神经性吞咽障碍不同浓度钡液吞咽造影检查分析

目的探讨神经性吞咽障碍不同浓度钡液吞咽造影检查的影像学特点。方法入选新发脑卒中合并吞咽障碍患者90例,随机分为100%钡液吞咽造影检查组、45%钡液吞咽造影检查组及对照组,每组30例,前两组分别采用相应浓度钡液调配的食物进行造影检查。结果 100%钡液吞咽造影检查组与45%钡液吞咽造影检查组两组造影结果均能显示患者口腔期及咽期的滞留、返流、误吸、隐匿性误吸及清除情况,差异无统计学意义(P>0.05),三组卒中后肺炎的发生率无明显差异(P>0.05)。结论 45%钡液及100%钡液吞咽造影检查均能安全有效地反映神经性吞咽障碍患者的吞咽功能,指导吞咽障碍的康复治疗。     

呼吸功能训练对脑卒中吞咽障碍患者吞咽功能的恢复作用

目的探讨呼吸功能训练对脑卒中吞咽障碍患者的影响。方法选取2016年2月-2017年2月我院收治的吞咽障碍患者90例,根据数字表法随机分为实验组和对照组,各45例,对照组患者给予常规吞咽功能训练,实验组患者在此基础上辅以呼吸功能训练。于治疗前、治疗4周后分别采用Rosenbek误吸程度分级标准、吸人性肺炎诊断标准评估患者误吸程度分级及吸入性肺炎发生率,采用洼田饮水试验、吞咽造影检查(VFSS)评估患者吞咽功能。对比两组治疗效果。结果治疗前后同组Rosenbek误吸程度分级有统计学差异(P0.05),且治疗后两组间差异显著(P0.05)。治疗后实验组吸入性肺炎的发生率(11.1%)明显少于对照组(26.7%)(P0.05)。实验组患者治疗有效率(95.6%)明显高于对照组(75.6%)(P0.05)。两组患者治疗后VFSS评分均较治疗前明显提高(P0.05),且实验组[(8.76±1.16)分]明显高于对照组[(7.26±2.10)分](P0.05)。结论早期呼吸功能训练有助于脑卒中吞咽障碍患者吞咽功能的恢复。     

吞咽功能的康复训练对卒中后肺炎的预防研究

目的 观察吞咽功能康复训练对卒中后吞咽障碍的恢复与预防肺炎的效果及对预后的影响.方法 对267例脑卒中住院患者进行床旁误吸试验,对误吸试验阳性的135例随机分为对照组与训练组,训练组进行各种吞咽功能训练.观察两组吞咽功能恢复、肺炎发生与死亡情况.结果 在治疗后14 d与21 d,训练组床旁误吸试验阳性率分别为31.3%与20.6%,而对照组为47.8%和40.3%,训练组均较对照组低(P<0.05);发病后1个月内训练组肺炎发生率11.8%,对照组为22.4%,差异无统计学意义(χ~2=2.69,P>0.05);但结合我们的以往资料进行比较,差异有统计学意义(χ~2=4.25,P<0.05).结论 脑卒中后吞咽障碍是肺炎的重要危险因素,吞咽功能康复训练能促进患者恢复,减少肺炎发生,改善预后.     

吞咽造影数字化分析评价脑干卒中后吞咽障碍患者咽部功能治疗前后的变化

目的探索吞咽造影数字化分析法在评估脑干卒中后吞咽障碍患者治疗前后的咽部功能变化中的临床价值。方法收集我院收治的脑干卒中后吞咽障碍患者60例,将其随机分成两组,对照组30例施行常规吞咽康复训练治疗,观察组30例在对照组的治疗基础上加用球囊扩张术进行治疗。通过吞咽造影评估与数字化测量分析对两组患者治疗前后的咽收缩率(PCR)与咽收缩时间进行评估比较分析。结果两组患者治疗前在吞咽稀流质、浓流质及糊状食物时的PCR对比,差异均无统计学意义(P>0.05)。与治疗前相比,两组患者治疗后在吞咽稀流质、浓流质及糊状食物时的PCR均有明显改善,差异有统计学意义(P<0.05),且观察组的改善程度较对照组更为显著(P<0.05)。两组患者治疗前在吞咽稀流质、浓流质及糊状食物时的咽收缩持续时间对比,差异均无统计学意义(P>0.05)。与治疗前相比,两组患者治疗后在吞咽稀流质、浓流质及糊状食物时的咽收缩持续时间均有明显改善,差异有统计学意义(P<0.05),且观察组的改善程度较对照组更为显著(P<0.05)。结论吞咽造影数字化分析技术可有效评估脑干卒中后吞咽障碍患者的咽部功能变化,可作为患者吞咽功能评估的重要参考。     

