脑卒中急性期吞咽障碍环咽肌功能的临床及影像学评定  

Clinical and Imaging Assessments of Central Pharyngeal Muscle Function with Dysphagia in Acute Stroke

作　　者：李爱东[1] 刘洪涛[1] 黄宗青[1] 张志[1] 周国强 张娟 

机构地区：[1]深圳市第四人民医院神经内科,深圳518033

出　　处：《中国康复》2011年第5期336-338,共3页Chinese Journal of Rehabilitation

基　　金：2009年深圳市科研立项项目(200903205)

摘　　要：目的:探讨脑卒中急性期吞咽障碍患者环咽肌功能障碍(CPD)的临床及影像学评定,旨在找到有效治疗CPD的依据和方法。方法:首次发病的急性脑卒中患者100例,均在入院24h进行临床吞咽功能评定,入院7d内完成吞咽造影录像检查(VFSS),以确定患者的吞咽异常模式及客观判断环咽肌功能。结果:100例患者中存在吞咽障碍40例,能完成VFSS 30例,其中环咽肌功能正常24例;存在CPD 6例,其病变部位在脑干及小脑,临床上表现为中重度吞咽障碍,其中口咽期均受损2例,咽期障碍4例。6例中环咽肌打开不能1例,打开不全5例,同一患者可以存在多种吞咽异常模式,包括喉上抬不足、梨状窝较多钡剂残留、喉渗透及误吸。结论:脑卒中后CPD主要发生在脑干的损伤部位,表现为环咽肌打开困难,其发生的机制可能为环咽肌的皮质延髓通道发生退行性变,使之呈现去抑制的后果。CPD对患者生活影响很大,应及时给予相应的康复干预。Objective： To explore the clinical and imaging assessments of pharyngeal muscle with dysphagia in acute stroke and the mechanism of the center pharyngeal muscle dysfunction（CPD） in stroke dysphagia so as to search for the effective treatment of CPD.Methods： The cranial MRI was done at the first onset of acute stroke patients on admission,and the locations of the lesion were recorded.According to locations,patients were divided into four groups： the left hemisphere group;the right hemisphere group;brain stem and cerebellum group;multi-site group.Clinical assessment of swallowing function was carried out within 24 h.The swallowing abnormalities of patients and the opening situation of pharynx were recorded.The patients with swallowing disorders received videofluoroscopic swallowing study（VFSS）,and the patterns of dysphagia were determined and central pharyngeal muscle function was judged.Results： Of 100 consecutive patients with acute stroke,there were 40 cases of swallowing disorders assessed by using the clinical swallowing assessment.The VFSS was done in 30 patients.The pharyngeal muscle of 24 cases was normal,and 6 patients presented with CPD in the brain stem and cerebellum group,showing clinically moderate to severe dysphagia（2 patients were impaired on the otopharynx,and 4 cases only showed obstacles of pharynx）.VFSS displayed that these 6 cases had significant abnormalities of the pharynx,and 5 had significantly reduced rate of laryngeal elevation;there were 4 cases of swallowing startup delay;there was one case of disability of center pharyngeal muscle open,and 5 cases of incomplete open.There were variety abnormal patterns of swallowing in the same patients,including lack of laryngeal elevation,more barium residue at the pyriform,laryngeal penetration and aspiration,etc.Conclusion： CPD occurred in locations of the brain stem stroke.It is often manifested with pharyngeal muscle spasm.The mechanisms involve in the degeneration of the corticobulbar channel of pharyngeal muscle.The conse

关 键 词：脑卒中 吞咽障碍 环咽肌功能 吞咽造影录像检查 

分 类 号：R743.3[医药卫生—神经病学与精神病学]