Study of the Therapeutic Effect of Intraoral Balloon Dilation Combined with K-point Stimulation in Patients with Post-stroke Pseudobulbar Palsy Associated Dysphagia and Trismus

doi:10.12114/j.issn.1007-9572.2025.0228

Abstract

Abstract:

Background

In patients with post-stroke pseudobulbar palsy, bilateral upper motor neuron injury manifests as trismus, hyperactive jaw-jerk reflex, and swallowing disorders. Among these symptoms, trismus significantly complicates rehabilitation therapies during the oral preparatory and oral phases of swallowing, as well as oral rehabilitation nursing procedures.

Objective

To explore the therapeutic effect of intraoral balloon dilation combined with K-point stimulation in patients with post-stroke pseudobulbar palsy associated dysphagia and trismus.

Methods

Forty patients with post-stroke pseudobulbar palsy associated dysphagia and trismus, who admitted to the China Rehabilitation Research Center from June 2021 to April 2024, were selected for the study. They were randomly assigned to either the control group (n=20) or the observation group (n=20) by the random number table method. The control group received conventional swallowing therapy and K-point stimulation to facilitate mouth opening, while the observation group received intraoral balloon dilation combined with K-point stimulation in addition to conventional swallowing therapy. Both groups underwent 4 weeks of treatment. Swallowing function was assessed using the Mann Assessment of Swallowing Ability and the 2-minute frequency of spontaneous swallowing at pretherapy after 4 weeks of treatment. Mouth opening function was evaluated using effective mouth opening times.

Results

After 4 weeks of treatment, the observation group showed a significantly higher severity score for swallowing difficulties (62.40±7.76) on the Mann Assessment of Swallowing Ability, compared to the control group (56.50±4.45) (P<0.05). The observation group also showed a significantly higher median 2-minute frequency of spontaneous swallowing compared to the control group [1.8 (1.4, 2.2) vs 1.4 (1.0, 1.8)] (P<0.05). Additionally, the observation group had a significantly higher times of effective mouth opening (23.3±1.3) compared to the control group (21.1±1.8) (P<0.05).

Conclusion

Intraoral balloon dilation combined with K-point stimulation can effectively improve dysphagia and trismus in patients with post-stroke pseudobulbar palsy.

Key words: Stroke, Pseudobulbar palsy, Dysphagia, Trismus, The Mann assessment of swallowing ability, The 2-minute frequency of spontaneous swallowing

摘要：

背景

卒中后假性延髓麻痹患者因双侧上运动神经元受损，常伴随张口困难、咬合反射活跃、吞咽障碍等症状，其中张口困难问题对吞咽障碍患者口腔准备期、口腔期吞咽康复治疗及口腔康复护理带来了极大的不便。

目的

探究口内球囊扩张联合K点刺激对卒中后假性延髓麻痹吞咽障碍合并张口困难患者的治疗效果。

方法

选取2021年6月—2024年4月中国康复研究中心收治的40例卒中后假性延髓麻痹吞咽障碍合并张口困难患者为研究对象，采用随机数字表法分为对照组（n=20）、观察组（n=20），对照组采用常规吞咽治疗配合K点刺激促使患者张口，观察组在常规吞咽治疗基础上进行口内球囊扩张联合K点刺激，两组均进行4周的治疗。治疗前及治疗4周末使用曼恩吞咽功能评估量表、2 min自发吞咽次数对患者吞咽功能进行评定，使用有效张口次数对患者张口功能进行评定。

结果

治疗4周末，观察组患者曼恩吞咽功能评估量表总分为（62.40±7.76）分，高于对照组的（56.50±4.45）分（P<0.05）；治疗4周末，观察组患者2 min自发吞咽次数为1.8（1.4，2.2）次，高于对照组的1.4（1.0，1.8）次（P<0.05）；治疗4周末，观察组患者有效张口次数为（23.3±1.3）次，高于对照组的（21.1±1.8）次（P<0.05）。

结论

口内球囊扩张联合K点刺激治疗能够有效改善卒中后假性延髓麻痹患者的吞咽障碍及张口困难问题。

关键词: 卒中, 假性延髓麻痹, 吞咽障碍, 张口困难, 曼恩吞咽功能评估, 2 min自发吞咽次数

HU Naixiao,ZHANG Hao,WANG Bo, et al. Study of the Therapeutic Effect of Intraoral Balloon Dilation Combined with K-point Stimulation in Patients with Post-stroke Pseudobulbar Palsy Associated Dysphagia and Trismus[J]. Chinese General Practice, 2026, 29(05): 591-596. DOI: 10.12114/j.issn.1007-9572.2025.0228.
胡乃晓,张皓,王博等. 口内球囊扩张联合K点刺激对卒中后假性延髓麻痹吞咽障碍合并张口困难患者的治疗效果研究[J]. 中国全科医学, 2026, 29(05): 591-596. DOI: 10.12114/j.issn.1007-9572.2025.0228.

