急性脑卒中患者脑损伤部位与吞咽障碍的关系

Relationship between dysphagia and the location of brain lesions in acute stroke

目的 探讨急性脑卒中患者脑损伤部位与吞咽障碍之间的关系. 方法 226例急性脑卒中患者于入院后48 h内进行洼田饮水试验评估吞咽功能.依据头颅CT和/或MRI判定卒中部位.依据美国国立卫生研究院脑卒中量表（NIHSS）评价患者入院时神经功能缺损程度. 结果 226例患者中,吞咽障碍患者为114例,发生率为50.4％.入院时神经功能缺损程度与吞咽障碍的发生显著相关（x^2＝13.35,P=0.02）.前循环中（颈内动脉系统）,颈内动脉主干病变（大脑半球＋基底节区/内囊）致吞咽障碍的发生率较单独皮层支（大脑半球-皮质）或深穿支（基底节/内囊）病变显著增高（x^2 =8.228,P＜0.05）;其中各脑叶皮层病变导致的吞咽障碍差异无统计学意义（x2=0.312,P＞0.05）.后循环（椎基底动脉系统）中,脑干病变致吞咽障碍的发生率高于丘脑和小脑（x^2=27.292,P＜0.001）.大脑半球＋（基底节/内囊）和脑干病变导致吞咽障碍的比率高于其他病变部位（x^2＝35.639,P＜0.000）. 结论 大脑半球＋基底节区/内囊多发病变和脑干病变易导致吞咽障碍的发生.

Objective To investigate the relationship between the incidence of dysphagia and the location of brain lesions in patients with acute stroke.Methods Swallowing function was assessed by Watin drinking water test within 48 hours after admission in 226 cases with acute stroke.The location of the brain lesions was identified by CT and / or MRI.According to the US National Institutes of Health Stroke Scale （NIHSS）,evaluation of nerve functions was evaluated within 24 hours after admission in stroke patients.Results The incidence of dysphagia was 50.4% （114 /226） in 226 patients in acute stage.The degree of neurological deficit of stroke patients on admission was significantly correlated with the occurrence of dysphagia （x^2 =13.35,P=0.02）.The incidence of dysphagia caused by lesions in internal carotid artery trunk （hemisphere in combination with basal ganglia/internal capsule） was more common in anterior circulating territory（internal carotid artery system）,dysphagia with internal carotid arterg（ICA） trunk occlusion （hemisphere in combination with basal ganglia/internal capsule） was more common than that caused by cortex branches occlusion （hemisphere-cortex） or penetrating ICA injuries （basal ganglia/internal capsule） and cortex branches occlusion （hemisphere-cortex）,respectively（x^2 =8.228,P〈0.05）.The incidences of dysphagia induced by brain lesions of different cortex lobes had no statistic differences（x^2 =0.312,P〉0.05）.In posterior circulating territory （vertebro-basilar system）,the incidence of swallowing disorders was significantly higher in brain stem group than in the thalamus and cerebellum （x^2 =27.292,P〈0.001）.The incidence of the dysphagia caused by lesions in cerebral hemispheres,combined basal ganglia / internal capsule and brain stem lesions were significantly higher than those caused by other lesions（x^2 =35.639,P〈0.000）.Conclusions Brain lesions of hemisphere combined basal ganglia/internal capsule and brain stem are significantly associated with the occurrence of dysphagia after acute stroke.