卒中患者渗透/误吸的影像学初步研究

目的 探讨电视X线透视吞咽功能检查（videofluoroscopic swallowing study,VFSS）在卒中患者误吸评估中的应用价值,观察卒中后渗透/误吸发生率。方法 对70例卒中患者（研究组）及80例健康成人（对照组）分别进行VFSS,比较两组误吸的发生情况及误吸与口、咽腔滞留的关系。研究组中,VFSS检查与发病的时间间隔为（61±32）d。结果 对照组无误吸发生,主要为轻度渗透。研究组各种食团吞咽均有渗透/误吸现象发生,主要为重度渗透/误吸,尤其是液体食团。其中隐匿性误吸占总误吸的24.4%。与无误吸组比较,误吸组中重度咽腔滞留发生率明显升高（P <0.05）。结论 卒中后误吸在康复期较为常见,可出现在各种食团吞咽中。VFSS是确切诊断误吸的方法。     

表面肌电生物反馈疗法联合吞咽康复训练对脑卒中后吞咽障碍功能恢复的影响

目的研究表面肌电生物反馈(sEMGBF)疗法联合吞咽康复训练对脑卒中后吞咽障碍功能恢复的影响。方法将我院收治的76例脑卒中后吞咽功能障碍患者随机分为2组,各38例,对照组仅进行吞咽康复训练,研究组实施sEMGBF疗法联合吞咽康复训练方案,比较2组拔管率、拔管时间、治疗前后吞咽功能、吞咽障碍恢复效果及并发症情况。结果研究组吞咽障碍恢复总有效率为92.11%,高于对照组73.68%(P0.05);2组治疗8周后拔管率比较无明显差异(P0.05);研究组拔管时间明显短于对照组,且VFSS评分明显高于对照组(P0.05);研究组并发症总发生率7.89%,低于对照组47.37%(P0.05)。结论对脑卒中后吞咽障碍患者采取sEMGBF联合吞咽康复训练治疗方案,能缩短拔除鼻饲管时间,有效提高吞咽功能,获得良好恢复效果,同时并发症少,值得推广。     

Logistic回归及ROC曲线综合评价溶积-黏度测试法对脑卒中口咽吞咽障碍诊断的应用价值

目的探讨Logistic回归及ROC曲线综合评价溶积-黏度测试法对脑卒中口咽吞咽障碍诊断的应用价值。方法选取2018年6月-2018年12月期间来我院接受治疗的脑卒中患者220例,所有患者均接受溶积-黏度测试法及视频透视检查(VFSS),采用Logistic回归分析筛选溶积-黏度测试中各项指标诊断口咽吞咽障碍的指标。然后得出口咽吞咽障碍诊断的回归方程,最后采用ROC曲线评价回归方程的最佳诊断分界值及诊断效能。结果 220例脑卒中患者中,经VFSS法检查确诊为口咽吞咽障碍98例,V-VST法诊断为口咽吞咽障碍89例(4例由吞咽造影诊断为阴性),阴性131例(13例由VFSS法诊断为阳性),即遗漏诊断13例,错误诊断4例,其准确率为92. 27%,特异性为90. 08%,灵敏度为86. 73%,多因素Logistic结果显示血氧饱和度、口腔残留、吞咽次数及咽部残留与口咽吞咽障碍相关性分别为0. 134、19. 394/74. 301及172. 344,均具有统计学差异(P 0. 05),最终胰腺癌的概率预测模型为P=1/[1+e~(-(181. 651-2. 010血氧饱和度+2. 965口腔残留+4. 308口腔残留+5. 149咽部残留))],新变量P的AUC为0. 999,远远高于其他变量,新变量P检验的诊断效能最好。结论行溶积-黏度测试法检查时联合血氧饱和度、口腔残留、吞咽次数及咽部残留的回归模型能够提高对口咽吞咽障碍的诊断效能,可提高其诊断敏感性和特异性,具有较高的临床应用价值。     

