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脑损伤后吞咽障碍患者电视X线透视吞咽功能检查参数与吞咽预后的相关性研究 被引量:9

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摘要 目的了解脑损伤后吞咽障碍患者的电视x线透视吞咽功能检查(VFSS)参数对于判断吞咽障碍预后的价值。方法选取77例经VFSS诊断的脑损伤恢复期吞咽障碍患者均接受专业吞咽训练,主要包括饮食改变(如选择合适的形状、大小等)、调整进食姿势(如吞咽前误吸的患者可低头吞咽等)、行为治疗(如对于吞咽中误吸可进行声门上吞咽、环咽肌开放不全的患者进行门德尔松法)和口颜面肌肉的训练(每日1次,每次45min,共12周)。经3个月的吞咽训练后,再次进行VFSS检查,分别进食3ml液态钡食、10ml液态钡食、10ml半固体(酸奶)钡食、10cm^3固体(1/4包钡蛋糕)钡食,确定能否完全经口进食。根据入组3个月后患者能否完全经口进食,将患者分为预后良好组(能完全经口进食,41例)和预后不良组(不能完全经口进食,36例)。分别采集患者VFSS参数,并记录3个月后各种食团吞咽时口腔传送时间、咽延迟时间、咽传送时间、舌骨上抬幅度、舌骨前移幅度,并对2组患者的VFSS参数及其与吞咽预后的相关性进行统计分析。结果预后不良组患者吞咽3ml液体时的口腔传送时间、咽延迟时间、咽传送时间[(0.88±0.18)、(0.40±0.21)和(0.61±0.11)S]较预后良好组[(0.75±0.16)、(0.26±0.17)和(0.53±0.13)S]明显延长,其舌骨上抬幅度[(1.19±0.38)cm]较预后良好组[(1.54±0.53)cm]明显减小,且组间且差异有统计学意义(P〈0.05)。预后不良组患者吞咽10ml半固体(酸奶)及10cmm^3固体(1/4包钡蛋糕)时的口腔传送时间、咽延迟时间均较预后良好组明显延长(P〈0.05);预后不良组患者吞咽10ml半固体(酸奶)时的咽传送时间及舌骨上抬幅度与预后良好组患者吞咽同类食团比较,差异亦有统计学意义(P〈0.05),但2组患者吞咽10cm^3固体(1/4包钡蛋糕)时的咽传送时间及舌骨上抬幅度差异不明显(P〉0.05)。经Logistic逐步回归分析统计显示,口腔传送时间(OR值=0.01,P=0.048)、咽延迟时间(OR值=0.01,P=0.040)、舌骨上抬幅度(OR值=20.26,P=0.000)与吞咽障碍预后不良有关,即口腔传送时间越长,咽延迟时间越长,舌骨上抬幅度越小,则吞咽障碍预后越差。未发现舌骨前移幅度与吞咽障碍预后的相关关系。结论VFSS参数对于分析中枢神经性吞咽障碍的预后有一定意义。
出处 《中华物理医学与康复杂志》 CAS CSCD 北大核心 2015年第12期913-916,共4页 Chinese Journal of Physical Medicine and Rehabilitation
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参考文献19

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二级参考文献24

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