Figures/Tables 6

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组别	例数	年龄（±s，岁）	性别[例（%）]		病种[例（%）]		病程（±s，d）
组别	例数	年龄（±s，岁）	男	女	脑出血	脑梗死	病程（±s，d）
对照组	20	52.0±12.4	14（70.0）	6（30.0）	12（60.0）	8（40.0）	32.2±9.9
观察组	20	50.7±12.0	13（65.0）	7（35.0）	15（75.0）	5（25.0）	31.2±8.6
t（χ²）值		0.345	0.114^a		1.030^a		0.307
P值		0.732	0.746		0.311		0.760

组别	例数	年龄（±s，岁）	性别[例（%）]		病种[例（%）]		病程（±s，d）
组别	例数	年龄（±s，岁）	男	女	脑出血	脑梗死	病程（±s，d）
对照组	20	52.0±12.4	14（70.0）	6（30.0）	12（60.0）	8（40.0）	32.2±9.9
观察组	20	50.7±12.0	13（65.0）	7（35.0）	15（75.0）	5（25.0）	31.2±8.6
t（χ²）值		0.345	0.114^a		1.030^a		0.307
P值		0.732	0.746		0.311		0.760

组别	例数	一般检查				口腔准备期
组别	例数	治疗前	治疗4周末	t_配对值	P值	治疗前	治疗4周末	t_配对值	P值
对照组	20	9.75±1.65	10.20±2.04	-1.831	0.082	14.15±1.93	18.35±3.60	-4.558	<0.001
观察组	20	9.45±1.10	10.05±1.76	-1.709	0.103	13.85±1.14	20.80±4.02	-3.526	<0.001
t值		-0.689	-0.369			-0.780	-2.029
P值		0.493	0.715			0.444	0.049
组别	口腔期				咽期				总分
组别	治疗前	治疗4周末	t_配对值	P值	治疗前	治疗4周末	t_配对值	P值	治疗前	治疗4周末	t_配对值	P值
对照组	7.50±1.00	11.40±1.88	-5.165	<0.001	9.75±1.29	16.55±3.87	-6.486	<0.001	41.15±3.94	56.50±4.45	-7.342	<0.001
观察组	7.45±0.83	12.95±2.24	-5.272	<0.001	9.80±1.24	19.55±4.97	-7.184	<0.001	40.55±2.68	62.40±7.76	-8.851	<0.001
t值	-0.172	-2.375			-0.124	-2.129			-0.563	-2.948
P值	0.864	0.022			0.901	0.039			0.576	0.005

组别	例数	一般检查				口腔准备期
组别	例数	治疗前	治疗4周末	t_配对值	P值	治疗前	治疗4周末	t_配对值	P值
对照组	20	9.75±1.65	10.20±2.04	-1.831	0.082	14.15±1.93	18.35±3.60	-4.558	<0.001
观察组	20	9.45±1.10	10.05±1.76	-1.709	0.103	13.85±1.14	20.80±4.02	-3.526	<0.001
t值		-0.689	-0.369			-0.780	-2.029
P值		0.493	0.715			0.444	0.049
组别	口腔期				咽期				总分
组别	治疗前	治疗4周末	t_配对值	P值	治疗前	治疗4周末	t_配对值	P值	治疗前	治疗4周末	t_配对值	P值
对照组	7.50±1.00	11.40±1.88	-5.165	<0.001	9.75±1.29	16.55±3.87	-6.486	<0.001	41.15±3.94	56.50±4.45	-7.342	<0.001
观察组	7.45±0.83	12.95±2.24	-5.272	<0.001	9.80±1.24	19.55±4.97	-7.184	<0.001	40.55±2.68	62.40±7.76	-8.851	<0.001
t值	-0.172	-2.375			-0.124	-2.129			-0.563	-2.948
P值	0.864	0.022			0.901	0.039			0.576	0.005

组别	例数	治疗前	治疗4周末	Z_配对值	P值
对照组	20	0.2（0.1，0.5）	1.4（1.0，1.8）	-3.824	<0.001
观察组	20	0.2（0.1，0.4）	1.8（1.4，2.2）	-3.921	<0.001
Z值		-0.291	-2.101
P值		0.771	0.036