康复护理对脑卒中患者摄食-吞咽功能恢复的应用效果观察

目的探讨康复护理对脑卒中患者摄食-吞咽功能恢复的应用效果。方法选取我院收治的158例脑卒中患者作为研究对象,随机分为观察组和对照组各79例,对照组给予常规护理,观察组在对照组的基础上给予康复护理干预。比较2组经摄食-吞咽功能训练后吞咽障碍程度和不良反应发生情况。结果 2组治疗后在摄食-吞咽障碍程度方面并无明显差异(P0.05),而观察组治疗过程中出现误咽、误吸、食管反流以及肺部感染的人数明显少于对照组,差异有统计学意义(P0.05)。结论对脑卒中患者摄食-吞咽功能训练过程中采取相应的康复护理干预,可有效减少患者出现误咽、误吸、食管反流以及肺部感染的发生率,值得临床推广使用。     

急性脑梗死部位及面积与吞咽障碍类型的关系

目的 探讨急性脑梗死部位及面积与吞咽障碍类型的关系.方法 对181例急性脑梗死患者及6名健康志愿者进行X线电视透视吞咽功能检查(videofluoroscopy swallowing study,VFSS),记录异常表现,吞咽障碍分口期、咽期及口咽混合期;通过磁共振软件测DWI序列梗死的面积及梗死部位.结果 急性期脑梗死患者吞咽障碍发生率为66.3%(120/181),前循环为67.7%(86/127),后循环为63.0%(34/54).多发性梗死出现吞咽障碍者高于皮层或基底节区梗死,丘脑梗死导致吞咽障碍低于桥脑梗死(P＜0.05);前循环梗死出现吞咽障碍主要为口咽混合期,后循环梗死出现吞咽障碍主要为咽期(P＜0.05),其中桥脑梗死主要表现为咽期吞咽障碍,而延髓梗死主要表现为口咽混合期吞咽障碍(P＜0.05).前、后循环不同面积梗死与吞咽障碍的发生及类型无关(P＞0.05).结论 急性脑梗死后吞咽障碍的发生及类型与梗死部位有关,而与梗死面积无关.     

脑卒中并发吞咽障碍的康复护理

目的 总结脑卒中患者吞咽障碍的康复护理.方法 加强心理护理,保持口腔清洁,进行摄食前基础训练和摄食训练.结果 显著提高了脑卒中并发吞咽障碍患者的康复效果.结论 对脑卒中并发吞咽障碍的患者应及时进行吞咽功能的康复训练.     

康复训练和吞咽治疗仪治疗卒中后吞咽障碍的疗效分析

目的探讨吞咽康复训练联合吞咽治疗仪对脑卒中吞咽障碍患者的康复效果。方法将80例脑卒中后吞咽障碍的患者分为治疗组和对照组各40例,均给予常规药物治疗和吞咽功能康复训练,治疗组在此基础上加用吞咽治疗仪治疗。康复治疗前及治疗后15d,评定吞咽功能。结果 2组均能改善吞咽障碍,但治疗组疗效优于对照组(P<0.05)。结论吞咽康复训练联合吞咽治疗仪可促进脑卒中吞咽障碍患者吞咽功能恢复。     

VitalStim吞咽治疗仪治疗急性脑梗死后不同阶段吞咽障碍的疗效

目的观察VitalStim吞咽治疗仪对急性脑梗死后不同阶段吞咽障碍的疗效。方法 135例急性脑梗死后吞咽障碍患者分为口腔期组、咽期组及混合期组各45例,均应用VitalStim吞咽治疗仪进行康复治疗,治疗28 d后比较疗效。结果三组患者治疗后吞咽功能评分与治疗前比较有所降低(均P0.05)。咽期组治疗后吞咽功能评分与口腔期组、混合期组的治疗后比较有所降低(均P0.05)。咽期组总有效率与口腔期组、混合期组总有效率比较有所升高(均P0.05)。结论 VitalStim吞咽治疗仪可改善不同类型吞咽功能障碍患者的吞咽功能,其中咽期吞咽功能康复效果优于口腔期及口咽混合期吞咽障碍。     

