幕下脑卒中后吞咽障碍的时序性及其与渗漏误吸的关联分析

关键词：脑卒中  吞咽障碍  吞咽造影  时序分析  误吸

Keywords:stroke  dysphagia  videofluoroscopic swallowing study  temporal analysis  aspiration

摘要：

      摘要 目的：本研究旨在阐述幕下脑卒中后吞咽障碍的时序特征及其与渗漏误吸的关联。 方法：共纳入幕下部位脑卒中患者51例及健康受试者26例，在吞咽造影检查下完成5ml稀流质食物吞咽各2口，分析口腔运送时间（OTT）、腭咽关闭时间（VCD）、舌骨位移时间（HMD）、喉前庭关闭时间（LCD）、UES开放时间（UOD）、平台过渡时间（STD），并评价4组动作先后顺序的时序标准的符合情况及其间期T1—T4，并对20%的结果进行评估者间信度检验。 结果：幕下脑卒中患者组40.2%的吞咽存在UES不开放，39.3%存在渗漏，20.5%存在误吸。患者组的OTT、VCD、STD显著长于健康对照组（P<0.01），UOD显著短于健康对照组（P<0.01），患者组时序3、4的符合率显著低于健康对照组（P<0.001），T1、T2、T3显著长于健康对照组（P<0.01）。VCD-PAS，UOD-PAS，以及T2之间存在显著负相关（P<0.01），所有指标信度良好。 结论：幕下部位脑卒中后吞咽障碍患者存在吞咽动作时序异常，且与渗漏误吸的程度存在关联，该发现有助于制定更为靶向的误吸干预策略。

Abstract:

      Abstract Objective： To elucidate the temporal characteristics of dysphagia following infratentorial stroke and its association with penetration/aspiration. Method： A total of 51 patients with infratentorial stroke and 26 healthy controls were recruited. All participants underwent videofluoroscopic swallowing studies (VFSS)， during which they swallowed 5ml of thin liquid in two separate trials. Swallowing parameters analyzed included oral transit time （OTT）， velopharyngeal closure duration （VCD）， hyoid movement duration （HMD）， laryngeal vestibule closure duration （LCD）， upper esophageal sphincter （UES） opening duration （UOD）， and stage transition duration （STD）. The temporal coordination and sequential order of four swallowing actions and the intervals namely T1—T4 were also assessed. Inter-rater variability was evaluated using intraclass correlation coefficients (ICCs) for 20% of the results. Result： In the patient group， 40.2% exhibited failed opening in UES， 39.3% had penetration， and 20.5% experienced aspiration. Compared to the control group, patients showed significantly prolonged OTT， VCD， and STD（P<0.01）， while UOD was significantly shorter （P<0.01）. The conformity rates of temporal sequences 3 and 4 were significantly lower in the patient group compared to controls （P<0.001）， and intervals T1， T2， and T3 were significantly longer （P<0.01）. Significant negative correlations were found between VCD and PAS， UOD and PAS， and T2 （P<0.01）. All measured parameters demonstrated good reliability. Conclusion： Patients with infratentorial stroke experience abnormal swallowing sequence， which is associated with the severity of penetration and aspiration. These findings may help in developing more targeted interventions to prevent aspiration.