重度创伤性颅脑损伤恢复期患者吞咽功能障碍的影像学特点

Imaging swallowing dysfunction among patients recovering from severe traumatic brain injury

目的观察重度创伤性颅脑损伤（TBI）恢复期患者吞咽功能的影像学特点，探讨电视X线透视吞咽功能检查（VFSS）的临床意义。方法对重度TBI恢复期患者（TBI组）40例和健康志愿者（健康组）40例分别进行VFSS检查，观察2组的渗透、误吸情况，并分析比较2组口腔期及咽期的时间及空间参数的异同点。结果健康组中17例（42．5％）出现轻度渗透，未出现重度渗透和误吸患者；TBI组5例（12．5％）发生轻度渗透，12例（30．0％）发生重度渗透，17例（42．5％）发生误吸。发生重度渗透和误吸的29例TBI患者，在吞咽3ml液体时的口腔启动延迟时间（ODT）、口腔传送时间（OTT）、咽启动延迟时间（PDT）、咽传送时间（PTT）以及舌骨上抬、前移幅度，分别为（0．86±0．37）s、（0．73±0．28）s、（0．50±0．35）S、（0．61±0．11）S、（0．98±0．38）cm、（0．37±0．37）cm，以上6项指标与健康组和无吞咽障碍的TBI患者比较，差异均有统计学意义（P〈0．05）。结论重度TBI恢复期患者吞咽障碍发生率高，口腔期、咽期吞咽障碍均较常见；部分VFSS参数与重度渗透和误吸有关，临床上通过实施VFSS可以明确患者吞咽功能障碍的主要部位和特征，有助于指导康复治疗。

Objective To explore the utility of videofluoroscopy in observing swallowing dysfunction after severe traumatic brain injury （TBI）. Methods Videoflouroscopic studies of swallowing （VFSSs） were performed on 40 patients with severe TBI as well as 40 healthy matched controls. Information about penetration and aspiration was collected, and oral delay time （ODT） , oral transit time （OTT） , pharyngeal delay time （PDT） , pharyngeal transit time （PTT） and the maximum vertical and anterior movement of hyoid bone were measured. Results Sev- enteen of the healthy controls （42.5%） displayed mild penetration, though none had severe penetration or aspiration. Among the severe TBI patients, 5 （12.5%） displayed mild penetration, 12 （30.0%） showed severe penetra- tion and 17 （42.5%） subjects had aspiration. The 3ml liquid swallowing parameters of the severe TBI group were ODT （0.86±0.37）s, OTT （0.73±0.28）s, PDT （0.50±0.35）s and PTT（0.61 ±0.11）s. The maximum verti- cal hyoid bone movement in this group averaged （0.98 ±0.38）cm, and maximum anterior movement was （0.37 ± 0.37） era. The healthy controls and severe TBI patients showed significant differences in terms of all six measures. Conclusion Dysphagia was found to be frequent among severe TBI patients, commonly occurring in the oral and pharyngeal phases. Videoflouroseopy may be helpful for identifying the main features of dysphagia and formulating better rehabilitation strategies.