Terré Rosa, Mearin Fermín
Functional Digestion Rehabilitation Unit, Institut Guttmann, Neurorehabilitation Hospital, University Institute affiliated with the Autonomous University of Barcelona, Badalona, Spain.
Am J Gastroenterol. 2009 Apr;104(4):923-32. doi: 10.1038/ajg.2008.160. Epub 2009 Mar 3.
We set out to ascertain the evolution and the clinical and videofluoroscopic (VFS) prognostic factors of aspiration recovery and return to oral intake in patients with stroke and VFS diagnosis of tracheal aspiration.
Twenty patients with stroke and VFS diagnosis of tracheal aspiration were prospectively evaluated. Clinical evaluation of oropharyngeal dysphagia and VFS examination were performed at admission and repeated at 1, 3, 6 and 12 months of follow-up.
At admission, videofluoroscopy showed 40% of patients to have an increase in oral transit time and 65% impaired tongue control; in the pharyngeal phase, mean pharyngeal transit time was increased in 70% of patients and the time required to trigger the swallowing reflex was delayed in 70%. During follow-up, an improvement was observed, and the number of patients with aspiration decreased progressively (the most significant change occurred at 6 months). Evolution was related to the vascular territory affected: at 1 year, aspiration persisted in 12% of anterior territory lesions vs. 58% of posterior territory lesions. Also, the number of silent aspirators decreased from 35% at baseline to no patients after 3 months. Persistent aspiration at 1 year of follow-up significantly correlated with the following baseline variables: vascular territory, gag reflex abolition, palatoglossal seal alteration and pharyngeal delay time.
Swallowing physiology in stroke greatly improved during follow-up, mainly between 3 and 6 months, and the number of aspirations decreased progressively. Prognostic factors for persisting aspiration are posterior vascular territory lesions, oropharyngeal reflex abolition, palatoglossal seal alteration and pharyngeal delay time at baseline.
我们旨在确定脑卒中且经视频荧光吞咽造影（VFS）诊断为气管误吸患者误吸恢复及恢复经口进食的演变情况、临床及视频荧光吞咽造影（VFS）预后因素。
对20例经VFS诊断为气管误吸的脑卒中患者进行前瞻性评估。入院时进行口咽吞咽困难的临床评估及VFS检查，并在随访的1、3、6和12个月重复进行。
入院时，视频荧光吞咽造影显示40%的患者口腔通过时间延长，65%的患者舌控制能力受损；在咽期，70%的患者平均咽通过时间延长，70%的患者触发吞咽反射所需时间延迟。随访期间，观察到有所改善，误吸患者数量逐渐减少（最显著的变化发生在6个月时）。演变情况与受影响的血管区域有关：1年后，前循环区域病变患者中有12%持续存在误吸，而后循环区域病变患者中这一比例为58%。此外，无症状误吸者的数量从基线时的35%降至3个月后无患者。随访1年时持续存在误吸与以下基线变量显著相关：血管区域、咽反射消失、腭舌封闭改变及咽部延迟时间。
脑卒中患者的吞咽生理功能在随访期间有很大改善，主要在3至6个月之间，误吸次数逐渐减少。持续误吸的预后因素为后循环区域病变、口咽反射消失、腭舌封闭改变及基线时的咽部延迟时间。
