卒中后吞咽困难的机制、评估与治疗

Mechanism,Evaluation and Treatment of Dysphagia after Stroke

吞咽困难是卒中常见的严重并发症之一,患者不能完成吞咽过程并保护呼吸道,显著影响患者的预后,其发病机制是由于吞咽皮质中枢及其投射纤维、延髓及相关神经的损伤所致。临床上可根据患者症状和体征进行临床筛查和仪器评估,了解其发病机制和评估方法有利于早期识别吞咽困难的有无及其性质,评测治疗手段的有效性和有利于治疗方案的制定。临床治疗上以康复锻炼为主。急性卒中所致的吞咽困难大部分可自行恢复,恢复困难者预后较差,病死率较高。

Dysphagia is one of the most important complications after stroke, with which the patients can not finish the process of swallowing and protect respiratory tract, which can affect their prognesis obviously. This disease results from nervous injury related toswallowing cortical area and its projection fibers as well as medulla and its related nerves. In mechanism. Clinical screening evaluation by instrument can be made based on symptoms and signs in clinic, Recognition of pathogenesy and evaluation method is helpful to recognize the existence of dysphagia or not earlier and its character, to evaluate the effectiveness of therapoutiv methods and design of therapeutic regimen. Rehabilitation exercise is its main clincal therapy. The majority of dysphagia resulting from acute apoplexy can autonomously recover, patients having difficulty in recovery have oor prognosis and high case fatality.