Observation on the therapeutic effect of stellate ganglion block combined with nicergoline on dysphagia after stroke

doi:10.11958/20241237

Abstract

Abstract:

Objective To investigate the clinical efficacy of stellate ganglion block (SGB) combined with nicergoline in patients with dysphagia after stroke.Methods A total of 104 patients with dysphagia after stroke were randomly divided into the observation group and the control group. The observation group was treated with niergoline and SGB, while the control group received functional electrical stimulation. The total effective rate, swallowing condition, inflammatory factor level and adverse events were compared between the two groups.Results After treatment, the total effective rate was significantly higher in the observation group (92.31%) than that of the control group (73.08%, P<0.05). The level of interleukin-6 (IL-6), the standardized swallowing assessment (SSA) score and the level of tumor necrosis factor alpha (TNF-α) were significantly lower in the observation group than those in the control group (P<0.05). The Mann swallowing ability assessment scale (MASA) score was significantly higher in the observation group than that of the control group (P<0.05). There were no significant differences in adverse reactions such as glottis closure and laryngeal spasm between the two groups (P>0.05).Conclusion The combined treatment of SGB and nicergoline can effectively improve swallowing function in patients with dysphagia after stroke, with good safety, ideal results and high clinical application value.

Key words: stroke, deglutition disorders, ganglionic blockers, stellate ganglion, nicergoline

CLC Number:

R743.3

Figures/Tables 5

References 21

[1]	LABEIT B, MICHOU E, HAMDY S, et al. The assessment of dysphagia after stroke:state of the art and future directions[J]. Lancet Neurol, 2023, 22(9):858-870. doi:10.1016/S1474-4422(23)00153-9.
[2]	BRAUN R G, ARATA J, GONZALEZ-FERNANDEZ M. Dysphagia and enteral feeding after stroke in the rehabilitation setting[J]. Phys Med Rehabil Clin N Am, 2024, 35(2):433-443. doi:10.1016/j.pmr.2023.07.001.
[3]	WANG J, CHANG E, JIANG Y. Effects of vitamin C stimulation on rehabilitation of dysphagia after stroke:a randomized trial[J]. Eur J Phys Rehabil Med, 2022, 58(4):558-564. doi:10.23736/S1973-9087.22.07337-3.
[4]	肖霞, 彭文根, 刘江蓉, 等. 老年护理院脑卒中吞咽障碍患者健康教育效果评价[J]. 中国健康教育, 2020, 36(5):468-471.
	XIAO X, PENG W G, LIU J R, et al. Effect of health education on stroke patients with dysphagia in elderly nursing homes[J]. Chinese Journal of Health Education, 2020, 36(5):468-471. doi:10.16168/j.cnki.issn.1002-9982.2020.05.018.
[5]	王迪, 孙忠人, 魏庆双, 等. 电针为主治疗卒中后吞咽障碍的临床研究进展[J]. 国际中医中药杂志, 2020, 42(1):90-93.
	WANG D, SUN Z R, WEI Q S, et al. Clinical research progress of electroacupuncture in the treatment of dysphagia after stroke[J]. International Journal of Traditional Chinese Medicine, 2020, 42(1):90-93. doi:10.3760/cma.j.issn.1673-4246.2020.01.021.
[6]	王曈, 董凌辉, 孟萍萍, 等. 重复经颅磁刺激治疗卒中后吞咽困难的相关临床研究进展[J]. 中华物理医学与康复杂志, 2022, 44(10):931-934.
	WANG T, DONG L H, MENG P P, et al. Clinical progress of repeated transcranial magnetic stimulation in the treatment of dysphagia after stroke[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2022, 44(10):931-934. doi:10.3760/cma.j.issn.0254-1424.2022.10.015.
[7]	李伟, 张鑫, 田恬, 等. 星状神经节阻滞联合中药蜡疗治疗脑卒中后肩手综合征疗效观察[J]. 现代中西医结合杂志, 2020, 29(21):2328-2332.
	LI W, ZHANG X, TIAN T, et al. Effect of stellate ganglion block combined with Chinese herbal wax therapy on shoulder-hand syndrome after stroke[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2020, 29(21):2328-2332. doi:10.3969/j.issn.1008-8849.2020.21.012.
[8]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9):666-682.
	Chinese Society of Neurology,Cerebrovascular Disease Group, Chinese Society of Neurology. Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2018[J]. Chinese Journal of Neurology, 2018, 51(9):666-682. doi:10.3760/cma.j.issn.1006-7876.2018.09.004.
[9]	赵性泉, 张婧. 脑卒中后吞咽障碍的诊断与治疗[M]. 北京: 科学技术文献出版社, 2011:85-88.
	ZHAO X Q, ZHANG J. Diagnosis and treatment of dysphagia after stroke[M]. Beijing: Scientific and Technical Academic Press, 2011:85-88..
[10]	刘先松, 董永书. 针刺联合吞咽训练对脑卒中后吞咽障碍病人SSA评分、MNA评分及吸入性肺炎发生率的影响[J]. 中西医结合心脑血管病杂志, 2021, 19(12):2083-2086.
	LIU X S, DONG Y S. Effects of acupuncture combined with swallowing training on SSA score,MNA score and incidence of aspiration pneumonia in patients with swallowing disorder after stroke[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2021, 19(12):2083-2086. doi:10.12102/j.issn.1672-1349.2021.12.028.
[11]	ANTONIOS N, CARNABY-MANN G, CRARY M, et al. Analysis of a physician tool for evaluating dysphagia on an inpatient stroke unit:the modified Mann Assessment of Swallowing Ability[J]. J Stroke Cerebrovasc Dis, 2010, 19(1):49-57. doi:10.1016/j.jstrokecerebrovasdis.2009.03.007.
[12]	JONES C A, COLLETTI C M, DING M C. Post-stroke dysphagia:recent insights and unanswered questions[J]. Curr Neurol Neurosci Rep, 2020, 20(12):61. doi:10.1007/s11910-020-01081-z.
[13]	COSENTINO G, TODISCO M, GIUDICE C, et al. Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease[J]. Curr Opin Neurol, 2022, 35(6):741-752. doi:10.1097/WCO.0000000000001117.
[14]	吕开月, 廖喜琳, 程树锦, 等. 腹针联合经皮穴位电刺激治疗脑卒中后吞咽障碍患者的疗效和安全性[J]. 广西医学, 2023, 45(18):2213-2218.
	LV K Y, LIAO X L, CHENG S J, et al. Efficacy and safety of abdominal acupuncture combined with percutaneous acupoint electrical stimulation in the treatment of patients with dysphagia after stroke[J]. Guangxi Medical Journal, 2023, 45(18):2213-2218. doi:10.11675/j.issn.0253-4304.2023.18.09.
[15]	ALAMER A, MELESE H, NIGUSSIE F. Effectiveness of neuromuscular electrical stimulation on post-stroke dysphagia:a systematic review of randomized controlled trials[J]. Clin Interv Aging, 2020, 15:1521-1531. doi:10.2147/CIA.S262596.
[16]	赵鹏, 郜静, 肖志娟. 尼麦角林结合舌三针治疗脑梗死后吞咽困难的效果评价[J]. 中国临床医生杂志, 2020, 48(7):878-879.
	ZHAO P, GAO J, XIAO Z J. Effect evaluation of niergoline combined with tongue injection in the treatment of dysphagia after cerebral infarction[J]. Chinese Journal for Clinicians, 2020, 48(7):878-879. doi:10.3969/j.issn.2095-8552.2020.07.040.
[17]	唐泉淼, 唐硕, 王玉玲. 星状神经节阻滞联合阿普唑仑治疗脑卒中后睡眠障碍的疗效观察[J]. 中国实用医刊, 2021, 48(17):78-81.
	TANG Q M, TANG S, WANG Y L. Effect of stele ganglion block combined with alprazolam on sleep disorder after stroke[J]. Chinese Journal of Practical Medicine, 2021, 48(17):78-81. doi:10.3760/cma.j.cn115689-20210413-01366.
[18]	ZENG H, ZHAO W, FANG L, et al. Effect of stellate ganglion block on dysphagia and cognitive impairment in cerebral small vessel disease: a randomized controlled study[J]. J Speech Lang Hear Res, 2024, 67(10):3660-3672. doi: 10.1044/2024_JSLHR-24-00145.
[19]	夏彬, 李晶, 朱洪山. 经颅磁刺激联合星状神经节阻滞对脑卒中后语言功能障碍恢复和生活质量的影响[J]. 实用医院临床杂志, 2020, 17(6):135-138.
	XIA B, LI J, ZHU H S. Effects of transcranial magnetic stimulation combined with stele ganglion block on recovery of speech dysfunction and quality of life after stroke[J]. Practical Journal of Clinical Medicine, 2020, 17(6):135-138. doi:10.3969/j.issn.1672-6170.2020.06.040.
[20]	陈雨花, 韩镇鸿, 许其欣. 中医康复疗法联合功能锻炼对缺血性脑卒中吞咽障碍患者的影响[J]. 四川中医, 2022, 40(3):170-172.
	CHEN Y H, HAN Z H, XU Q X. Influence of traditional Chinese medicine rehabilitation therapy combined with functional exercise on patients with swallowing disorder after ischemic stroke[J]. Journal of Sichuan Traditional Chinese Medicine, 2022, 40(3):170-172.
[21]	刘鸿, 王莉敏. 帕罗西汀联合尼麦角林对脑卒中后抑郁症患者抑郁状态及炎症因子水平的影响[J]. 中外医学研究, 2019, 17(19):18-20.
	LIU H, WANG L M. Effects of paroxetine combined with niergoline on depressive state and levels of inflammatory factors in patients with post-stroke depression[J]. Chinese and Foreign Medical Research, 2019, 17(19):18-20. doi:10.14033/j.cnki.cfmr.2019.19.008.

