中风后喉敏感性与食物误咽/误吸的相关性
Correlation between laryngeal sensitivity and penetration/aspiration after stroke.
作者信息
Onofri Suely Mayumi Motonaga, Cola Paula Cristina, Berti Larissa Cristina, da Silva Roberta Gonçalves, Dantas Roberto Oliveira
机构信息
Department of Speech and Language Therapy, São Paulo State University - UNESP, Av. Hygino Muzzi Filho, 737, Campus Universitário, Marília, São Paulo, 17525-900, Brazil,
出版信息
Dysphagia. 2014 Apr;29(2):256-61. doi: 10.1007/s00455-013-9504-7. Epub 2014 Jan 21.
Stroke is the most common neurological disease in adults that is associated with deglutition disorders. The presence of laryngeal sensitivity is very important in developing safe swallowing without risk of pulmonary complications. The aim of this study was to correlate laryngeal sensitivity with laryngeal penetration and tracheal aspiration after swallows of three food consistencies (puree, thickened liquid, and liquid) in poststroke individuals in the late phase. A cross-sectional clinical study was performed with 91 post-ischemic stroke individuals, with oropharyngeal dysphagia, who were in rehabilitation center treatment from 2009 to 2011. They had a mean age of 68.1 years and average time since injury was 22.6 months; 39 had injury to the right hemisphere and 52 had injury to the left hemisphere. All underwent fiberoptic endoscopic evaluation of swallowing and evaluation of laryngeal sensitivity by touching the tip of the endoscope to the arytenoids and aryepiglottic folds. The linear correlation coefficient of Spearman was applied to evaluate the correlation between laryngeal penetration and tracheal aspiration and the presence/absence of laryngeal sensitivity. There was a negative correlation between the observation of penetration and tracheal aspiration and laryngeal sensitivity, with all bolus consistencies (p < 0.001 for aspiration and p ≤ 0.01 for penetration). The absence of laryngeal sensitivity determines the more frequent findings of penetration and tracheal aspiration. This sensory stimulus in the mucosa of the pharynx and larynx is an essential element for safe swallowing and its deficiency associated with altered motor activity can cause laryngeal penetration and aspiration in poststroke individuals regardless of food consistency.
中风是成年人中最常见的与吞咽障碍相关的神经疾病。喉部敏感性的存在对于实现安全吞咽且无肺部并发症风险非常重要。本研究的目的是在中风后期患者吞咽三种食物稠度(泥状食物、增稠液体和液体)后,将喉部敏感性与喉部穿透和气管误吸进行关联。对91名患有口咽吞咽困难的缺血性中风后患者进行了一项横断面临床研究,这些患者于2009年至2011年在康复中心接受治疗。他们的平均年龄为68.1岁,受伤后的平均时间为22.6个月;39人右半球受损,52人左半球受损。所有人均接受了纤维内镜吞咽评估,并通过将内镜尖端触碰杓状软骨和杓会厌襞来评估喉部敏感性。应用Spearman线性相关系数来评估喉部穿透和气管误吸与喉部敏感性的存在与否之间的相关性。在所有食团稠度下,穿透和气管误吸的观察结果与喉部敏感性之间均呈负相关(误吸p < 0.001,穿透p≤0.01)。喉部敏感性的缺失决定了更频繁出现穿透和气管误吸的情况。咽部和喉部黏膜中的这种感觉刺激是安全吞咽的关键要素,其缺乏与运动活动改变相关,可导致中风后患者出现喉部穿透和误吸,而与食物稠度无关。