食道钡剂造影对鼻咽癌患者放疗后的吞咽功能评估

目的研究食道钡剂造影对鼻咽癌患者放疗后吞咽功能的评估价值,为临床诊治提供参考。方法对2012年1月-2015年12月间收治的鼻咽癌放疗后的患者156例进行回顾性分析,其中78例进行过调强放疗治疗(设为观察组),78例进行过常规放疗治疗(设为对照组)。两组患者均进行食道钡剂造影检查及随访调查,并与其喉镜检查结果比较,对比三者结果并作深入分析。结果应用食道钡剂造影检查发现观察组出现吞咽障碍总计为55.13%(43/78),显著低于对照组的85.90%(67/78);通过随访调查统计得到观察组出现吞咽功能障碍患者总计60.26%(47/78),显著低于对照组的91.03%(71/78);对喉镜检查结果对比发现观察组出现吞咽功能障碍总计56.41%(44/78),显著低于对照组的88.46%(69/78)。最后对比三种结果得到两组中食道钡剂造影与随访调查、喉镜对鼻咽癌放疗后吞咽功能检查结果对比均差异无统计学意义(P>0.05)。结论鼻咽癌患者进行放疗治疗后普遍出现吞咽功能障碍,而调强放疗后出现的比例较低。采用食道钡剂造影检查后对吞咽功能障碍了解详细,可为了解病情发展严重程度及治疗提供依据,具有较高的应用价值。     

姿势控制联合呼吸康复锻炼对脑出血后吞咽障碍患者肺部感染的防控效果

目的 探讨姿势控制联合呼吸康复锻炼对脑出血后吞咽障碍患者吞咽障碍的改善情况及肺部感染的防控效果。方法 研究对象为2020年1月-2020年12月于北京市大兴区人民医院进行康复治疗的脑出血后吞咽功能障碍患者224例,将其随机分为康复锻炼组与对照组,每组112例。对照组均采用常规治疗方式,康复锻炼组在对照组基础上加入姿势控制与呼吸康复锻炼治疗。对比两组患者训练前与训练30 d后经口摄食能力、误吸情况、肺部感染发病情况以及临床疗效。结果 训练前,两组脑出血后吞咽功能障碍患者的吞咽功能分级比较,无统计学差异;训练后两组患者吞咽功能分级改善(P<0.05);与对照组相比,训练后康复锻炼组吞咽功能更佳(P<0.05)。康复锻炼组脑出血后吞咽功能障碍患者的临床治疗痊愈率与有效率分别为75.00%与98.22%,对照组脑出血后吞咽功能障碍患者的临床治疗痊愈率与有效率分别为55.36%与87.50%,康复锻炼组优于对照组(P<0.05)。训练后,康复锻炼组渗透-误吸评分以及肺部感染率低于对照组(P<0.05)。结论 将姿势控制联合呼吸康复锻炼应用于脑出血后吞咽障碍患者康复训练中,...     

医护联合式健康教育在预防脑卒中吞咽障碍患者误吸中的效果观察

目的探讨医护联合式健康教育在预防脑卒中吞咽障碍患者误吸中的临床效果。方法选取2017年10月到2018年6月我院收治的脑卒中吞咽障碍患者120例,随机分为两组各60例。对照组给予常规健康教育,观察组接受医护联合式健康教育。比较两组的误吸发生率及疾病认知。结果观察组的误吸发生率为5.00%,显著低于对照组的16.67%(P <0.05)。干预后,观察组的吞咽障碍相关知识评分、安全喂食方法评分、吞咽功能训练评分、误吸后紧急处理评分均显著高于对照组(P <0.05)。结论医护联合式健康教育可有效降低脑卒中吞咽障碍患者的误吸发生率,提高患者的疾病认知。     

