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.

Image characteristics under videofluoroscope of dysphagia in stroke

Objective Videofluoroscopy could identify the pathophysiologic changes of swallowing and be help to make management plan. The study was to identify image manifestation and characteristics of dysphagia in stroke under X-ray. Methods Videofluoroscopy were performed in 56 stroke inpatients and 30 healthy volunteers who drunk 1, 3 and 5 ml barium with viscosity of 60%w/v, 180%w/v and ate half piece of cake smeared with barium. Abnormal swallowing and quantitative measurements in antero-posterior and lateral position were recorded. Chi square test and Logistic regression analysis were used to identify abnormal swallowing associated with accidental aspiration. Rank test and t test were used to analysis the difference of quantitative measurements between control and accidental aspiration group. Results All the swallowing apparatus could be injured after stroke which led to a variety of abnormal oral and pharyngeal swallowing including decreased tongue and palate motility, insufficient glottis closure, delayed swallowing, accidental aspiration etc. All patients presented abnormality in pharyngeal phase and 46 in oral phase. Compared with that of volunteers, height and velocity of larynx elevation decreased, opening width of cricopharyngeal muscle reduced and swallowing latency prolonged in dysphagia patients. Accidental aspiration was seen in 34 patients, of whom 14 patients presented silent aspiration. Statistic analysis showed that decreased tongue movement(P=0.021), poor tongue-hard palate contact (P=0.021), insufficient glottis closure(P=0.011), decreased height and velocity of larynx elevation(P=0.003), delayed swallowing (P=0.001) and penetration (P=0.000) were associated with accidental aspiration. Conclusions Stroke may injure all the swallowing apparatus, more frequently in pharyngeal phase. Tongue weakness, insufficient glottis closure, poor larynx elevation, delayed swallowing and penetration are associated with accidental aspiration.