中风患者的吞咽困难
Dysphagia in stroke patients.
作者信息
Singh S, Hamdy S
机构信息
Department of GI Sciences, Hope Hospital, Manchester, UK.
出版信息
Postgrad Med J. 2006 Jun;82(968):383-91. doi: 10.1136/pgmj.2005.043281.
Abstract
Swallowing musculature is asymmetrically represented in both motor cortices. Stroke affecting the hemisphere with the dominant swallowing projection results in dysphagia and clinical recovery has been correlated with compensatory changes in the previously non-dominant, unaffected hemisphere. This asymmetric bilaterality may explain why up to half of stroke patients are dysphagic and why many will regain a safe swallow over a comparatively short period. Despite this propensity for recovery, dysphagia carries a sevenfold increased risk of aspiration pneumonia and is an independent predictor of mortality. The identification, clinical course, pathophysiology, and treatment of dysphagia after stroke are discussed in this review.
摘要
吞咽肌肉组织在两侧运动皮层中的表征是不对称的。影响具有优势吞咽投射的半球的中风会导致吞咽困难，而临床恢复与先前非优势、未受影响的半球的代偿性变化相关。这种不对称的双侧性可能解释了为什么多达一半的中风患者会出现吞咽困难，以及为什么许多患者会在相对较短的时间内恢复安全吞咽。尽管有这种恢复倾向，但吞咽困难会使吸入性肺炎的风险增加七倍，并且是死亡率的独立预测因素。本文综述了中风后吞咽困难的识别、临床过程、病理生理学和治疗方法。
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本文引用的文献
1
Can bedside assessment reliably exclude aspiration following acute stroke?床边评估能否可靠地排除急性中风后的误吸？
Age Ageing. 1998 Mar;27(2):99-106. doi: 10.1093/ageing/27.2.99.
2
Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables.使用多种吞咽困难变量的因子分析来识别一种用于中风患者吞咽困难的简单筛查工具。
J Rehabil Med. 2005 Jul;37(4):247-51. doi: 10.1080/16501970510026999.
3
Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1,340 consecutive examinations.伴有感觉测试的吞咽功能灵活内镜评估：1340例连续检查的患者特征及安全性分析
Ann Otol Rhinol Laryngol. 2005 Mar;114(3):173-6. doi: 10.1177/000348940511400301.
4
Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial.吞咽困难的中风患者肠内管饲的时机和方法的影响（FOOD）：一项多中心随机对照试验。
Lancet. 2005;365(9461):764-72. doi: 10.1016/S0140-6736(05)17983-5.
5
Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial.
Lancet. 2005;365(9461):755-63. doi: 10.1016/S0140-6736(05)17982-3.
6
Effects of viscosity, taste, and bolus volume on swallowing apnea duration of normal adults.黏度、味道和食团体积对正常成年人吞咽呼吸暂停持续时间的影响。
Otolaryngol Head Neck Surg. 2004 Dec;131(6):860-3. doi: 10.1016/j.otohns.2004.06.706.
7
Influence of bolus consistency on lingual behaviors in sequential swallowing.团块稠度对连续吞咽中舌部行为的影响。
Dysphagia. 2004 Summer;19(3):192-206. doi: 10.1007/s00455-004-0006-5.
8
Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback.采用辅助表面肌电图生物反馈的吞咽困难治疗的功能效益
Dysphagia. 2004 Summer;19(3):160-4. doi: 10.1007/s00455-004-0003-8.
9
Effects of age, gender, bolus volume, bolus viscosity, and gustation on swallowing apnea onset relative to lingual bolus propulsion onset in normal adults.年龄、性别、团块体积、团块黏度和味觉对正常成年人吞咽呼吸暂停起始相对于舌部团块推进起始的影响。
J Speech Lang Hear Res. 2004 Jun;47(3):572-83. doi: 10.1044/1092-4388(2004/044).
10
Pneumonia in acute stroke patients fed by nasogastric tube.经鼻胃管喂养的急性卒中患者的肺炎
J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):852-6. doi: 10.1136/jnnp.2003.019075.
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