X线动态造影联合颅脑磁共振DWI在脑梗死后吞咽功能障碍患者中的临床应用研究

目的分析X线动态造影联合颅脑磁共振DWI在脑梗死后吞咽功能障碍患者中的应用效果。方法选择我院收治的60例脑梗死患者,依据患者是否存在吞咽功能障碍分为非吞咽功能障碍组(n=36)与吞咽功能障碍组(n=24)。依据患者是否发生误吸将吞咽功能障碍组分为非误吸组(n=11)与误吸组(n=13)。所有患者均行X线动态造影及颅脑磁共振DWI检查。分析患者出现吞咽功能障碍、误吸与脑梗死部位之间的关系。结果合并吞咽功能障碍的脑梗死患者,梗死部位多集中于脑干位置,且多合并误吸症状,无位于小脑部位。结论采用颅脑磁共振DWI明确脑梗死患者梗死位置,可预测合并吞咽功能障碍,联合X线动态造影可对患者吞咽功能进行准确评价,二者联合应用可为临床治疗提供准确的参考意见,对保护患者吞咽功能具有重要的意义。     

半夏厚朴汤配合针刺治疗卒中后假性球麻痹吞咽障碍的疗效及安全性

目的探讨半夏厚朴汤配合针刺治疗卒中后假性球麻痹吞咽障碍的疗效及安全性。方法选择2018年8月至2020年8月期间医院收治的卒中后假性球麻痹吞咽障碍患者94例作为研究对象,按照组间性别、年龄、病程、出血类型均衡可比的原则分为对照组和观察组,每组各47例。对照组采用单纯针刺治疗,观察组采取半夏厚朴汤配合针刺治疗。评价两组治疗效果及吞咽功能,观察不良反应发生情况。结果观察组治疗有效率为95.74%,高于对照组的78.72%,差异有统计学意义(P0.05)。治疗后,观察组洼田饮水试验评级优于对照组,VFSS量表口腔期、咽喉期、误吸评分高于对照组,差异有统计学意义(P0.05)。两组均无不良反应发生。结论治疗卒中后假性球麻痹吞咽障碍采取半夏厚朴汤配合针刺方案可促使吞咽功能有效改善,恢复正常进食、饮水,无呛咳,可提高治疗效果,而且未发生不良反应,安全性高。     

佩戴说话瓣膜对吞咽障碍患者渗漏和误吸影响的研究

目的：探讨气管切开患者治疗方法,分析说话瓣膜对气管切开吞咽障碍患者渗漏、误吸的影响。方法：收集气管切开、病程较长、未能拔除气管套管的伴吞咽障碍患者,在其气管套管口配戴说话瓣膜,采用吞咽造影检查观察配戴时与未配戴说话瓣膜时渗漏、误吸程度的变化,应用Rosenbek误吸程度分级对其分析,对照使用前后渗漏和误吸发生率。结果：气管切开患者在配戴说话瓣膜时与未配戴时进行吞咽造影检查发现,患者中配戴说话瓣膜者与未配戴者级别有变化;佩戴说话瓣膜时降低了误吸发生率。结论：患者佩戴说话瓣膜时误吸程度逐渐向渗漏程度改善,患者自身的渗漏、误吸程度减轻,降低了误吸发生率。     

卒中后吞咽障碍临床治疗效果分析

目的分析经颅直流电刺激结合吞咽训练治疗卒中后吞咽障碍的疗效。方法选取本院卒中后吞咽障碍患者50例(2017年12月—2018年12月),随机分为吞咽训练治疗的对照组(25例)与经颅直流电刺激结合吞咽训练治疗的观察组(25例),观察患者治疗效果、洼田饮水试验评分、VFSS(电视透视吞咽功能检查)评分。结果观察组治疗有效率96.00%,对照组76.00%,χ2=4.1528,P=0.0415,差异有统计学意义。治疗后,观察组洼田饮水试验评分(1.40±0.53)分,低于对照组,t=8.8522,P=0.0000,差异有统计学意义。治疗后,观察组VFSS评分(7.98±0.37)分,高于对照组,t=21.2033,P=0.0000,差异有统计学意义。结论给予卒中后吞咽障碍患者经颅直流电刺激结合吞咽训练治疗,能有效提高患者治疗效果,改善患者吞咽功能。     

不同深度针刺双侧风池、翳风穴治疗脑卒中后吞咽障碍的临床观察

目的比较不同深度针刺双侧风池、翳风穴治疗脑卒中后吞咽障碍的临床疗效。方法收集2017年3月—2018年11月在辽宁中医药大学附属医院神经内科治疗的脑卒中后吞咽障碍患者90例,随机分为对照组和观察组,每组各45例。两组均给予康复训练、神经肌肉电刺激联合针刺治疗(两组取穴相同,针刺深度不同),治疗4周。观察两组临床疗效、吞咽功能、表面肌电图(sEMG)、血清IL-6和hs-CRP水平、不良反应、神经功能评分、中医症状评分和生活质量评分等。结果治疗后,对照组无不良反应发生,观察组出现1例瘀青,1例血肿;观察组治疗有效率明显高于对照组(P0.05),且观察组更优(P0.05);观察组口角歪斜程度、眼裂闭合程度等症状,WST、VFSS、NIHSS和SWAL-QOL评分,sEMG最大波幅值以及吞咽过程等改善情况均优于对照组(P0.05);观察组血清IL-6、hs-CRP水平均显著低于对照组(P0.05)。结论深刺双侧风池穴、翳风穴联合神经肌肉电刺激治疗脑卒中后吞咽障碍疗效显著。     