吞咽造影检查联合内镜吞咽检查在脑卒中后吞咽功能 评估中的应用价值

目的 探讨电视X线透视吞咽功能检查（VFSS） 联合内镜吞咽检查（FEES） 在脑卒中患者吞 咽功能评估中的应用价值。方法 2014 年6 月—2016 年10 月,将收治的108 例脑卒中患者随机分为实 验组和对照组各54 例。对照组采用VFSS进行评估,实验组采用VFSS 和FEES 进行评估。所有患者根 据评估结果进行针对性治疗和康复训练。观察比较两组患者的误吸检出率、治疗前后吞咽功能变化和 疗效差异。结果 与对照组（22.22%）相比,实验组患者的误吸检出率（50.00%）明显较高,且差异有统计 学意义（χ2=15.62,P＜ 0.01）;治疗后,两组患者VFSS 评分均较治疗前明显升高（P＜ 0.05）,且实验组高 于对照组,差异有统计学意义（P＜ 0.01）;实验组总有效率（87.03%）高于对照组（70.37%）,差异有统计学 意义（χ2=3.31,P=0.042）。结论 VFSS联合FEES 有助于脑卒中后吞咽功能评估,值得在临床上推广。     

神经肌肉电刺激结合饮食指导对卒中后吞咽障碍患者的疗效

目的 探究神经肌肉电刺激结合饮食指导对脑卒中后吞咽障碍的治疗,并分析其治疗效 果。方法 选择2014 年6 月—2016 年10 月因脑卒中后首次出现吞咽障碍患者95 例纳入本次研究,并 随机分为研究组（47 例）和对照组（48 例);后因肺部感染等病因出现脱落,研究组脱落2 例,对照组脱落 3 例。对照组采用传统吞咽康复训练,研究组患者则在进行传统吞咽康复训练基础上,根据吞咽障碍发 生原因,进行神经肌肉电刺激治疗,并结合相应的饮食指导,包括改进食物性状、调整患者进食体位、 针对性改进喂养方法、选择进食器具、训练吞咽技巧等方面进行全面指导。为评估治疗效果,对脑卒 中吞咽障碍患者于治疗前后分别采用电视荧光放射吞咽功能检查（VFSS）评分法、功能性经口摄食量表 （FOIS）、视频吞咽造影功能障碍量表（VDS）评价患者吞咽功能。结果 训练后两组的吞咽功能评分较训 练前均有显著提高（P＜ 0.05）,但训练后研究组功能评分明显高于对照组（P＜ 0.05）,研究组的好转情况 要显著优于对照组。两组患者干预前,摄食情况、VDS 评分比较,差异无统计学意义（P＞ 0.05）;干预后, 两组患者摄食情况、VDS评分均存在一定程度改善,且研究组优于对照组（P＜ 0.05）。研究组治疗总有 效率为86.67%,对照组为68.90%,研究组高于对照组（χ2=3.38,P=0.026）。结论 神经肌肉电刺激结合 饮食指导训练对改善脑卒中患者吞咽功能障碍的疗效优于单纯吞咽训练。     

The effect of 5Hz high‐frequency rTMS over contralesional pharyngeal motor cortex in post‐stroke oropharyngeal dysphagia: a randomized controlled study

