摘要
目的探讨不同类型脑瘫患儿吞咽障碍和口运动特点及其临床评定方法。方法对2009年6月至2010年9月在我院康复中心门诊及住院治疗的116例脑瘫患儿（年龄18～96个月，男66例，女50例）进行吞咽障碍调查（DDS）和口运动评估，分析不同类型脑瘫患儿的吞咽障碍特点。按年龄、性别匹配健康儿童对照组进行口运动评估，对比分析。结果116例脑瘫患儿中，66例（56．9％）存在吞咽障碍，其中26例（22．4％）为轻度吞咽障碍，40例（34．5％）为中-重度吞咽障碍。脑瘫患儿DDS总分范围为0～22分，中位值为6分。吞咽障碍症状主要表现为各种进食技能不足（涉及吸吮、咬合、咀嚼和吞咽），进食时或进食后呛咳、噎食、呕吐，下颌运动和唇闭合差，舌的搅拌、侧方转运能力差；进食过程中头颈过伸展或哭闹；不同类型的脑瘫吞咽困难表现和严重程度有所不同，痉挛型四肢瘫、不随意运动型和混合型脑瘫比较严重，痉挛型双瘫的吞咽障碍最轻。本组90例（77．6％）患儿存在口运动障碍，痉挛型双瘫和偏瘫患儿的口运动障碍发生率相对较低，分别为62．2％（28例）和55．0％（11例），其他各类型所有患儿都存在明显的口运动障碍。结论口腔期吞咽障碍和口运动障碍是脑瘫患儿的主要临床问题之一；DDS调-查表和口运动评估二者结合，可以作为评估脑瘫口腔期吞咽障碍的临床工具，但对于咽期和食管期的吞咽问题则应配合电视荧光吞咽检查等进一步评估。
Objective To investigate the symptom characteristis as well as the clinical assessment methods of dysphagia and oral motor function in children with cerebral palsy （CP）. Methods A total of 116 children with CP, aged 18 months to 96 months （66 boys and 50 girls） , treated in Qingdao Rehabilitation Center for Disabled Children from June 2009 to September 2010,were included in the study. Diagnosis and subtype of CP were deter- mined by neuropaediatrician, the dysphagia disorders survey （DDS） as well as oral motor assessment were conducted by the speech therapists. Results Of the 116 cases, 22.4% of the cases were with mild dysphagia and 34.5% with moderate to severe dysphagia, resulting in a prevalence of dysphagia of 56.9%. The main problems of these cases occurred during oral phase and pharyngeal phase, including inadequate feeding skills （involving sucking, biting, chewing or/and swallowing）, coughing, vomiting and choking during feeding, cry/overextension of neck and head during feeding, drooling, hypertonic tongue and inadequate tongue lateralization. The severe dysphagia was encountered frequently in children with spastic quadriplegic, dyskinetic or mixed type CP children. Of the 116 cases, 90 cases （77.59%） were with oral motor dysfunction （including all spastic quadriplegic, dyskinetic or mixed type children）. The oral motor scores of CP children were significantly lower than those of the controls （ P 〈 0. 01 ）. Conclusions Oral phase dysphagia and oral motor disorder might be considered as the common clinical problems among the patients with CP, and could be assessed by using DDS combined with oral motor assessment, but for dysphagia during pharyngeal or esophagus phase, the videofluoroscopic modified barium swallow should be used for further evaluation.
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2011年第12期902-905,共4页
Chinese Journal of Physical Medicine and Rehabilitation
关键词
脑性瘫痪
吞咽障碍
口运动障碍
临床评估
Cerebral palsy
Deglutition disorder
Oral movement disorder
Clinical assessment
