帕金森病患者吞咽功能障碍的发病机制及康复治疗进展

Pathogenesis of Swallowing Dysfunction in Parkinson′s Disease and Its Rehabilitation Progress

帕金森病(PD)是一种常见的神经退行性疾病。吞咽功能障碍是PD的常见症状,严重影响患者的预后和生活质量,也是吸入性肺炎导致患者死亡的主要原因。PD吞咽功能障碍可能与发病早期脑干吞咽中枢和吞咽相关的周围神经损害、基底节壳核和苍白球功能障碍以及胆碱能功能障碍等有关。PD吞咽功能障碍可以通过相关量表、X线透视吞咽功能、纤维喉镜吞咽检查、高分辨率食管测压、咽部表面肌电图等进行评价。目前尚无证据证实药物治疗能够完全改善患者的吞咽功能。吞咽障碍的康复治疗主要包括代偿干预与运动康复,通过改变食物性状与吞咽姿势以及吞咽动作的训练改善吞咽功能,提高患者的生活质量。

Parkinson′s disease(PD)is a common neurodegenerative disease.Swallowing dysfunction is a common symptom of PD,which seriously affects the prognosis and quality of life of the patients.It is also the main cause of death of patients with aspiration pneumonia.PD of swallowing dysfunction may be related to brain stem swallowing center,swallowing related peripheral nerve damage,basal ganglia putamen and globus pallidus dysfunction,cholinergic dysfunction and so on.PD of swallowing dysfunction can be evaluated by correlation scale,X-ray fluoroscopy,laryngoscopy,high-resolution esophageal manometry,and surface electromyography.At present,there is no evidence that drug treatment can completely improve the swallowing function of the patients.The dysphagia rehabilitation treatments mainly include compensatory intervention and sports rehabilitation,improving swallowing function by changing food properties and swallowing posture and swallowing action,so as to improve the quality of life of the patients.