脑干卒中导致吞咽障碍的临床特征及康复  

Clinical characteristics and rehabilitation of dysphagia after brainstem stroke

作　　者：高飞[1,3] 刘丽旭[1,3] 袁永学[2,3] GAO Fei;LIU Lixu;YUAN Yongxue(Department of Neurology Rehabilitation,Beijing Bo'ai Hospital,China Rehabilitation Reserch Center,Beijing 100068,China;Department of Hearing and Speech,Beijing Bo'ai Hospital,China Rehabilitation Reserch Center,Beijing 100068,China;Capital Medical University School of Rehabilitation Medcine,Beijing 100068,China)

机构地区：[1]中国康复研究中心北京博爱医院神经康复科,北京市100068 [2]中国康复研究中心北京博爱医院听力语言科,北京市100068 [3]首都医科大学康复医学院,北京市100068

出　　处：《中国康复理论与实践》2023年第4期465-471,共7页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的探讨脑干卒中吞咽障碍患者的临床特征、康复治疗效果及影响因素。方法回顾性分析2018年4月至2021年12月北京博爱医院收治的脑干卒中后吞咽障碍的患者。收集患者性别、年龄、病程、治疗时间等一般资料,吞咽造影咽期结果,治疗前后才藤荣一吞咽障碍7级评价法(DSS)评分、Fugl-Meyer评定量表(FMA)评分、FMA-平衡功能评分、美国国立卫生研究院卒中量表中文版(NIHSS)评分、Barthel指数(BI)、简易精神状态检查(MMSE)评分,以及出院时是否经口进食。根据吞咽造影结果分为非环咽肌失弛缓组(对照组)和环咽肌失弛缓组(观察组)。结果共纳入患者60例,对照组29例,观察组31例。观察组FMA评分、FMA-平衡功能评分、BI、MMSE评分均明显高于对照组(|t|>3.281,P<0.01),NIHSS评分显著低于非失迟缓组(t=4.390,P<0.001)。治疗前,观察组DSS评分显著低于对照组(t=5.785,P<0.001);治疗后,两组均显著提高(|t|>5.387,P<0.001);两组间比较无显著性差异(t=1.675,P=0.099),但观察组治疗前后差值明显大于对照组(t=-2.729,P=0.008)。两组经口进食率无显著性差异(χ²=2.742,P=0.098)。对照组内,经口进食与鼻饲进食患者间,FMA-平衡功能评分、NIHSS评分、BI指数、入院时吞咽障碍严重程度评分有显著性差异(|t|>2.429,P<0.05);观察组内,经口进食与鼻饲进食患者间,各因素无显著性差异(P>0.05)。对照组内入院时DSS评分为能否经口进食的影响因素(OR=3.947,95%CI 1.361~11.450,P=0.012),观察组内无独立影响因素。结论脑干卒中导致吞咽障碍患者中,出现环咽肌失弛缓患者吞咽障碍程度重,伴随障碍轻。脑干卒中吞咽障碍患者康复治疗有效,环咽肌失弛缓患者治疗效果总体好于非环咽肌失弛缓患者。非环咽肌失弛缓患者吞咽障碍预后与入院时吞咽障碍严重程度相关,环咽肌失弛缓患者预后与各临床因素无关。Objective To investigate the clinical characteristics of dysphagia after brainstem stroke,and rehabilitation effect and influencial factors for it.Methods A retrospectively analysis was conducted in patients who were diagnosed as dysphagia after brainstem stroke in the Beijing Bo'ai Hospital from April,2018 to December,2021.The following data were collected:the general information(gender,age,course of disease,and time of treatment),the result of videofluoroscopic swallowing study(VFSS),the Dysphagia Severity Scale(DSS)score before and after treatment,the scores of Fugl-Meyer As‐sessment(FMA),FMA-Balance(FMA-B),National Institutes of Health Stroke Scale(NIHSS)and Barthel index(BI),Mini-Mental State Examination(MMSE),and whether oral feeding.Based on the result of VFSS,all patients were divided into non-cricopharyngeal achalasia group(control group)and cricopharyngeal achalasia group(observation group).Results A total of 60 patients were collected,with 29 in the control group and 31 in the observation group.The scores of FMA,FMA-B,BI and MMSE were higher(|t|>3.281,P<0.01),and the NIHSS score was lower(t=4.390,P<0.001)in the observation group than in the control group.Before treatment,the score of DSS was significantly lower in the observation group than in the control group(t=5.785,P<0.001);after treatment,the scores improved in both groups(|t|>5.387,P<0.001),and no significant difference was found between two groups(t=1.675,P=0.099);however,the d-value was more in the observation group than in the control group(t=-2.729,P=0.008).There was no significant difference in the rate of oral feeding(χ²=2.742,P=0.098).In the control group,there were differences in the scores of NIHSS,FMA-B,BI and DSS between patients with oral feeding and those with nasal feeding(|t|>2.429,P<0.05);however,no significant difference was found in all factors in the observation group(P>0.05).The DSS score was the influence factor of oral feeding in the control group(OR=3.947,95%CI 1.361 to 11.450,P=0.012),and no influencing factor was foun

关 键 词：脑卒中 吞咽障碍 康复 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]