Deglutitive laryngeal closure in stroke patients
Deglutitive laryngeal closure in stroke patients
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DOI：
10.1136/jnnp.2006.101857
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发表时间：
2007-02-01
影响因子：
11
通讯作者：
Thompson, D. G.
中科院分区：
文献类型：
--
作者：
Power, M. L.;Hamdy, S.;Thompson, D. G.
背景：据报道，高达70%的卒中患者存在吞咽困难，易导致误吸和肺炎。尽管如此，愿望的机制仍然不清楚。目的：确定脑卒中患者吞咽期间食团流量与喉闭合之间的关系，并检查导致误吸的感觉运动机制。研究方法：在反复自愿吞咽控制体积的稀液体后，对90例中风患者和50例健康成人的数字视频荧光透视图像进行吞咽和团流测量。使用经验证的渗透-抽吸量表评估抽吸。口腔感觉也通过电刺激在颅柱测量。结果如下：卒中后，喉上升延迟（平均值（标准差（SD））0.31（0.06）s，p < 0.001），导致咽部通过时间延长（1.17（0.07）s，p < 0.001），而喉闭合持续时间没有伴随增加（0.84（0.04）s，p=0.9）。喉上抬延迟与误吸严重程度（r=0.5，p < 0.001）和口腔感觉（r=0.5，p < 0.001）相关。结论：脑卒中后，喉延迟的持续时间和感觉障碍的程度与误吸的严重程度相关。这些发现表明感觉运动相互作用在控制吞咽中的作用，并对卒中后吞咽困难的评估和管理具有意义。
Background: Dysphagia has been reported in up to 70% of patients with stroke, predisposing them to aspiration and pneumonia. Despite this, the mechanism for aspiration remains unclear. Aims: To determine the relationship between bolus flow and laryngeal closure during swallowing in patients with stroke and to examine the sensorimotor mechanisms leading to aspiration. Methods: Measures of swallowing and bolus flow were taken from digital videofluoroscopic images in 90 patients with stroke and 50 healthy adults, after repeated volitional swallows of controlled volumes of thin liquid. Aspiration was assessed using a validated Penetration-Aspiration Scale. Oral sensation was also measured by electrical stimulation at the faucial pillars. Results: After stroke, laryngeal ascent was delayed (mean (standard deviation (SD)) 0.31 (0.06) s, p < 0.001), resulting in prolongation of pharyngeal transit time (1.17 (0.07) s, p < 0.001) without a concomitant increase in laryngeal closure duration (0.84 (0.04) s, p=0.9). The delay in laryngeal elevation correlated with both the severity of aspiration (r=0.5, p < 0.001) and oral sensation (r=0.5, p < 0.001). Conclusions: After stroke, duration of laryngeal delay and degree of sensory deficit are associated with the severity of aspiration. These findings indicate a role for sensorimotor interactions in control of swallowing and have implications for the assessment and management of dysphagia after stroke.