吞咽造影录像检查定量评价脑卒中患者吞咽功能改变

Video fluoroscopic swallowing study for quantitative evaluation of swallowing function changes in stroke patients

目的观察吞咽造影录像检查(VFSS)定量评价脑卒中患者吞咽功能改变的价值。方法回顾性分析107例脑卒中患者的VFSS资料,并将其分为吞咽功能正常组(n=19)、口期吞咽障碍组(n=14)和咽期吞咽障碍组(n=74);比较3组间舌骨喉复合体VFSS相关参数的差异,包括舌骨及喉部的前移幅度和上移幅度、舌骨喉复合体咽期启动延迟时间及运动时间、会厌折返功能及环咽肌功能。结果3组间舌骨前移幅度及舌骨喉复合体咽期启动延迟时间总体差异均有统计学意义(F=3.788、P=0.026,H=30.229、P<0.001),咽期吞咽障碍组舌骨前移幅度小于吞咽正常组(P=0.026),舌骨喉复合体咽期启动延迟时间大于吞咽功能正常组及口期吞咽障碍组(P均<0.001);3组间其余参数差异均无统计学意义(P均>0.05)。咽期吞咽障碍组中,56例会厌折返障碍,47例环咽肌功能障碍,占比均高于其余2组(P均<0.05)。结论VFSS有助于量化评估脑卒中患者吞咽功能改变;脑卒中后咽期吞咽障碍者舌骨前移幅度缩短,舌骨喉复合体启动时间延迟,易出现会厌折返障碍和环咽肌功能障碍。

Objective To observe the value of video fluoroscopic swallowing study(VFSS)for quantitative evaluation on swallowing function changes in stroke patients.Methods VFSS data of 107 stroke patients were retrospectively analyzed and divided into normal swallowing function group(n=19),oral dysphagia group(n=14)and pharyngeal dysphagia group(n=74).VFSS-related parameters of hyoid-laryngeal complex,including the amplitude of forward and upward movement of hyoid and laryngeal,the initiation delay time and movement time of hyoid-laryngeal complex,the function of epiglottis reentry and cricopharyngeal muscle were compared among 3 groups.Results There were statistical differences of forward movement amplitude of hyoid and the initiation delay time of hyoid-laryngeal complex among 3 groups(F=3.788,P=0.026;H=30.229,P<0.001).The forward movement amplitude of hyoid in pharyngeal dysphagia group was shorter than that in normal swallowing function group(P=0.026),the initiation delay time of hyoid-laryngeal complex in pharyngeal dysphagia group was longer than that of oral dysphagia group and normal swallowing function group(both P<0.001),but there was no significant difference of the rest parameters among 3 groups(all P>0.05).In pharyngeal dysphagia group,there were 56 cases of epiglottic reentry dysfunction and 47 cases of cricopharyngeal muscle dysfunction,both more than those in the other 2 groups(both P<0.05).Conclusion VFSS was helpful for quantifying the changes of swallowing function in stroke patients.After stroke,patients with pharyngeal dysphagia often had shortened forward hyoid displacement,delayed hyoid-laryngeal complex initiation time,who were prone to epiglottis reentry dysfunction and cricopharyngeal muscle dysfunction.