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吉兰-巴雷综合征与吞咽功能障碍

Guillain-Barré Syndrome and Swallowing Dysfunction.

作者信息

Mengi Tuğçe, Seçil Yaprak, İncesu Tülay Kurt, Arici Şehnaz, Akkiraz Zehra Özde, Gürgör Nevin, Gedizlioğlu Muhteşem, Ertekin Cumhur

机构信息

*Department of Clinical Neurophysiology, Katip Çelebi University Atatürk Training and Research Hospital, Karabağlar, İzmir, Turkey;†Department of Neurology, İzmir Training and Research Hospital, Karabağlar, İzmir, Turkey; and‡Department of Clinical Neurophysiology and Neurology, Medical School Hospital, Aegean University, Bornova, İzmir, Turkey.

出版信息

J Clin Neurophysiol. 2017 Sep;34(5):393-399. doi: 10.1097/WNP.0000000000000380.

Abstract

PURPOSE

Patients with Guillain-Barré syndrome (GBS), especially severe cases that require treatment in intensive care units, often experience swallowing difficulties. However, the oropharyngeal function of patients with GBS not treated in intensive care units is not typically evaluated using neurophysiological techniques.

METHODS

Electrophysiological techniques were used to determine dysphagia limit and sequential water swallowing values in an electromyography laboratory.

RESULTS

This study assessed 18 patients with GBS who were not treated in the intensive care unit between 4 and 45 days after their hospital admission; 18 healthy volunteers were used as a control group. Of the 18 patients with GBS, 7 exhibited the clinical involvement of either a single cranial nerve or a combination of cranial nerves while 11 did not show any lower cranial nerve involvement. Clinical dysphagia was observed in seven patients and six of these cases involved a lower cranial nerve while five patients without cranial nerve involvement had silent dysphagia according to the dysphagia limit test. In addition, the duration of sequential swallowing was significantly prolonged in all patients with GBS compared with the control subjects.

CONCLUSIONS

The present findings demonstrated that neurophysiological techniques are useful and easily applicable for patients with GBS and that there were no complications. Furthermore, cranial nerve involvement in patients with GBS likely increased the incidence of oropharyngeal dysphagia, and subclinical dysphagia may be present in this population as well. Therefore, neurophysiological techniques can be initially used and then repeated during follow-up visits for all types of patients with GBS.

摘要

目的

吉兰 - 巴雷综合征(GBS)患者,尤其是需要在重症监护病房接受治疗的重症患者,常伴有吞咽困难。然而,未在重症监护病房接受治疗的GBS患者的口咽功能通常未使用神经生理学技术进行评估。

方法

在肌电图实验室中,使用电生理技术来确定吞咽困难极限和连续饮水吞咽值。

结果

本研究评估了18例未在重症监护病房接受治疗的GBS患者,这些患者在入院后4至45天之间;18名健康志愿者作为对照组。在18例GBS患者中,7例表现出单条颅神经或多条颅神经的临床受累,而11例未表现出任何下颅神经受累。7例患者观察到临床吞咽困难,其中6例涉及下颅神经,而根据吞咽困难极限测试,5例无颅神经受累的患者存在隐匿性吞咽困难。此外,与对照组相比,所有GBS患者的连续吞咽持续时间均显著延长。

结论

目前的研究结果表明,神经生理学技术对GBS患者有用且易于应用,并且没有并发症。此外,GBS患者的颅神经受累可能增加口咽吞咽困难的发生率,并且该人群中可能也存在亚临床吞咽困难。因此,神经生理学技术可首先用于所有类型的GBS患者,并在随访期间重复使用。

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