侯亚静,王泳,武百山,等.超声引导下A型肉毒毒素唾液腺注射治疗真性球麻痹患者流涎症的疗效研究[J].中华物理医学与康复杂志,2026,48(4):311-316
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| 超声引导下A型肉毒毒素唾液腺注射治疗真性球麻痹患者流涎症的疗效研究 |
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| DOI：10.3760/cma.j.cn421666-20250507-00387 |
| 中文关键词: 真性球麻痹 流涎症 A 型肉毒毒素 超声引导 |
| 英文关键词: Bulbar palsy Sialorrhea Botulinum toxin type A Ultrasound guidance |
| 基金项目:北京市自然科学基金面上项目 (723072)；2024 年学生科研创新项目 (h020681)；2024 年首都医科大学附属复兴医院培育基金 (PY-C-202406) |
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| 中文摘要: |
| 目的 观察超声引导下A型肉毒毒素唾液腺注射治疗真性球麻痹患者流涎症的临床疗效。 方法 募集真性球麻痹伴流涎患者40例，在超声引导下向双侧腮腺（每侧30 U）和下颌下腺（每侧20 U）注射BTX-A，总剂量100 U。于注射1、2、4周后采用照顾者总体印象变化量表（GICS）评估患者流涎症的整体改善情况；于注射前和注射1、2、4周后采用流涎严重程度与频率量表（DSFS）评估患者的流涎症状；于注射前和注射1、2周后采用Murray分泌物量表（MSS）评估患者咽喉部分泌物情况；比较注射前和注射2周后患者的肺部感染发生情况、营养指标〔血清白蛋白（Alb）和血红蛋白（Hb）〕、汉密尔顿抑郁量表（HAMD）评分和匹兹堡睡眠质量指数（PSQI）评分。 结果 注射2、4周后，患者的GICS评分分别为（1.10±0.30）分和（1.05±0.22）分，均显著优于注射1周后的（2.35±0.48）分，差异均有统计学意义（P<0.01）。注射1、2、4周后，患者的DSFS-S、DSFS-F和DSFS-T评分均显著优于注射前（P<0.01），且注射2、4周后，患者的DSFS-S、DSFS-F和DSFS-T评分亦显著优于注射1周后，差异均有统计学意义（P<0.01）。注射1、2周后，患者的MSS评分均显著优于注射前（P<0.01），且注射2周后的MSS评分亦显著优于注射1周后（P<0.01）。注射2周后，患者的Alb水平、肺部感染发生率、睡眠障碍发生率、抑郁障碍发生率较注射前均显著改善，差异均有统计学意义（P<0.05）。 结论 超声引导下BTX-A唾液腺注射可安全、有效地改善真性球麻痹患者流涎症的症状，降低其肺部感染、睡眠障碍和抑郁障碍的发生率。 |
| 英文摘要: |
| Objective To document any effect of botulinum toxin type A(BTX-A) injections in the treatment of sialorrhea among persons with bulbar palsy. Methods Forty patients with bulbar palsy and sialorrhea were enrolled. Under ultrasound guidance, BTX-A was injected into their bilateral parotid glands(30U per side) and submandibular glands(20U per side), with a total dose of 100U. The Drooling Severity and Frequency scale(DSFS) was administered at baseline and after 1, 2 and 4 weeks. The Caregiver Global Impression of Change scale(GICS) and the Murray Secretion scale(MSS) were used to evaluate overall improvement and oropharyngeal secretion at 1, 2, and 4 weeks(GICS), and 1 and 2 weeks(MSS) post-injection. The incidence of pulmonary infection, serum albumin(Alb) and hemoglobin levels, Hamilton Depression Scale scores, and Pittsburgh Sleep Quality Index scores were assessed at baseline and 2 weeks post-injection. Results The GICS scores dropped significantly(from 2.35±0.48 at week 1 to 1.10±0.30 at week 2 and 1.05±0.22 at week 4). The severity and frequency domains of the DSFS and the total scores showed significant improvement at weeks 1, 2 and 4, with further significant reductions observed at weeks 2 and 4 compared to week 1. The average MSS scores also decreased significantly at weeks 1 and 2 compared to baseline, with a more pronounced reduction at week 2. By week 2, significant improvements were also noted in serum Alb levels, pulmonary infection rates, sleep quality, and depressive symptoms compared to baseline. Conclusions Ultrasound-guided BTX-A injection into the salivary glands is safe and effective for improving sialorrhea in patients with bulbar palsy. It reduces the risk of pulmonary infection and improves their nutritional status and sleep quality. |
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