Moon Hyun Im, Yoon Seo Yeon, Yi Tae Im, Jeong Yoon Jeong, Cho Tae Hwan
Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, 13590, Gyeonggi-do, Republic of Korea.
Dysphagia. 2018 Jun;33(3):321-328. doi: 10.1007/s00455-017-9856-5. Epub 2017 Oct 11.
Some stroke patients show oral phase dysphagia, characterized by a markedly prolonged oral transit time that hinders oral feeding. The aim of this study was to clarify the clinical characteristics and lesions responsible for delayed swallowing.
We reviewed 90 patients with stroke. The oral processing time plus the postfaucial aggregation time required to swallow semisolid food was assessed. The patients were divided into two groups according to oral transit time, and we analyzed the differences in characteristics such as demographic factors, lesion factors, and cognitive function. Logistic regression analyses were performed to examine the predictors of delayed oral transit time. Lesion location and volume were measured on brain magnetic resonance images. We generated statistic maps of lesions related to delayed oral phase in swallowing using voxel-based lesion symptom mapping (VLSM).
The group of patients who showed delayed oral transit time had significantly low cognitive function. Also, in a regression model, delayed oral phase was predicted with low K-MMSE (Korean version of the Mini Mental Status Exam). Using VLSM, we found the lesion location to be associated with delayed oral phase after adjusting for K-MMSE score. Although these results did not reach statistical significance, they showed the lesion pattern with predominant distribution in the left frontal lobe.
Delayed oral phase in post-stroke patients was not negligible clinically. Patients' cognitive impairments affect the oral transit time. When adjusting it, we found a trend that the lesion responsible for delayed oral phase was located in the left frontal lobe, though the association did not reach significance. The delay might be related to praxis function.
一些中风患者表现出口腔期吞咽困难，其特征是口腔运送时间明显延长，这妨碍了经口进食。本研究的目的是阐明导致吞咽延迟的临床特征和病变。
我们回顾了90例中风患者。评估了吞咽半固体食物所需的口腔处理时间加咽后聚集时间。根据口腔运送时间将患者分为两组，我们分析了人口统计学因素、病变因素和认知功能等特征的差异。进行逻辑回归分析以检验口腔运送时间延迟的预测因素。在脑磁共振图像上测量病变位置和体积。我们使用基于体素的病变症状映射（VLSM）生成了与吞咽延迟口腔期相关的病变统计图。
口腔运送时间延迟的患者组认知功能显著低下。此外，在回归模型中，低K-MMSE（韩国版简易精神状态检查）可预测口腔期延迟。使用VLSM，我们发现调整K-MMSE评分后病变位置与口腔期延迟有关。尽管这些结果未达到统计学意义，但它们显示出病变模式主要分布在左额叶。
中风后患者的口腔期延迟在临床上不可忽视。患者的认知障碍会影响口腔运送时间。调整后，我们发现尽管相关性未达到显著水平，但导致口腔期延迟的病变有位于左额叶的趋势。这种延迟可能与实践功能有关。