Background We sought to find the therapeutic effect of 5Hz high‐frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected pharyngeal motor cortex in post‐stroke dysphagic patients. Methods Eighteen patients with unilateral hemispheric stroke oropharyngeal dysphagia that lasted more than 1 month were randomly divided into two groups. They all performed videofluoroscopic swallowing study (VFSS) before rTMS intervention. The experimental group (EG) received 5Hz rTMS over contra‐lesional pharyngeal motor cortex for 10 min per day for 2 weeks. The control group (CG) received sham stimulation under the same condition. Videofluoroscopic swallowing study were performed again just after treatment cessation and 2 weeks afterward. The evaluation was performed using videofluoroscopic dysphagia scale (VDS) and penetration‐aspiration scale (PAS). Key Results Mean baseline VDS and PAS of EG was 33.6 ± 12.1 and 3.41 ± 2.32 respectively and the scores were reduced to 25.3 ± 9.8 and 1.93 ± 1.52 just after 2 weeks intervention (P < 0.05). This effect lasted for up to 2 weeks after treatment. However, there was no change in the CG. Baseline prevalence of aspiration, pharyngeal residue, delayed triggering of pharyngeal swallowing and abnormal pharyngeal transit time (PTT) in EG was 66.7%, 66.7%, 33.3%, and 44.4%, respectively. After rTMS, the prevalence of aspiration and pharyngeal residue was reduced to 33.3% and 33.3%, respectively. However, the prevalence of delayed triggering and abnormal PTT was not changed. Conclusions & Inferences A 5Hz high‐frequency rTMS on contra‐lesional pharyngeal motor cortex might be beneficial for post‐stroke dysphagic patients. This intervention can be used as a new treatment method in post‐stroke patients with dysphagia.     

NMES疗法及单纯吞咽训练对脑卒中后吞咽障碍的疗效观察

目的分析脑卒中后吞咽障碍患者采用神经肌肉电刺激疗法(NMES)联合单纯吞咽训练治疗的疗效。方法选取本科2013年1月至2015年1月的脑卒中后吞咽障碍患者90例,随机分为NMES联合治疗组和常规单纯运动训练组,常规单纯运动训练组予以单纯吞咽功能训练,NMES联合治疗组在常规单纯运动训练组基础上加用NMES疗法。对比两组患者治疗前后的各项吞咽功能评分和临床疗效。结果治疗3个疗程后,NMES联合治疗组和常规单纯运动训练组的洼田饮水试验分级、口面运动功能评分显著低于治疗前,吞咽X线电视透视检查(VFSS)评分、藤岛一郎吞咽疗效评分显著高于治疗前(P0.05);治疗3个疗程后,NMES联合治疗组的洼田饮水试验、口面运动功能评分显著低于对照组,VFSS评分、藤岛一郎吞咽疗效评分显著高于常规单纯运动训练组(P0.05)。治疗3个疗程后,NMES联合治疗组的总有效率为95.55%(43/45)显著高于常规单纯运动训练组77.78%(35/45)(P0.05)。结论对于脑卒中后吞咽障碍患者单纯吞咽训练联合采用NMES疗法,疗效更佳。     

Dysphagia and multiple sclerosis

Over 30% of persons with multiple sclerosis (pwMS) suffer from swallowing symptoms, a higher rate than previously assumed. Neurogenic dysphagia (ND) may cause many different kinds of oropharyngeal sensorimotor dysfunctions in pwMS, and is associated with both the amount of disability and brainstem signs. About 15% of pwMS with mild disability may also suffer from ND. Diagnostic tools comprise history taking, bedside screening examination (50 ml water test combined with assessment of pharyngeal sensation or with pulse oximetry) and sometimes a videofluoroscopic swallowing study (VFSS) and fibreoptic endoscopic evaluation of swallowing (FEES). VFSS and FEES are complementary methods and both have advantages and disadvantages. Interventions for ND in pwMS are mainly based on functional swallowing therapy, including methods of restitution, compensation and adaptation. The aim of intervention is to prevent aspiration and aspiration pneumonia. Outcome assessment should focus on clinically relevant parameters, such as activity limitation, participation restriction and health-related quality of life.     

