林依秋,彭嘉颖,谢纯青,等.脑卒中后吞咽障碍患者的吞咽安全性及呼吸-吞咽时序特征分析[J].中华物理医学与康复杂志,2025,47(12):1081-1087
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| 脑卒中后吞咽障碍患者的吞咽安全性及呼吸-吞咽时序特征分析 |
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| DOI：10.3760/cma.j.cn421666-20250714-00589 |
| 中文关键词: 脑卒中 吞咽障碍 病灶部位 吞咽造影 时序特征 误吸 |
| 英文关键词: Stroke Dysphagia Stroke lesion locations Videofluoroscopy Aspiration Swallowing coordination |
| 基金项目:国家自然科学基金青年基金（82402972）；广州市科技计划项目（2025A03J3212） |
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| 中文摘要: |
| 目的 本研究旨在通过对不同部位脑卒中后吞咽障碍患者的吞咽安全性及呼吸-吞咽空间协同关键时序异常特征进行分析，从而探究病灶特异性呼吸-吞咽空间协同异常时序改变与吞咽安全性的关联。 方法 本研究共入选124例脑卒中后吞咽障碍患者，根据病灶部位将其分为幕上（皮质和/或皮质下）卒中组（61例）、幕下非延髓（脑桥和/或小脑）卒中组（25例）及延髓卒中组（38例）。所有患者均进行吞咽造影检查，并对比各组患者进食中稠食物时渗漏误吸分级，同时分析与呼吸-吞咽空间协同相关联的4组吞咽动作的异常时序特征。 结果 延髓卒中组误吸患者占比为31.6%，显著高于幕上卒中组的13.1%（P<0.05）。延髓卒中组吞咽时序3、4的符合率均显著低于幕上卒中组相应水平（P<0.05），且误吸患者吞咽时序3、4的符合率均显著低于安全吞咽患者及渗漏患者相应水平（P<0.01）。与幕上卒中组比较，延髓卒中组患者吞咽时序间期T1显著延长，T3明显缩短，幕下非延髓卒中组患者吞咽时序间期T2显著延长（P<0.05）。另外本研究还发现延髓卒中组有28.9%的患者吞咽时食管上括约肌（UES）不开放。 结论 不同部位脑卒中患者其吞咽安全性受损情况及呼吸-吞咽空间协同性存在明显差异，与幕上脑卒中患者比较，延髓卒中患者的吞咽安全性受损程度更严重，不同幕下部位卒中患者的吞咽时序异常特征也存在一定差异。脑桥/小脑卒中患者表现为UES开放延迟，延髓卒中患者表现为UES开放与舌喉复合体最大趋近时序逆转，喉关闭到UES开放的间隔时间显著延长。临床应根据不同部位脑卒中患者的吞咽障碍特点进行早期评估及干预，以降低误吸风险，提高患者的康复疗效及生存质量。 |
| 英文摘要: |
| Objective To define any association between lesion-specific abnormal timing and the coordination of respiration and swallowing among stroke survivors with dysphagia. Methods A total of 124 persons with post-stroke dysphagia were divided into three groups based on the location of their lesion: a supratentorial (cortical and/or subcortical) stroke group (61 cases), an infratentorial non-medullary (pons and/or cerebellum) stroke group (25 cases), and a medullary stroke group (38 cases). All underwent videofluoroscopic examination (VFSS) while ingesting moderately thickened food. The proportion of unsafe swallowing was observed and penetration aspiration scale (PAS) scores were assigned. Any abnormal temporal characteristics of four sets of swallowing movements related to respiratory-swallowing spatial coordination were analyzed. Results In the medullary stroke group the proportion of patients with aspiration was 31.6%, significantly higher than the 13.1% in the supratentorial stroke group. The compliance rates of swallowing timings 3 and 4 in the medullary stroke group were significantly lower than among the supratentorial stroke group, on average, and those in patients with aspiration were significantly lower than those among patients with safe swallowing and penetration. Compared with the supratentorial stroke group, swallowing time interval T1 was significantly prolonged and T3 was significantly shortened in the medullary stroke group, and interval T2 was significantly prolonged in the infratentorial non-medullary stroke group. In addition, no opening of the upper esophageal sphincter (UES) during swallowing was observed in 28.9% of the medullary stroke group. Conclusions There are significant differences in the impairment of swallowing safety and in the coordination of respiration and swallowing among patients whose strokes were at different sites. Those who have survived a medullary stroke tend to have greater impairment of swallowing safety than after a supratentorial stroke. Abnormal swallowing timing tends to differ among persons whose stroke was at different infratentorial sites. Patients with a pontine or cerebellar stroke present with delayed UES opening. After a medullary stroke there tends to be reversed timing between maximum approximation of the tongue-hyoid complex and UES opening, and a significantly prolonged interval from larynx closure to UES opening. Early assessment and intervention is clearly called for to reduce the risk of aspiration and improve the prospects for rehabilitation and life quality. |
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