脑卒中气管切开患者吞咽生物力学特征的研究

Research of swallowing biomechanical characteristic in stroke tracheotomy patients

目的应用高分辨率固态测压技术(HRM)探究脑卒中气管切开患者在不同进食状态(空吞咽、水、浓流质)下的吞咽生物力学特征;探讨利用咽腔与食管上括约肌(UES)压力参数预测吞咽功能的应用价值。方法脑卒中气管切开患者43例作为气管切开组,另选取健康受试者43例作为对照组。两组在年龄、性别,身高及BMI等方面比较差异均无统计学意义。所有受试者均进行临床吞咽功能评估和HRM压力参数测定。评定指标包括:改良曼恩吞咽能力评分(MMASA)、鄂咽收缩压力峰值、鄂咽收缩时长、UES松弛残余压及UES松弛时间。将气管切开组MMASA评分与空吞咽时的HRM压力参数值行相关性分析。结果气管切开组患者在空吞咽,进食水(1号)和浓流质(2号)食物时,UES松弛残余压均比对照组增高(P<0.05),而UES松弛时间,鄂咽收缩压力峰值及鄂咽收缩时长均比对照降低(P<0.05)。相关性分析显示:气管切开组UES松弛残余压(r=-0.935,P<0.01)和MMASA评分之间存在负的线性相关;UES松弛残余时间(r=0.983,P<0.01)、鄂咽收缩压力峰值(r=0.944,P<0.01)及鄂咽收缩时长(r=0.957,P<0.01)与MMASA评分之间存在正的线性相关。结论卒中气管切开患者吞咽生物力学的特点主要为咽部吞咽肌群的收缩能力下降及UES松弛功能紊乱。随着压力参数的改善,患者的吞咽能力也相应的提高。HRM的压力参数可预测卒中气管切开患者的吞咽功能。

Objective To explore the swallowing biomechanical characteristic of taking different foods(nothing,water and dense food)by using HRM in stroke tracheotomy patients.To evaluate the application value of predicting swallowing function by using pressure parameters of pharynx and UES.Methods 43 stroke tracheotomy inpatients were assigned to tracheotomy group,while 43 healthy subjects were assigned to control group.There was no significant difference in age,gender,weight and BMI between two groups.The scores of MMASA,velopharynx maximal pressure,velopharynx time,UES residual pressure and duration of UES relaxation were used as outcome measures.All subjects should accept clinical swallowing evaluation and HRM test.The correlation of the scores of MMASA with pressure parameters of pharynx and UES were analyzed.Results Compared with the control group,the tracheotomy group had significantly greater improvement on the scores of MMASA(P<0.05),velopharynx maximal pressure(P<0.05),velopharynx time(P<0.05),UES residual pressure(P<0.05)and duration of UES relaxation(P<0.05)while taking different foods(nothing,water and dense food).The scores of MMASA were significantly positively correlated with velopharynx maximal pressure(r=0.944,P<0.01),velopharynx time(r=0.957,P<0.01)and duration of UES relaxation(r=0.983,P<0.01).The scores of MMASA was significantly negatively correlated with UES residual pressure(r=-0.935,P<0.01).Conclusion The swallowing biomechanical characteristic is mainly contractility decline of pharyngeal swallowing muscle and disorder of UES relaxation in stroke tracheotomy patients.The swallowing function improves,meanwhile the HRM pressure parameters is improving.The pressure parameters of pharynx and UES can predict the swallow function.