神经肌肉电刺激对卒中后吞咽障碍治疗作用的研究

目的 应用视频透视吞咽检查（video fluoroscopy swallowing study,VFSS）方法从吞咽运动学变化方 面研究神经肌肉电刺激（neuromuscular electrical stimulation,NMES）对卒中患者吞咽障碍的治疗作用。 方法 将卒中后吞咽障碍患者随机分为研究组和对照组,研究组给予NMES治疗,对照组给予假 刺激,治疗均为每次20 mi n,5次/周,持续4周。同时所有患者均进行吞咽常规训练。治疗前后均行 VFSS,获取3 ml液态钡食、10 ml液态钡食、半固体钡食及固体钡食4种食团吞咽的Rosenbek渗透-误吸 量表（penetration-aspiration scale,PAS）评分、咽传递时间（pharyngeal transit time,PTT）、咽延迟时间 （pharyngeal delayed time,PDT）、舌骨向前最大幅度、舌骨向上运动最大幅度、喉向前最大幅度及喉向 上运动最大幅度。对比两组治疗前后PAS量表评分及上述吞咽运动学参数的变化。 结果 研究共纳入43例患者,其中研究组23例,对照组20例。治疗后,两组患者4种食团吞咽时PAS评 分均较治疗前下降,PTT、PDT较治疗前缩短（均P＜0.05）。治疗前和治疗后,研究组在各食团吞咽时 PAS评分及PTT、PDT较对照组差异均无显著性。治疗前,两组间舌骨向前、向上运动,喉向前、向上运 动的最大幅度差异均无显著性;治疗后,研究组食团吞咽时舌骨向上运动、喉向上运动的最大幅度 均较对照组显著增大（均P＜0.05）,但两组舌骨向前、喉向前运动差异无显著性。 结论 NMES和常规吞咽康复训练均可改善卒中患者的吞咽功能。NMES更能提高喉-舌骨复合体的向 上运动。     

脑卒中后吞咽困难的影像学分析

目的明确脑卒中后吞咽困难在X线透视影像学上的表现及特点.方法对56例脑卒中后吞咽困难患者及30名健康志愿者进行X线电视透视检查,记录异常表现,测量定量参数.统计方法采用秩和检验、t检验、卡方检验及Logistic回归分析.结果脑卒中后所有吞咽器官都表现功能异常,口期吞咽异常者46例,咽期异常者56例.与正常组对照,误吸组喉上抬幅度、速度降低,环咽肌打开宽度减少,吞咽潜伏期延长.34例存在误吸.误吸与舌运动减弱（P=0.021）、舌与硬腭接触不良（P=0.021）、声门关闭不全（P=0.011）、喉上抬慢且幅度降低（P=0.003）、吞咽延迟（P=0.001）及穿透（P=0.000）有关.结论脑卒中可损伤所有参与吞咽的器官,咽期吞咽更易受损,舌肌无力、声门关闭不全、喉结构上抬差及吞咽延迟可造成误吸.     

脑卒中后吞咽障碍196例临床分析

目的探讨吞咽障碍与脑卒中患者预后的相关性,旨在提高对卒中后吞咽障碍的重视。方法选择住院的397例急性脑卒中患者为研究对象,入院后48h内完成标准吞咽评估(standardized swallowing assessment,SSA)。观察急性卒中后吞咽障碍发生率、误吸发生率、1个月内获得性肺炎发生率。按SSA分为吞咽障碍组和无吞咽障碍组。6个月后完成改良Rankin量表(mRS)评分、Barthel指数(BI)评分、NIHSS评分。比较2组预后情况。结果 397例卒中患者中196例吞有咽障碍(49.37%),其中误吸112例,6个月后45例仍存吞咽障碍,8例仍需胃管饮食。无吞咽障碍组BI评分、NIHSS评分分别高于、低于吞咽障碍组(P<0.05),预后良好率高于吞咽障碍组(P<0.05)。结论卒中后吞咽障碍发生率较高,吞咽障碍影响脑卒中患者预后。     

Deglutition disorders in neurological patients. A prospective study of diagnosis,pattern of impairment,therapy and outcome

We performed a prospective study on 208 patients with neurogenic dysphagia who were consecutively admitted for swallowing therapy over a 3-year period. The most frequent etiology was stroke (48%). Videofluoroscopic and/or fiber optic endoscopic evaluation of swallowing were performed in 204 patients. Swallowing therapy was comprised of restitution methods, compensation, and adaptation, each of which was applied in more than 80% of the patients. Mean duration of swallowing therapy was 2 months (full oral patients 1 month, patients dependent on tube feeding or tracheostomy 2.5 and 3.5 months, respectively). Fifty-five percent of the patients initially dependent on tube feeding were full oral feeders after swallowing therapy. A target variable reflecting functional feeding status showed significant improvement after swallowing therapy, also in patients with a disease duration of more than half a year, ruling out spontaneous recovery as a sole explanation of amelioration. The following variables were the main contributors to outcome prediction: functional feeding status, Barthel index, duration of disease, and degree of aspiration as shown by endoscopy.     

