Singh S, Hamdy S
Department of GI Sciences, Hope Hospital, Manchester, UK.
Postgrad Med J. 2006 Jun;82(968):383-91. doi: 10.1136/pgmj.2005.043281.
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.
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。
