卒中后咽期吞咽障碍患者咽反射异常程度与隐性误吸的相关性分析

Correlation between the severity of abnormal gag reflex and silent aspiration in patients with pharyngeal dysphagia after stroke

目的:比较不同咽反射异常程度的卒中后咽期吞咽障碍患者隐性误吸发生率及吞咽功能的差异,探讨咽反射异常程度与发生隐性误吸的相关性。方法:选取脑卒中后咽期吞咽障碍患者120例,根据咽反射检查结果分为3组,咽反射正常组(A组)39例、咽反射减退组(B组)54例和咽反射消失组(C组)27例。采用吞咽X射线电视透视检查(VFSS)和纤维内窥镜吞咽评估(FEES)对3组患者咽期吞咽障碍的异常征象、视频吞咽造影功能障碍(VDS)评分、Rosenbek渗漏-误吸(PAS)评级、耶鲁咽部残留物严重程度(YPR-SRS)评级、咽部感觉受损、隐性误吸及卒中相关性肺炎(SAP)的发生情况进行评估,分析咽反射异常程度与吞咽功能和隐性误吸及SAP的相关性。结果:3组患者吞咽启动延迟、会厌折返障碍、喉上抬障碍、咽部感觉受损、隐性误吸和SAP的发生率比较差异具有统计学意义(P<0.01),C组高于B组、B组高于A组(均P<0.05)。3组患者梨状窝残留、咽后壁残留、误吸、VDS评分、PAS及YPR-SRS评级比较差异无统计学意义。通过相关性分析发现,入组患者咽反射异常程度与吞咽启动延迟、会厌折返障碍、喉上抬障碍、咽部感觉受损、隐性误吸及SAP均具有正相关性(均P<0.05)。咽反射消失预测患者发生隐性误吸的敏感度为52.00%,特异度为85.26%;咽反射异常预测患者发生隐性误吸的敏感度为96.00%,特异度为40.00%。结论:卒中后患者咽反射异常程度与咽期吞咽功能障碍严重程度相关。咽反射异常程度越高,可能伴随更高的隐性误吸发生率。

Objective:To compare the differences in silent aspiration and swallowing function among post-stroke patients with pharyngeal dysphagia with varying degrees of abnormal gag reflex,and to explore the correlation between the degree of abnormal gag reflex and silent aspiration.Methods:In total,120patients with post-stroke pharyngeal dysphagia were selected.Based on the results of the gag reflex examination,these patients were divided into three groups:normal gag reflex group(group A,n=39),reduced gag reflex group(group B,n=54),and absent gag reflex group(group C,n=27).The videofluoroscopic swallowing study(VFSS)and fiberoptic endoscopic evaluation of swallowing(FEES)were used to assess the occurrence of abnormal swallowing modes,videofluoroscopic dysphagia scale(VDS)scores,penetration aspiration scale(PAS)ratings,Yale pharyngeal residue severity rating scale(YPR-SRS)ratings,the occurrence of pharyngeal sensory impairment and silent aspiration in all three groups.The correlation between the degree of abnormal gag reflex and both swallowing function and silent aspiration was analyzed.Results:There were statistically significant differences among the three groups in terms of delayed triggering of swallow,epiglottis folding dysfunction,abnormal laryngeal uplift,silent aspiration,pharyngeal sensory impairment,and stroke associated pneumonia(P<0.01),with group C having a higher incidence rate than groups A and B(P<0.05),and group B higher than group A(P<0.05).No statistically significant differences were found in pyriform sinus residue,coating of pharyngeal wall,aspiration,VDS scores,PAS and YPR-SRS ratings among the three groups.Correlation analysis revealed that the degree of abnormal gag reflex was positively correlated with delayed triggering of swallow,epiglottis folding dysfunction,abnormal laryngeal uplift,silent aspiration,pharyngeal sensory impairment,and stroke associated pneumonia(P<0.05).The disappearance of the gag reflex predicted a sensitivity of 52.00%and a specificity of 85.26%in identifying silent aspiration in patients.Abnormal gag reflex predicted a sensitivity of 96.00%660 Chinese Journal of Rehabilitation,Nov 2024,Vol.39No.11 and a specificity of 40.00%in predicting silent aspiration in patients.Conclusion:The degree of abnormal gag reflex in post-stroke patients is related to the severity of certain pharyngeal swallowing dysfunctions.The higher the degree of abnormal gag reflex,the higher the incidence of silent aspiration may be.