脑卒中吞咽困难异常表现与影像学表现的相关性分析

目的 探讨脑卒中患者吞咽困难临床表现与其影像学异常表现的相关性。方法 对56例住院治疗的脑卒中吞咽困难患者进行临床评估及电视透视检查（VF检查），并对上述2种方法的检查结果进行相关性分析。结果 经Logistic回归分析后发现，食物或水从口角漏出（P=0．037）可预测唇闭合异常，仰头动作（P=0．010）及构音障碍（P=0．025）可预测舌运动障碍，喉上抬差（P=0．024）、咽反射减弱或消失（P=0．005）可预测会厌返折不全，用力吞咽（P=0．016）可预测喉上提异常，进食呛咳可预测声门关闭不全（P=0．011）及误吸（P=0．042）；未发现有临床表现可准确预测软腭运动障碍、咽蠕动减弱、环咽肌打开不全等影像学异常改变。结论 脑卒中吞咽困难患者的某些临床表现可以有效预测影像学检查下的部分器官功能异常改变，增强了临床评估的准确性及客观性，有利于指导那些不能接受VF检查的患者进行吞咽障碍治疗。

The value of abnormal clinical manifestations in predicting image abnormalities in patients with dysphagia caused by stroke

Objective To identify whether abnormal clinical manifestations of dysphagia in stroke patients could predict associated imaging abnormalities. Methods Clinical evaluations and videofluoroscopy were performed on 56 consecutive cases of stroke. The clinical and image manifestations of dysphagia were observed and analyzed u-sing logistic regression analysis. Results A bolus leaking from the mouth was found (P =0.037) to predict abnormal lip closure. Raising the head when swallowing (P =0.010) and dysarthria (P =0.025) were found to predict reduced tongue movement. Exertion in swallowing (P = 0.016) could predict poor laryngeal elevation. Abnormal la-ryngeal elevation (P =0.024) and reduced or absent gag reflex (P =0.005) were found to predict insufficient epiglottis tilt down. Coughing caused by swallowing could predict incomplete vocal fold closure (P =0.011) and aspiration (P = 0.042). Conclusion Videofluoroscopic manifestations could be predicted to some extend by some clinical swallowing abnormalities, which could increase the accuracy of clinical evaluation and help in the management of dysphagia in those who could not endure videofluoroscopy.