脑卒中合并吞咽困难患者上食管括约肌动力特征

Characteristics of Upper Esophageal Sphincter Motility in Stroke Patients with Dysphagia

【目的】探讨脑卒中吞咽困难患者上食管括约肌（UEs）动力特征。【方法】急性脑卒中伴吞咽困难的患者20例（卒中组），健康志愿者19名（对照组），行高分辨率食管测压检查，测量两组对象的UES的静息压、残余压、松弛持续时间、恢复时间、松弛前峰压及松弛后峰压。【结果】卒中组患者UES静息压力、UES松弛持续时间、UES松弛后峰压、UES松弛恢复时间均明显低于对照组（P〈0．05），UES松弛时残余压明显高于对照组（P〈0．05），两组患者UES松弛前峰压比较无明显差别（P〉0．05）。【结论】脑卒中合并吞咽困难患者存在UES异常动力功能，异常的UES动力功能对吞咽困难患者气道保护不利，可能增加并发症的风险。

[Objective] To explore the characteristics of upper esophageal sphincter（UES） motility in stroke patients with dysphagia by using high-resolution esophageal manometry system. [Methods] Twenty cases of acute stroke with dysphagia（stroke group） and nineteen healthy volunteers（control group） were enrolled in this study. A high-resolution esophageal manometry was used to measure the resting pressure, residual pressure, relaxation duration, recovery time of UES and peak pressure before and after the relaxation of UES in patients of two groups. [Results] The resting pressure of UES, the duration of UES relaxation, the peak pressure after UES re- laxation, the recovery time of UES relaxation in stoke group were obviously lower than those in control group（ P 〈0.05）. The residual pressure of UES relaxation in stroke group was obviously higher than that in control group （ P〈0.05）. There was no significant difference in the peak pressure before UES relaxation between stroke patients with dysphagia in stroke group and control group（ P 〉0.05）. [Conclusion] Stoke patients with dysphagia has the dysfunction of UES including low resting pressure of UES, short relaxation duration and recovery time and low peak pressure after UES relaxation. Complete UES relaxation is very important for the clearance of oral secretion and the transport of food bolus. Abnormal UES motility has adverse effect on airway protection of dysphagia patients, and may increase the risk of complications and affect the prognosis and quality of life.