卒中后吞咽延迟患者与健康志愿者吞咽任务相关功能磁共振的对比研究

Comparison of Central Activation between Volunteers and Ischemic Stroke Patients with Dysphagia during Swallow Tasks

目的探讨吞咽延迟卒中患者吞咽任务相关的吞咽中枢激活区域的变化,以期寻找吞咽延迟与吞咽中枢异常之间的关系。方法5例经电视透视检查证实存在吞咽延迟的缺血性卒中患者以及7例健康志愿者接受功能磁共振成像检查。试验者间隔一定时间(从20、25、30s中随机抽取一个时间)向受试者口中注入1ml室温纯净水,令受试者进行吞咽。共注入11ml水。在3.0T核磁共振仪(西门子)上,利用血氧水平依赖法(BOLD)采集吞咽过程的数据。结果电视透视检查发现吞咽延迟卒中患者吞咽潜伏期中位数为0.09(0.03～0.15)s。2例患者有轻度的会厌谷滞留,1例患者存在咽部感觉减退,其余无明显异常表现。患者的功能磁共振结果显示研究组没有岛叶激活,但有扣带回激活。对照组有岛叶激活但没有扣带回激活。研究组运动区激活区域少于健康志愿者。结论患者在自主吞咽过程中没有岛叶激活提示自主吞咽脑区功能异常,可能与吞咽延迟有关。运动皮层激活区少于健康志愿者可能与吞咽肌力弱有关。

Objective To identify the change of swallow related central activation in ischemic stroke patients compared with healthy volunteers in the same swallow tasks. Methods Five ischemic stroke patients with dysphagia and seven healthy adult volunteers were studied utilizing blood oxygenation level-dependent technique on a 3.0 T magnetic resonance scanner(Seimens). Subjects swallowed 1 ml water bolus after it was infused into their oral cavity through a plastic catheter placed in the midline in certain interval time(20, 25 or 30 s in randomized sequence) and total 11 boluses were injected. Patients also undertook videofluoroscopic examination during drinking 5 ml 60% w/v barium. Results Videofluoroscopy investigation indicated significant delayed pharyngeal swallow with median latency time to be 0.09(0.03-0.15) s. Two patients had mild residue in epiglottic vallecula and one patient had decreased sensation of pharynx. There were no other significant abnormalities in videofluoroscopic examination. Patients had no insular activation but the anterior cingule was activated, while not in volunteers. The sites of activated motor cortex in patients were less than those in volunteers. Conclusion No insular activation indicates that voluntary control of swallow in patients is decreased which may lead to delayed pharyngeal swallow. Activation areas of motor cortex in patients smaller than volunteers may be associated with the voluntary control of swallowing injured or weakness of swallowing muscles.