Sarcopenic Dysphagia: A Narrative Review from Diagnosis to Intervention

Sarcopenia, defined as a decline in muscle mass and function related to aging, affects both limb and swallowing-related muscles. Sarcopenic dysphagia is characterized by decreased swallowing function; therefore, early detection of subclinical dysphagia and subsequent intervention appear to be crucial in the elderly. Numerous tools have been employed to measure the function, strength, and mass of swallowing-related muscles in sarcopenic elderly. The swallowing function can be evaluated by questionnaires like Eating Assessment Tool, Functional Oral Intake Scale, and Food Intake Level Scale, and tests such as the modified water swallowing test and videofluoroscopic swallowing study. Surface electromyography and high-resolution manometry can be applied for quantifying swallowing-related muscle strength. Modalities such as ultrasonography and magnetic resonance imaging are capable of estimating the swallowing muscle mass. In patients with sarcopenic dysphagia, a thorough assessment should be given followed by an integrated intervention combining swallowing muscle strengthening, nutrition support, food texture modification, physical, and occupational therapies. This article aimed to comprehensively summarize the diagnostic criteria/tools as well as their associations/performance in sarcopenic dysphagia. The intervention strategy will also be narrated in this review.     

The Incidence of Oropharyngeal Dysphagia in Infants With GERD‐Like Symptoms

Background: Symptoms of infantile gastroesophageal reflux disease (GERD) may overlap with oropharyngeal dysphagia, but the evaluation and treatment of these conditions vary greatly. In this investigation, the incidence of oropharyngeal dysphagia in infants with GERD‐like symptoms is determined. Materials and Methods: A retrospective chart review was performed on infants referred to a pediatric gastroenterology clinic for GERD‐like symptoms. A feeding screen was performed in all infants. Standardized bedside swallow evaluation and modified barium swallow (MBS) studies were then performed when clinically indicated. A similarly aged cohort of normal participants also underwent a standard bedside swallow evaluation for group comparison. Results: Study population included 67 infants. A swallow evaluation was recommended in 39 of 67 infants with abnormalities noted in all. Swallowing abnormalities were more frequent and clustered in infants with GERD‐like symptoms vs controls. MBS was abnormal in 16 of 17 qualifying infants. Characteristics of at‐risk infants included extreme prematurity, developmental delay, or symptoms refractory to antireflux medications. Conclusion: Oropharyngeal dysphagia is prominent in infants with GERD‐like symptoms.     

间歇性口腔食管进食法在帕金森病吞咽障碍患者中的应用

目的 探讨间歇性口腔食管进食法在帕金森病吞咽障碍患者中的应用.方法 以我院2017年3月—2018年的10月间收治80例帕金森病伴吞咽障碍的患者作为探讨对象,按照随机分配原则将其分为对照组与试验组,每组各40例,对照组使用常规胃管鼻饲法进食;试验组则采取间歇性口腔食管进食法,观察各组插管后心率加快次数、插管耗时、首次置...     

Effects of Bolus Rheology on Aspiration in Patients with Dysphagia

Bolus manipulation is a primary treatment strategy in the management of oral-pharyngeal dysphagia. The use of thickening agents to alter bolus rheology is particularly commonplace; however, the precise effects of these alterations on swallowing remain uncertain. The purpose of our study, a prospective, double-blind clinical trial (Level 1b), was to investigate the effects of viscosity on aspiration. One hundred patients with dysphagia were prospectively evaluated with fluoroscopic swallow studies performed across three standardized and randomized conditions: thin liquid barium (THIN), liquid barium thickened with a starch-based agent (STARCH), and liquid barium thickened with a gum-based agent (GUM). Outcome measures included the prevalence of aspiration and score on the Penetration-Aspiration Scale. A total of 23 out of 100 patients exhibited 56 episodes of aspiration. Twenty patients aspirated on THIN, 15 on STARCH, and 11 on GUM bolus conditions (P<0.05, thin vs gum). There were 28 instances of aspiration on THIN, 16 on STARCH, and 12 on GUM. Mean Penetration-Aspiration Scale score±standard deviation was 2.11±2.22 for THIN, 1.76±1.88 for STARCH, and 1.42±1.47 for GUM conditions, respectively (P<0.001, THIN vs GUM). A clinically significant reduction in the incidence of penetration and aspiration was observed for gum-thickened barium compared with thin liquid barium.     

