脑卒中后吞咽障碍的异常模式

The abnormal swallowing modes in videofluorographic study after stroke

目的:初步探讨脑卒中后吞咽器官在X线透视下是否存在不同的异常运动模式。方法:对80例脑卒中后吞咽困难患者进行电视透视检查,吞咽60%W/V液体钡剂5ml,对吞咽器官的异常运动进行定性和定量测量,区分不同模式。结果:脑卒中后吞咽困难的患者表现出三种不同的吞咽模式,分别为以舌肌无力为主的口腔期吞咽困难、以舌骨及喉结构复合体运动保留的咽期运动损伤模式、以舌骨及喉结构运动分离为主的吞咽异常。结论:脑卒中后吞咽困难有多种模式,可能与病变部位有关。明确不同的模式有助于采用不同的康复方法。

Objective：To prove the hypothesis that there may be different swallowing modes in dysphagia stroke patients.Method：Consecutive 80 dysphagic patients underwent videoflouroscopy drinking 5ml 60% W/V liquid barium. Height percent of larynx raise was calculated by＂ the vertical excursion of air volume in the main bronchus according to its position at rest.Result：There were 3 swallowing modes.Mode l： There were 7 male patients presenting abnormal oral swallowing mainly injured tongue movement. The pharyngeal swallowing did not present difficulties. Barium couldn＇t be push backward by the tongue and fell into pharynx by the gravity. All the patients had aspiration because of delayed swallow.Mode 2： In this mode,there were two subtypes named group A and B. Of group A,hyoid elevation decreased （66.31%±13.46%） with significantly delayed pharyngeal swallowing （0.08s±0.104s）. Delayed swallowing was the main cause of aspiration. Of group B,hyoid-laryngeal complex elevation were significantly decreased （45.38%±17.80%） which made short laryngeal closure（0.03s±0.015s） and obvious aspiration. Mode 3： Total 15 patients presented divergent movement of hyoid and larynx with no or light injured oral phase. The hyoid movement triggered in time or delayed lightly（0.024s±0.03s） with sufficient excursion,while larynx raise delayed for 1.34s±2.27with decreased excursion 26.74%±12.72%. Larynx closure time was 0.07s±0.03s. Aspiration happened in all patients.Conclusion：Different swallowing modes in stroke patients may be helpful to identify the main cause in swallow,which could facilitate the management.