Meng N H, Wang T G, Lien I N
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Republic of China.
Am J Phys Med Rehabil. 2000 Mar-Apr;79(2):170-5. doi: 10.1097/00002060-200003000-00010.
This study was conducted to delineate the incidence and outcome of dysphagia among hospitalized patients who were referred for rehabilitation because of brainstem stroke.
We retrospectively reviewed the medical records of 36 patients who were admitted because of brainstem stroke. Information on the patients' clinical features, feeding status, and the results of clinical and videofluoroscopic swallowing examinations were obtained through chart review. Follow-up interviews were conducted via telephone to learn the general medical condition and feeding status of the patients 7-43 mo after hospital discharge.
A total of 81% of the patients had dysphagia at the time of initial clinical swallowing evaluation, which was performed 10-75 days after the onset of stroke. A total of 79% of the dysphagic individuals depended on tube feeding at the initial evaluation; 22% of all individuals could not resume oral intake at discharge. Statistical analyses revealed a significant association between poor outcome and disease involving the medulla, the presence of a wet voice during the initial swallowing test, and a delay or absence of the swallowing reflex. The incidence of aspiration pneumonia was 11%. There was a correlation between the detection of aspiration by modified barium meal videofluoroscopy and the development of aspiration pneumonia. Follow-up interviews showed that 88% of the 27 patients who were contacted had resumed full oral intake 4 mo after the onset of stroke.
The incidence of dysphagia was relatively high in our study population. The long-term outcome was favorable.
本研究旨在明确因脑干卒中而接受康复治疗的住院患者吞咽困难的发生率及预后情况。
我们回顾性分析了36例因脑干卒中入院患者的病历。通过查阅病历获取患者的临床特征、进食状况以及临床和视频透视吞咽检查结果等信息。出院后7至43个月通过电话随访了解患者的一般健康状况和进食状况。
在卒中发病后10至75天进行的首次临床吞咽评估时，共有81%的患者存在吞咽困难。在初次评估时，共有79%的吞咽困难患者依赖鼻饲；所有患者中有22%在出院时仍无法恢复经口进食。统计分析显示，预后不良与延髓受累疾病、初次吞咽测试时出现湿性啰音以及吞咽反射延迟或缺失之间存在显著关联。吸入性肺炎的发生率为11%。改良钡餐视频透视检查发现的误吸与吸入性肺炎的发生之间存在相关性。随访访谈显示，在接受随访的27例患者中，88%在卒中发病4个月后已恢复完全经口进食。
在我们的研究人群中，吞咽困难的发生率相对较高。长期预后良好。
