脑瘫患儿流涎情况及其与吞咽障碍和粗大运动功能水平的关系

Drooling in cerebral palsy and its relationship with dysphagia and gross motor functioning

目的 探讨不同类型脑瘫患儿流涎症的发生率、严重程度及其与口运动评分、吞咽障碍评分及粗大运动功能分级间的关系.方法 采用流涎严重程度评估量表对2013年7月至2016年7月期间在青岛市妇女儿童医院康复中心门诊及住院治疗的100例脑瘫患儿及在本院健康查体的50例正常儿童进行流涎评估,同时对脑瘫患儿进行口运动评估、吞咽障碍评分(DDS)及粗大运动功能分级(GMFCS)评估,分析不同类型脑瘫患儿流涎严重程度与其口运动评分、吞咽障碍评分及GMFCS分级水平的关系.结果 本研究入选脑瘫患儿流涎症(流涎Ⅱ级～Ⅴ级)发生率为32％,明显高于正常对照组流涎症发生率(P＜0.01),脑瘫流涎严重程度分级情况如下:Ⅰ级68例,Ⅱ级8例,Ⅲ级16例,Ⅳ级8例,Ⅴ级0例.不同类型脑瘫患儿其流涎严重程度间存在显著差异,痉挛型四肢瘫、不随意运动型和混合型脑瘫患儿流涎程度较严重,其次是痉挛型双瘫和共济失调型患儿,偏瘫患儿无流涎发生.脑瘫患儿流涎严重程度分级与口运动评分呈显著负相关(r=-0.764,P＜0.01),而与DDS评分(r=0.772,P＜0.01)及GMFCS分级(r=0.788,P＜0.01)呈正相关.结论 约1/3脑瘫患儿并发流涎症,其流涎严重程度与脑瘫类型、口运动障碍、吞咽障碍及粗大运动障碍程度密切相关.

Objective To analyze the incidence and severity of drooling in children with cerebral palsy and explore its correlation with oral dyskinesia,dysphagia and gross motor function.Methods A hundred children with cerebral palsy treated in Qingdao Women's and Children's Hospital between July 2013 and 2016 and 50 healthy children examined in the health examination center were assessed using the drooling severity scale,oral motor assessment,a dysphagia disorders survey (DDS) and the gross motor function classification system (GMFCS).The relationship between drooling severity,oral dyskinesia,dysphagia and their gross motor function was analyzed.Results Of the 100 children with cerebral palsy,32％ displayed drooling (at levels Ⅱ through Ⅴ),which was significantly higher than among the healthy controls.Another sixty-eight displayed level Ⅰ drooling.The severity of drooling was significantly different among children with different cerebral palsies.The drooling of children with spastic quadriplegia,dyskinesia or mixed-type cerebral palsy was the most severe,followed by those with ataxia and spastic diplegia whose drooling was often mild.No hemiplegic child drooled at level Ⅱ.Drooling severity was negatively correlated with the oral motor score,but positively correlated with the average DDS and GMFCS scores.Conclusions About one third of cerebral palsy children suffer from drooling.Their drooling severity is closely associated with the type of the cerebral palsy,oral dyskinesia,dysphagia and GMFCS levels.