摘要
目的探讨老年脑梗死患者隐性误吸与吞咽异常模式的相关性。方法选取2011年6月—2012年12月我院神经内科及康复科收治的急性及亚急性老年脑梗死患者80例,入院后24 h内对其进行临床吞咽功能评估,均合并吞咽障碍。患者在入院14 d内完成吞咽X线荧光透视检查(VFSS),记录显性误吸与隐性误吸发生率;分析吞咽异常模式与隐性误吸相关性。结果完成VFSS的80例患者中,误吸者33例,误吸发生率为41.3%(33/80),其中显性误吸20例、隐性误吸13例。隐性误吸患者的临床表现为:舌运动差,软腭运动感觉差,咽反射消失,多次吞咽,重复吞咽,喉上抬差;在临床评估中存在不同程度的自主咳嗽能力下降,吞咽反射减弱或消失,口咽部食物潴留等体征。回归分析显示,与隐性误吸相关的VFSS吞咽异常模式是软腭运动减弱、吞咽启动延迟、舌肌运动减弱、会厌折返不全、声门关闭不全、喉结构上抬不足。结论老年脑梗死患者吞咽异常模式与隐性误吸间存在一定的相关性,且部分吞咽器官功能障碍可表现出一种或多种吞咽异常模式,有助于客观评估隐性误吸风险,对有效防治卒中相关性肺炎,缩短患者住院时间并改善其预后有重要的临床意义。
Objective To investigate the correlation between recessive aspiration and abnormal swallowing pattern in elderly patients with cerebral infarction. Methods 80 patients with cerebral infarction combined with dysphagia admitted to our hospital from June 2011 to December 2012 were analyzed. All patients were detected by dysphagia swallowing X - ray fluoroscopy （VFSS） within 14 days after admission, recording incidence of dominant aspiration and recessive aspiration; the correlation be- tween abnormal swallowing pattern and recessive aspiration were analyzed. Results The incidence of aspiration was 41.3% （33/80）, including 20 cases with dominant aspiration, 13 cases with recessive aspiration. Recessive aspiration patients were presented poor tongue movement, soft palate movement feeling bad, pharyngeal reflex disappeared, repeatedly swallowing, la- ryngeal elevation difference; clinical assessment showed decreased ability of independent cough, swallowing reflex diminished or disappeared, oropharyngeal food retention. Regression analysis showed soft palate movement weakened, swallowing startup delay, tongue muscle motility, epiglottis incomplete exhumation, glottal insufficiency, throat structure elevation inadequate were corre- lated with recessive aspiration. Conclusion There is a certain correlation between abnormal swallowing pattern and recessive as- piration in elderly patients with cerebral infarction, and part of organ swallowing dysfunction can exhibit one or more abnormal swallowing patterns, that can objectively evaluate the hidden aspiration risk, prevent stroke associated pneumonia, shorten hos- pitalization time and improve prognosis.
出处
《实用心脑肺血管病杂志》
2014年第4期31-33,共3页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
2011年深圳市资助科研基金项目:老年脑梗死隐性误吸与吞咽异常模式相关性临床研究(201102081)
关键词
脑梗死
老年人
误吸
吞咽障碍
吞咽X线荧光透视检查
Brain infarction
Aged
Respiratory aspiration
Deglutition disorders
Swallowing X - ray fluoroscopy
