Characteristics and Prognostic Factors of Swallowing Dysfunction in Patients with Lateral Medullary Infarction
Characteristics and Prognostic Factors of Swallowing Dysfunction in Patients with Lateral Medullary Infarction
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DOI：
10.1016/j.jstrokecerebrovasdis.2021.106122
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发表时间：
2021-09-25
影响因子：
2.5
通讯作者：
Wakabayashi, Shinichi
中科院分区：
文献类型：
--
作者：
Hara, Naoyuki;Nakamori, Masahiro;Wakabayashi, Shinichi
目的：侧髓梗塞主要损害咽期吞咽功能。我们的目的是研究吞咽功能评估工具在侧髓梗死患者中的实用性，并确定可以预测吞咽功能结果的因素。材料和方法：本前瞻性研究纳入了 2016 年 8 月 1 日至 2020 年 3 月 31 日期间入住 Suiseikai Kajikawa 医院的 15 名侧髓梗死患者（年龄 62.7 +/- 14.8 岁，5 名女性）。诊断是通过脑部磁共振成像进行的。我们通过多元逻辑回归分析，分析了与严重吞咽功能障碍相关的因素，严重吞咽功能障碍被定义为入院第 90 天需要管饲。结果：多变量分析确定重复唾液吞咽试验、改良水吞咽试验和中风病变垂直扩散是影响严重吞咽功能障碍的独立显着因素（分别为 p = 0.002、0.016 和 0.011）。曼吞咽能力评估的咽期分项评分也与严重吞咽功能障碍显着相关（p < 0.001）。然而，舌压、电视透视检查中的严重通道模式异常和椎动脉夹层与吞咽功能障碍没有显着相关性。结论：由于外侧延髓梗死主要表现为咽期吞咽功能障碍，因此可用于评估咽期吞咽功能的工具，如重复唾液吞咽试验和改良水吞咽试验，比测量更有用。
Objectives: Lateral medullary infarction mainly impairs the pharyngeal phase of swallowing. We aimed to investigate the utility of the assessment tools of swallowing function in patients with lateral medullary infarction and to determine the factors that could predict the outcomes of swallowing function. Materials and Methods: 15 patients with lateral medullary infarction who were admitted to Suiseikai Kajikawa Hospital between August 1, 2016, and March 31, 2020 (age 62.7 +/- 14.8 years, 5 women) were enrolled in this prospective study. The diagnosis was made using brain magnetic resonance imaging. We analyzed the factors associated with severe swallowing dysfunction, which was defined as the necessity for tube feeding on the 90th day from admission, with multiple logistic regression analysis. Results: Multivariate analyses identified the repetitive saliva swallowing test, modified water swallowing test, and vertical spread of stroke lesions as independent significant factors affecting severe swallowing dysfunction (p = 0.002, 0.016, and 0.011, respectively). The sub-scores of the pharyngeal phase of the Mann Assessment of Swallowing Ability were also significantly associated with severe swallowing dysfunction (p < 0.001). However, tongue pressure, severe passage pattern abnormality on videofluoroscopic examination, and vertebral artery dissection were not significantly associated with swallowing dysfunction. Conclusions: Since lateral medullary infarction presents with swallowing dysfunction mainly in the pharyngeal phase, tools that can be used to evaluate the pharyngeal phase of swallowing, such as repetitive saliva swallowing test and modified water swallowing test, are moreuseful than measurement.