脑卒中后吞咽障碍患者的吞咽功能与肺通气功能及呼吸肌肌力的相关性  

Correlation between swallowing function and pulmonary ventilation function and respiratory muscles strength in patients with dysphagia after stroke

作　　者：肖灵君[1] 郭倩 黄粉燕[1] 廖美新 张路路 燕铁斌[1] Xiao Lingjun;Guo Qian;Huang Fenyan;Liao Meixin;Zhang Lulu;Yan Tiebin(Department of Rehabilitation Medicine,the Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510030,China;Department of Speech Therapy,Shenzhen Children′s Hospital,Shenzhen 518000,China;Department of Ultrasonic Diagnosis,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]中山大学孙逸仙纪念医院康复医学科,广州510030 [2]深圳市儿童医院言语治疗科,深圳518000 [3]北京大学第三医院超声诊断科,北京100191

出　　处：《中华医学杂志》2020年第7期504-508,共5页National Medical Journal of China

基　　金：国家自然科学基金(81772447);广州市科技计划(201704020140)。

摘　　要：目的比较有无吞咽障碍的脑卒中患者与年龄病程相匹配人群间的呼吸功能差异,探讨吞咽功能与呼吸功能的相关性。方法从2018年9月至2019年4月中山大学孙逸仙纪念医院康复科及神经科住院脑卒中患者310例中,选取标准的脑卒中患者60例。根据有无吞咽障碍将60例脑卒中患者分为吞咽障碍组和非吞咽障碍组,另选取资料匹配的30名健康人作为健康对照组。使用肺功能检测仪分别评估3组的呼吸功能,比较3组间的差异;对吞咽障碍组行吞咽功能检查,取其电视荧光吞咽造影(VFSS)资料,使用Rosenbek渗透/误吸量表(PAS)、吞咽障碍结局与严重度量表(DOSS)和视频吞咽造影功能障碍量表(VDS)对吞咽功能量化评定,分析吞咽功能与呼吸功能的相关性。结果三组间的呼吸功能指标差异均有统计学意义(P<0.05);除脑卒中吞咽障碍组和脑卒中非吞咽障碍组间的25%用力呼气流量(FEF25)、用力呼气量(FVC)、用力吸气量(FIVC),脑卒中非吞咽障碍组和健康对照组间的75%用力呼气流量(FEF75)差异无统计学意义(P>0.05)外,其他各项指标的组间两两比较差异均有统计学意义(P<0.05)。PAS与最大吸气压(MIP)(r=-0.618,P=0.001)、最大呼气压(MEP)(r=-0.410,P=0.038)、峰值呼气流速(PEF)(r=-0.443,P=0.024)间的相关性均有统计学意义。DOSS与MIP(r=0.602,P=0.000)、MEP(r=0.496,P=0.005)、PEF(r=0.553,P=0.002)间的相关性均有统计学意义。VDS与MEP(r=-0.483,P=0.012)、PEF(r=-0.494,P=0.010)间的相关性具有统计学意义。结论脑卒中吞咽障碍患者的呼吸功能明显下降,且吞咽障碍的严重程度与呼吸功能的下降具有相关性。Objective To observe the difference of pulmonary function among patients with dysphagia after stroke, patients without dysphagia and normal people, and to explore the correlation between swallowing function and pulmonary function.Methods From September 2018 to April 2019, 310 stroke patients were enrolled from the rehabilitation department and neurology department of sun yat-sen memorial hospital, sun yat-sen university, of which 60 were selected as standard stroke patients. Pulmonary function of the three groups was assessed by pulmonary function detector and further compared. The swallowing function of the dysphagia group after stroke was examined by using videofluroscopic swallowing study (VFSS). The swallowing function was quantitatively assessed by Rosenbek penetration-aspiration scale (PAS), dysphagia outcome and severity scale (DOSS) and videofluoroscopy dysphagia scale (VDS), and the correlation between swallowing function and respiratory function was analyzed.Results There were significant differences in pulmonary function among three groups (P<0.05). Besides the FEF25,FVC, FIVC between patients with dysphagia after stroke and patients without dysphagia, the FEF75 between patients without dysphagia and normal people (all P>0.05), there were significant differences in the pairwise comparison of other indicators (all P<0.05). There were correlations between PAS and MIP (r=-0.618, P=0.001),PAS and MEP (r=-0.410, P=0.038), PAS and PEF (r=-0.443, P=0.024), DOSS and MIP (r=0.602, P=0.000),DOSS and MEP (r=0.496, P=0.005), DOSS and PEF (r=0.553, P=0.002), VDS and MEP (r=-0.483, P=0.012),VDS and PEF (r=-0.494, P=0.010), respectively.Conclusion The pulmonary function of dysphagia patients after stroke decrease significantly, and the severity of dysphagia is correlated with the decrease of pulmonary function.

关 键 词：脑卒中 吞咽障碍 肺通气 呼吸肌 

分 类 号：R74[医药卫生—神经病学与精神病学]