内镜直视下气囊扩张术治疗贲门失弛缓症的随访研究

目的观察评价贲门失弛缓症的内镜直视下气囊扩张术的疗效。方法选择92例贲门失弛缓症并经过内镜下气囊扩张术治疗的患者,术后6个月、1年、2年定期随访,详细询问病史,并经内镜和钡餐检查对原有的吞咽困难等症状缓解程度进行评估。结果92例患者吞咽困难症状均有显著改善。1次扩张有效率达86.9%,2次有效率可达100%。术中可见贲门黏膜撕裂、渗血,未见致命性出血及穿孔等并发症。结论内镜下气囊扩张术治疗贲门失弛缓症可获得良好的近期和远期疗效,具有安全、简便、价廉的特点,是治疗贲门失弛缓症的首选方法。     

老年住院患者吞咽障碍及膳食质量评价

目的 了解老年住院患者吞咽障碍以及其膳食质量,为吞咽障碍患者营养管理措施提供科学依据。方法 65岁以上老年住院患者通过中文版吞咽障碍指数量表(Chinese-Dysphagia Handicap Index, C-DHI)自查吞咽障碍情况,分为吞障风险组和无吞障风险组; 采用中国膳食平衡指数(Diet Balance Index-16,DBI-16)分析两组膳食质量。结果 本研究共收集对象306人,吞障碍风险124人(40.5%),无吞障风险182人(59.5%); 吞障风险组年龄较大(χ²=12.172,P<0.001),且两组营养状况不同(χ²=6.001,P=0.05); 吞障风险组存在中度的摄入不足和中度摄入失衡,膳食模式以模式C(严重的摄入不足)、E(中度摄入不足和摄入过量)、H(严重的摄入过量伴随中度的摄入不足)为主,分别为31.5%、20.2%和16.9%; 吞障组粮谷类摄入量(96.73±73.5)和肉类食物摄入量(65.9±36.9)均低于无风险组(P<0.05)。结论 对于有吞障风险的老年人尽早调整膳食结构和食物质构,以提高老年人健康水平和生活质量。     

Instrumental Swallowing Assessment in Adults in Residential Aged Care Homes: A Scoping Review

ObjectivesTo systematically describe evidence on the use of instrumental swallowing assessment for residents of aged care homes.DesignScoping review using the Joanna Briggs Institute methodology for scoping reviews.Setting and ParticipantsPublished peer-reviewed and gray literature written in English between 2000 and 2020 about instrumental swallowing assessment (ISA) in adults in residential aged care homes (RACHs).MeasuresA systematic, 3-tiered search of databases including Medline, CINAHL, Embase, Scopus, and Cochrane Database of Systematic Reviews, and gray literature databases was conducted. Content analysis identified common themes.ResultsForty-two sources, 30 from peer-reviewed journals, 12 gray literature publications, and 66 websites of mobile ISA providers that discussed videofluoroscopic swallowing studies (VFSS) and/or fiberoptic endoscopic evaluation of swallowing (FEES) use in RACHs were included. Most peer-reviewed sources were referenced narratives or surveys of speech pathology practice patterns (53.3%). Researchers in 3 studies used onsite mobile FEES and in 2 studies off-site VFSS, with adults living in RACHs, as part of their research design (16.7%). There were 66 mobile instrumental swallowing assessment provider websites, based within the United States. Three countries (Australia, United States, United Kingdom) had professional guidelines that stipulated minimal requirements for the safe and appropriate provision of ISA services across settings. Themes identified across sources included (1) the approach to swallowing management and clinical indicators for ISA, (2) the role of ISA, (3) service and consumer influences on ISA, and (4) mobile FEES.Conclusions and ImplicationsThere is a paucity of quality research on instrumental swallowing assessment in adults living in RACHs. There are broad regional and international variances in the way that videofluoroscopy and FEES are accessed and used. A more robust evidence base is required to guide health professionals to design tailored ISA care pathways for residents of RACHs, to achieve high-quality health, social, and economic outcomes.