脑卒中患者口期和咽期吞咽功能改变与误吸的相关性：基于电视透视吞咽检查

doi:10.3969/j.issn.1006-9771.2023.08.010

摘要/Abstract

摘要：

目的基于电视透视吞咽检查(VFSS)分析脑卒中患者口期和咽期吞咽功能改变与误吸之间的相关性。
方法回顾性分析2014年1月至2021年12月在徐州市中心医院放射科行VFSS的240例脑卒中患者的造影录像资料，依据Rosenbek渗漏/误吸量表(PAS)将其分为误吸组(n = 108，≥ 5级)和非误吸组(n = 132，< 5级)，采用吞咽障碍造影评分量表比较两组口期和咽期的吞咽功能改变。采用Logistic多因素回归对误吸发生的病理机制进行分析。
结果两组VFSS表现在口唇闭合不全、食团成型障碍、吞咽失用、舌与硬腭接触不全、食团后漏、口腔运送时间延长、咽期吞咽启动延迟、会厌折返障碍、梨状窝残留和咽后壁残留均有显著性差异(χ² > 5.802, P < 0.05)。口腔运送时间延长(OR = 3.964, P = 0.036)、咽期吞咽启动延迟(OR = 5.684, P < 0.001)、会厌折返功能障碍(OR = 11.571, P < 0.001)和梨状窝食物残留(OR = 4.524, P = 0.002)与误吸相关。
结论口腔运送时间延长、咽期启动延迟、会厌折返障碍、梨状窝残留是导致脑卒中患者发生误吸的危险因素。

关键词: 脑卒中, 吞咽障碍, 误吸, 电视透视吞咽检查

Abstract:

Objective To analyze the correlation between the changes of swallowing function and aspiration in stroke patients using videofluroscopic swallowing study.
Methods From January, 2014 to December, 2021, 240 stroke patients who underwent videofluroscopic swallowing study in the radiology department of Xuzhou Central Hospital were retrospectively analyzed. They were divided into aspiration group (n = 108, ≥ grade 5) and non-aspiration group (n = 132, < grade 5) according to Rosenbek Penetration/Aspiration Scale (PAS). The swallowing function changes in the oral and pharyngeal phases were compared between two groups according to Videofluoroscopic Dysphagia Scale, the risk factors of aspiration were analyzed using Logistic multivariate regression.
Results There were significant differences in incomplete lip closure, impaired bolus formation, apraxia, incomplete tongue-to-palate contact, premature bolus loss, prolonged oral transit time, delayed triggering of pharyngeal swallow, epiglottis folding dysfunction, pyriform sinus residue, and coating of pharyngeal wall (χ² > 5.802, P < 0.05). Prolonged oral transit time (OR = 3.964, P = 0.036), delayed triggering of pharyngeal swallow (OR = 5.684, P < 0.001), epiglottis folding dysfunction (OR = 11.571, P < 0.001) and pyriform sinus residue (OR = 4.524, P = 0.002) were correlated with aspiration.
Conclusion Prolonged oral transit time, delayed triggering of pharyngeal swallow, epiglottis folding dysfunction and pyriform sinus residue are risk factors of aspiration after stroke.

Key words: stroke, dysphagia, aspiration, videofluroscopic swallowing study

中图分类号:

R743.3

李振亚, 孙洁, 郭鹏飞, 王光明. 脑卒中患者口期和咽期吞咽功能改变与误吸的相关性：基于电视透视吞咽检查[J]. 《中国康复理论与实践》, 2023, 29(8): 933-939.

LI Zhenya, SUN Jie, GUO Pengfei, WANG Guangming. Correlation between changes of swallowing function in oral and pharyngeal phases, and aspiration in stroke patients based on videofluroscopic swallowing study[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 933-939.

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组别	n	性别(男/女)/n	年龄/n		卒中类型/n
组别	n	性别(男/女)/n	≥ 65岁	< 65岁	缺血	出血
误吸组	108	75/33	63	45	82	26
非误吸组	132	101/31	75	57	89	43
χ²值		1.519	0.056		2.096
P值		0.218	0.813		0.148

变量	B值	B值标准误	Wald χ²值	P值	OR值	95%CI
口唇闭合不全	0.525	0.535	0.964	0.326	1.691	0.593~4.823
食团成型障碍	-0.394	0.499	0.622	0.430	0.675	0.254~1.794
吞咽失用	-0.666	0.761	0.765	0.382	0.514	0.116~2.285
食团后漏	0.287	0.433	0.438	0.508	1.332	0.570~3.111
口腔运送时间延长	1.377	0.656	4.410	0.036	3.964	1.096~14.333
咽期吞咽启动延迟	1.738	0.383	20.558	< 0.001	5.684	2.682~12.045
会厌折返障碍	2.448	0.529	21.411	< 0.001	11.571	4.102~32.642
梨状窝残留	1.509	0.492	9.414	0.002	4.524	1.725~11.867
咽后壁残留	-0.895	0.562	2.539	0.111	0.409	0.136~1.229
常量	-2.024	0.397	26.001	< 0.001	0.132