岛盖综合征患者临床特征与康复规律的研究

The clinical characteristics and recovery of patients with opercular syndrome

目的:探讨岛盖综合征的主要临床特征和恢复规律,优化岛盖综合征的临床诊断和康复干预方法。方法:收集13例门诊或住院的岛盖综合征患者,用口面失用量表、Frenchay构音障碍评定法等量表,在首次门诊或入院后第1天、出院前1天评定患者,根据入院后第1天康复评定的结果予以住院患者个体化的康复干预。结果:8例皮质型患者的皮质病损部位累及单侧或双侧岛盖;所有患者首诊或入院时口面失用量表评定均提示有显著的口、面、舌肌的自主运动障碍,住院患者经康复干预后口面失用量表评分显著性增高,9例入院时为鼻饲营养的住院患者经康复治疗后有6例患者改为经口进食,约占66.7%;所有患者首诊或入院时均表现为重度构音障碍,10例住院患者经20天以上的康复训练,仍为重度构音障碍。结论:口腔期吞咽障碍和重度构音障碍是岛盖综合征患者重要临床特征,大多数岛盖综合征患者经康复治疗能恢复经口进食,而构音障碍却很难恢复。

Objective：To investigate the clinical characteristics and recovery of opercular syndrome （OS）, and optimize its clinical diagnosis and treatment. Method： Prospectively recruit thirteen patients with opercular syndrome, and assess them with oralfacial aprax- ia assessment and Frenchay dysarthria assessment at outpatient clinic or the day after admission and the day be- fore discharge. All inpatients got individual therapy based on admission assessment. Result： The cortical lesions of eight patients were involved with one or both sides of opercular area. The re- sults of oralfacial apraxia assessment showed that all thirteen patients have the voluntary movement disorder of Oral-mandibular/buccal-lingual muscle, and the average score of oralfacial apraxia assessment got a significant increase after rehabilitation therapy. Six of nine patients who needed nasogastric tube feeding transited to oral feeding after inpatient rehabilitation therapy, and the percentage is 66.7%. The results of Frenchay dysarthria as- sessment revealed that 100% of the thirteen patients got severe dysarthria, and ten inpatients didn＇t get signifi- cant improvement by after rehabilitation therapy. Conclusion： Oral dysphagia and severe dysarthria are the characteristic symptom of opercular syndrome. Most of OS patients can return to oral feeding after rehabilitation therapy, while no improvement in articulation.