电视荧光放射录相术对脑卒中后吞咽障碍患者的评估价值(英文)  

Value of video fluoroscopy in the diagnosis of dysphagia after stroke

作　　者：王德文[1] 刘志顺[1] 张维[1] 

机构地区：[1]中国中医研究院广安门医院放射科,北京市100053

出　　处：《中国临床康复》2004年第22期4610-4611,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：奚背景:电视荧光放射录相术(videoflurography,VFG)可以了解吞咽过程中不同时相的通过时间,有无钡剂残留和误吸,从而了解吞咽障碍的特点,对临床制定治疗计划有一定的参考价值,在国外早已普遍应用。目的:探讨VFG对脑卒中后吞咽障碍患者的评估的价值。设计:非随机、标准对照、开放实验,前瞻性研究。地点和对象:在中国中医研究院广安门医院神经内科病房选择脑卒中后吞咽障碍患者60例。同时向社会招募健康中老年人20例。干预:以上两组由中国中医研究院广安门医院放射科王德文医师行VFG检查。主要观察指标:分别记录两组受试者吞咽稀钡及半胶钡(含钡面糊)过程中的口通过时间和咽通过时间,并评价口、咽功能,记录有无舌肌运动减弱,钡剂残留梨状隐窝、会厌,是否误吸入气管。结果:①吞咽障碍组各吞咽时间相通过时间均较健康中老年组延长。②会厌钡剂残留在患者中发生率最高,梨状隐窝钡剂残留发生率较高。③脑干病变组各病理征象发生率均高于大脑半球病变组。经统计学处理,脑干病变组与大脑半球病变组误吸发生率差异有显著性意义(P<0.05)。结论:VFG可以对吞咽全过程特别咽时相的病理征象进行更详细的观察,是脑卒中后吞咽障碍检查的有效方法。BACKGROUND:Video fluorography(VFG) can be used for investigating the transit t ime of the barium meal during swallow and identifying retention and aspiration o f the barium meal, so as to understand the features of dysphagia to facilitate c linical decisions on the treatment planning.This modality has been widely used i n clinical practice abroad. OBJECTIVE:To explore the clinical value of VFG in the diagnosis of dysphagia a fter stroke. DESIGN:A non-randomized,standard controlled,open,prospective study. SETTING and SUBJECTS:Sixty patients with dysphagia were selected from the Depa rtment of Neurology of Guang'anmen Hospital,China Academy of Traditional Chinese Medicine,with 20 healthy aged or middle-aged subjects also recruited as contro ls. INTERVENTION:All subjects were assessed with VFG by a professional radiographe r Wang DW from Guang'anmen Hospital. MAIN OUTCOME MEASURES:Oral and pharyneal transit time of the barium meal in bo th groups were observed respectively during swallowing for evaluation of the oro pharyneal function.Meanwhile,such pathological signs as reduced motion of the li ngual muscle,residual barium in the pyriform fossa and epiglottic vallecula,aspi ration into the airway were also observed. RESULTS:The transit time at different phases of swallowing in dysphagic group was significantly longer than that in the control group.Barium retention at the epiglottic vallecula was the most common finding in dysphagic patients,followed in frequency by retention in the pyriform fossae.Patients with brain stem lesion s were more likely to develop the pathological signs than those with cerebral he misphere lesions, and the occurrence of aspiration into the airway differed sign ificantly between them(P< 0.05). CONCLUSION:VGF can be used for close observation of the pathological signs in the whole course of swallowing,which is especially descriptive of the pharyngeal phase,and therefore can be effective in the diagnosis of dysphagia after stroke .

关 键 词：吞咽障碍 会厌 脑血管意外 放射摄影术 

分 类 号：R743[医药卫生—神经病学与精神病学]