吞咽造影同步咽腔测压评估脑干损伤后吞咽障碍  

Applying manofluorography in the evaluation of dysphagia after brainstem injury

作　　者：于帆[1] 窦祖林[2] 陈文华[1] 兰月[3] 林拓[3] 卫小梅[2] 

机构地区：[1]上海市第一人民医院康复医学科,上海200080 [2]中山大学附属第三医院康复医学科 [3]广州市第一人民医院康复医学科

出　　处：《中华物理医学与康复杂志》2016年第1期24-28,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的使用吞咽造影同步咽腔测压（MFG）评估脑干损伤后吞咽障碍患者的吞咽功能，分析异常的运动学与生物力学参数以及舌骨位移与咽腔、上食管括约肌（UES）压力之间的关系。方法对脑干损伤后吞咽障碍患者（病例组）13例与健康志愿者（对照组）13例分别进行MFG检查，对比两组吞咽时的运动学与生物力学参数。分析两组运动学与生物力学参数之间的关系。结果病例组舌根与下咽部的压力峰值、压力上升速率、舌骨向前位移低于对照组，病例组UES的最大开放幅度、开放后压力峰值、开放持续时间低于对照组。病例组舌根部与下咽部的收缩持续时间、UES松弛残余压高于照组。对照组舌骨向前位移与UES松弛残余压成负相关；病例组舌骨向前位移分别与舌根部压力峰值、下咽部压力峰值成正相关。结论MFG可以同时使用吞咽造影和高分辨率咽腔测压评估吞咽功能，可作为临床一种精确、全面的定量评估吞咽功能的方法。Objective To evaluate the swallowing function of patients with dysphagia after brainstem injury using manofluorography （MFG） , analyzing the abnormal biomechanieal and kinematic parameters as well as any cor- relation between changes in the pharynx and the upper esophageal sphincter （UES） measured manometrically and changes in the kinematics of the hyoid bone. Methods Thirteen patients with dysphagia after brainstem injury （the patient group） and 13 healthy participants （the control group） underwent manofluorography. Kinematics and biome- ehanical changes during swallowing were compared between the two groups and the correlations between the observa- tions were analyzed. Results The patient group showed significantly lower maximum pressure and rate of pressure change at the base of the tongue and in the hypopharynx, as well as less hyoid anterior displacement, smaller and briefer UES opening, but significantly higher minimum pressure at UES relaxation. The duration of tongue root eleva- tion and hypopharynx pressure was also shorter than in the control group, on average. There was a negative correlation between hyoid anterior displacement and the minimum pressure on UES relaxation in the control group, and a positive correlation between hyoid anterior displacement and the maximum pressure at the base of the tongue and in the hypo- pharynx in the patient group. Conclusions The concurrent use of manometry and video-fluorography for evaluating dysphagia can be an objective and effective diagnostic tool for the comprehensive evaluation of swallowing function.

关 键 词：吞咽障碍 吞咽造影 同步咽腔测压 高分辨率测压 

分 类 号：R651.15[医药卫生—外科学] R49[医药卫生—临床医学]