障碍疗效观察[J]. 上海针灸杂志, 2020, 39(4): 440-445.
[55] 高佳秀, 周鸿飞. 项丛刺疗法结合吞咽功能训练治疗脑卒中吞咽障碍疗效观察[J]. 中国针灸, 2020, 40(6): 586-590.
[56] Wu, J., Wang, Y., Wang, X., Xie, Y. and Li, W. (2023) A Systematic Review and Meta-Analysis of Acupuncture in Parkinson’s Disease with Dysphagia. Frontiers in Neurology, 14, Article 1099012. [Google Scholar] [CrossRef] [PubMed]
[57] 吴明霞, 王留根, 李和平, 等. 针刺辅助治疗帕金森病患者吞咽障碍: 随机对照研究[J]. 中国针灸, 2021, 41(5): 485-488.
[58] 赵婷, 李鹏鹤. 针刺联合美多巴对帕金森病合并吞咽障碍患者吞咽功能及营养状况的影响[J]. 临床医学工程, 2023, 30(6): 769-770.
[59] 冯卫星, 王豆, 谢福恒. 刺激悬雍垂对卒中后吞咽障碍患者呛咳状态和进食速度的影响[J]. 中华中医药杂志, 2019, 34(10): 4985-4988.
[60] 汪逍, 冯卫星, 田申, 等. 咽三针、止颤八针联合康复训练治疗帕金森病吞咽障碍[J]. 吉林中医药, 2020, 40(10): 1383-1386.
[61] 牛丽芸, 冯卫星, 杨妙琳, 等. 咽三针联合中药膏摩治疗帕金森病吞咽障碍疗效观察[J]. 现代中西医结合杂志, 2021, 30(33): 3683-3687.
[62] 冯卫星, 杨妙琳, 唐丽娟, 等. 针刺对帕金森病吞咽障碍患者吞咽功能的影响[J]. 中国针灸, 2023, 43(7): 739-742.
[63] 陈叶萍, 孙秀萍. 温针灸法配合功能训练改善老年帕金森病患者吞咽功能障碍分析[J]. 辽宁中医药大学学报, 2019, 21(1): 200-202.
[64] 栗先增, 顾伯林, 周红, 等. 项针治疗对脑梗死患者吞咽功能的影响[J]. 解放军医学杂志, 2019, 44(4): 322-326.
[65] 王琳晶, 王雪, 张继瑶, 等. 项针结合吞咽训练对帕金森患者吞咽障碍的影响[J]. 康复学报, 2020, 30(3): 202-205.
[66] 赵德福, 景俊, 方琪, 等. 重复经颅磁刺激结合上肢机器人虚拟情景训练对脑卒中患者认知功能的研究[J]. 中国康复, 2020, 35(6): 295-298.
[67] 马喆喆, 巩尊科, 温炜婷, 等. 高频重复经颅磁刺激在脑卒中后注意障碍患者中的临床研究[J]. 中国康复, 2020, 35(4): 175-178
[68] 王丽娟, 聂坤, 高玉元, 等. 中国帕金森病重复经颅磁刺激治疗指南[J]. 中国神经精神疾病杂志, 2021, 47(10): 577-585.
[69] Gong, W., Huang, P., Wang, S., Sun, R., Zhu, Z., Li, X., et al. (2022) Increased Activation of the Caudate Nucleus and Parahippocampal Gyrus in Parkinson’s Disease Patients with Dysphagia after Repetitive Transcranial Magnetic Stimulation: A Case-Control Study. Neural Regeneration Research, 17, 1051-1058. [Google Scholar] [CrossRef] [PubMed]
[70] 郑秀琴, 于苏文, 崔红霞, 等. 高频重复经颅磁刺激联合神经肌肉电刺激治疗帕金森病吞咽功能障碍的疗效分析[J]. 中华物理医学与康复杂志, 2018, 40(1): 29-32.
[71] 甘莉, 王磊, 龚玉来, 等. 体外膈肌起搏器治疗结合吞咽功能训练对原发性帕金森病吞咽功能的疗效[J]. 神经损伤功能重建, 2021, 16(6): 316-318, 322.
[72] Cheng, I., Sasegbon, A. and Hamdy, S. (2022) Dysphagia Treatments in Parkinson’s Disease: A Systematic Review and Meta‐Analysis. Neurogastroenterology & Motility, 35, e14517. [Google Scholar] [CrossRef] [PubMed]
[73] 杨鹤超, 王玥, 陈荣杰, 等. 远程网络支持性心理干预与康复治疗对帕金森患者生活质量的影响[J]. 中国处方药, 2020, 18(12): 163-165.