Effects of Comprehensive Swallowing Intervention on Obstructive Sleep Apnea and Dysphagia After Stroke: A Randomized Controlled Trial

ObjectiveThis study aims to explore the effects of comprehensive swallowing intervention on obstructive sleep apnea (OSA) and dysphagia in stroke patients.MethodsWe performed a randomized controlled trial in stroke patients with obstructive sleep apnea (OSA) complicated by dysphagia, divided into treatment group and control group. The treatment group underwent comprehensive swallowing intervention and received swallowing care for 4 weeks, while the control group received only swallowing care. Outcome measurements were obtained at baseline and after the 4-week intervention, evaluated by polysomnography (PSG), videoendoscopic swallowing study (VFSS) synchronized surface electromyography (sEMG), oropharyngeal magnetic resonance imaging (MRI) and swallowing assessment scales.ResultsSixty patients with stroke (30 treatment and 30 control) were eligible to participate in this study. There were no significant differences in any assessment between two groups at baseline. After a 4-week intervention, compared with to control group, there was a significant decrease in the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), and increased mean and minimal oxygen saturation (SaO₂), amplitudes of suprahyoid muscle group (ASUPMG) and subhyoid muscle group (ASUBMG). Moreover, the posterior palatal distance (PPD), posterior lingual distance (PLD) and minimal cross-sectional area (MCSA) were obviously elevated in the treatment group. Additionally, the scores of Gugging swallowing screen (GUSS) and VFSS were significantly increased in the treatment group, compared to control group.ConclusionsThe comprehensive swallowing intervention had therapeutic effects on OSA and dysphagia after stroke, and the mechanism was related to enhancing oropharyngeal muscle strength and changing upper airway structure.     

A Comparative Study of Two Tube Feeding Methods in Patients with Dysphagia After Stroke: A Randomized Controlled Trial

Background: Dysphagia is a common symptom seen in stroke patients, it not only affects patients' nutrition supply, but also causes aspiration pneumonia. To solve the problem of nutritional support for patients with dysphagia after stroke, nasogastric tubes are routinely indwelling to provide nutrition in China. However, this feeding method sometimes causes food reflux, aspiration, pneumonia, and often affects the patients’ comfort and self-image acceptance. Aim: The aim of this study was to determine whether a new feeding method called intermittent oroesophageal (IOE) tube feeding compared with continuous nasogastric tube feeding as a practical and beneficial mean of decreasing the rate of stroke associated pneumonia (SAP), and improving patients’ swallowing function, comfort, psychological status. Design: This was an assessor-blinded, single-center, randomized controlled trial. Methods: Ninety-seven hospitalized stroke patients with dysphagia in the rehabilitation department from January to December 2018 were randomized to a control group and an intervention group. Patients in both groups received routine nursing, rehabilitation treatment and swallowing therapy. Patients in the intervention group were given IOE tube feeding, while those in the control group were fed by indwelling nasogastric tube. Outcomes were assessed at admission, discharge or the end of the tube feeding. Results: The incidence of SAP in the intervention group was 16.33% lower than that (31.25%) in the control group; the comfort score (2.08 ± .64), anxiety score (10.98 ± 2.28), depression score (7.39 ± 2.16) were lower than those (3.02 ± .70), (12.10 ± 2.18), (8.42 ± 2.34) in the control group. The improvement rate of swallowing function in the intervention group was 83.67% higher than that (66.67%) in the control group (all P < .05). Conclusions: The IOE tube feeding compared with continuous tube feeding may reduce the incidence of SAP, and improve patients’ swallowing function, comfort, psychological status in patients with dysphagia after stroke.