脑卒中患者吞咽障碍及康复效果影像学研究

目的探讨电视X线透视吞咽功能检查（videofluoroscopic swallowing study,VFSS）在脑卒中患者吞咽功能评估中的应用价值,观察脑卒中后吞咽障碍发生情况,康复前后患者吞咽功能变化.方法脑卒中患者70例及健康成人80名分别作为研究组与对照组均进行VFSS,比较两组误吸等VFSS异常征象的发生情况.对发现误吸患者进行吞咽功能康复训练4周,训练后复查VFSS,比较训练前后吞咽异常的发生情况变化.结果对照组渗透或误吸、口腔滞留、咽腔滞留的发生率为5.0%,13.4%,25.3%.主要为轻度渗透及口咽腔滞留.研究组渗透或误吸、口腔滞留、咽腔滞留发生率为45.0%,46.5%,48.9%,主要为重度渗透或误吸,中重度口咽腔滞留.其中隐匿性误吸为10次（占总误吸的24.4%）.误吸患者康复治疗后渗透或误吸发生率较康复治疗前减少（P＜0.05）.结论脑卒中后吞咽障碍在康复期仍较为常见,可表现为多种影像学异常.VFSS可确切诊断吞咽异常,进行针对性康复训练,使患者吞咽功能提高.

A radiological study of dysphagia and rehabilitative outcome in post-stroke patients

Objective To explore the effects of videofluoroscopic swallowing study (VFSS) in the assessment of dysphagia in post-stroke patients. To study the representation and rehabilitative outcome of dysphagia following stroke. Methods Seventy post-stroke patients and 80 normal adults were assigned to study group and control group and underwent VFSS. Abnormal signs on VFSS were compared between 2 groups. Aspiration patients received swallowing therapy for 4 weeks followed by VFSS again. Abnormal signs on VFSS were compared with those of pre-treatment. Results Penetration/aspiration, oral retention and pharyngeal retention occurred respectively at a frequency of 5.0%, 13.4% and 25.3% in control group in mild status, 45.0%,46.5%, 48.9% in study group in moderate to severer status. 10 times of silent aspiration were seen, accounting for 24.4% of all aspiration. The frequency of severe penetration/ aspiration decreased after the treatment (P<0.05). Conclusion Dysphagia following stroke was still common in convalescence. There are many abnormal radiological signs seen on VFSS. VFSS could confirm dysphagia. The swallowing therapy, according to VFSS, increases the swallowing function of post-stroke patients.