吞咽造影数字化分析在脑干卒中后吞咽障碍患者疗效评估中的应用

Application of videofluoroscopy digital analysis in swallowing function assessment for brainstem stroke patients with dysphagia

目的:使用吞咽造影(VFSS)数字化分析方法观察改良球囊扩张治疗对脑干卒中后吞咽障碍患者食道上括约肌(UES)和舌骨移动功能的影响,定量评价脑干卒中后吞咽功能变化。方法:30例脑干卒中后经吞咽造影确诊为咽期吞咽障碍的患者,分为球囊扩张治疗组与吞咽常规治疗组,每组各15例。球囊扩张组给予球囊扩张治疗及常规吞咽康复治疗,每日各1次,每次30min;吞咽常规治疗组仅给予常规吞咽康复训练,2次/d,每次30min;两组治疗均为5次/周。分别在治疗前、拔除鼻饲管或治疗已达3周后,进行功能性经口摄食量表(FOIS)、吞咽造影评估并进行数字化测量分析。测量的指标包括舌骨位移距离,UES最大开放前后径宽度。结果:球囊扩张组12例患者拔除了鼻饲管,吞咽稀流质、浓流质及糊状食物时舌骨位移距离,UES最大开放幅度治疗前后差异有显著性意义(P<0.05)。常规治疗组仅有2例拔除了鼻饲管,治疗后吞咽稀流质、浓流质及糊状食物时舌骨位移距离,UES最大开放幅度治疗前后差异没有显著性意义(P>0.05)。结论:吞咽造影数字化分析能够有效地量化吞咽功能,可用于分析治疗前后的变化。

Objective： To evaluate effect of modified balloon dilatation intervention on opening oi upper esophageal sphincter（UES） and excursion of hyoid bone in brainstem stroke patients with dysphagia before and after treatment by using digital analysis of videofluoroscopie swallowing study（VFSS）. Method; Thirty brainstem stroke patients with pharyngeal dysphagia were recruited in this study. Fifteen of them as dilatation treatment group completed 3 weeks of modified balloon dilatation treatment and routing swal- lowing therapy. Another 15 of them as control group only completed 3 weeks of routing swallowing therapy. Before, and after ballon dilatation opening of UES and excursion of hyoid bone were measured during swallow- ing thin liquid, thick liquid, and pasty material with 3ml volumes. These results were compared to identical measures obtained from control group Result： After dilatation treatment, nasal feeding tubes were removed in 12 of 15 patients of dilatation group Post-dilatation the opening of UES and excursion of hyoid bone were both significantly better than pre-dilata- dilatation treatment group for swallowing thin liquid, thick liquid and pasty materials （P〈O.05 ）. In cor-trol group, the nasal feeding tubes were removed only in 2 of 15 patients after traditional swallowing therapy. However, post-treatment the relaxation of UES in control group did not shown any significantly difference from pre-treatment （P〉 0.05） for three kinds of food materials. Conclusion： Using digital analysis of VFSS, it is found dysphagia therapy with dilatation could improve the opening of UES and excursion of hyoid bone during swallowing. Author＇s address Dept. of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630