组别	性别（男/女）	年龄/岁	病程/d	卒中类型（缺血性/出血性）
对照组	31/21	63.15±6.69	15.04±2.59	34/18
观察组	28/24	63.56±6.74	15.12±2.63	30/22
χ²或t	0.353	0.311	0.156	0.650

组别	性别（男/女）	年龄/岁	病程/d	卒中类型（缺血性/出血性）
对照组	31/21	63.15±6.69	15.04±2.59	34/18
观察组	28/24	63.56±6.74	15.12±2.63	30/22
χ²或t	0.353	0.311	0.156	0.650

组别	显效	有效	无效	总有效
对照组	18（34.62）	20（38.46）	14（26.92）	38（73.08）
观察组	26（50.00）	22（42.31）	4（7.69）	48（92.31）
χ²				6.718^＊

组别	显效	有效	无效	总有效
对照组	18（34.62）	20（38.46）	14（26.92）	38（73.08）
观察组	26（50.00）	22（42.31）	4（7.69）	48（92.31）
χ²				6.718^＊

组别	SSA评分
组别	治疗前	治疗后	t
对照组	32.27±4.52	23.85±3.04	26.594^＊＊
观察组	32.35±4.56	20.63±2.43	35.707^＊＊
t	0.090	5.966^＊＊
组别	MASA评分
组别	治疗前	治疗后	t
对照组	61.21±7.05	83.02±8.76	35.226^＊＊
观察组	60.75±7.01	92.54±9.64	47.100^＊＊
t	0.334	5.270^＊＊