Jang Sung Ho, Kwak So Young, Chang Chul Hoon, Jung Young Jin, Kim JongHoon, Kim Seong Ho, Kim Jun Young
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea.
Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea.
Dysphagia. 2020 Dec;35(6):985-992. doi: 10.1007/s00455-020-10093-3. Epub 2020 Feb 10.
We investigated the predictive value of the corticobulbar tract (CBT) for dysphagia using diffusion tensor tractography in the early stage of intracerebral hemorrhage (ICH) for dysphagia. Forty-two patients with spontaneous ICH ± intraventricular hemorrhage (IVH) and 22 control subjects were recruited. The patients were classified into three groups: group A-could remove nasogastric tube (NGT) in the acute stage of ICH, group B-could remove NGT within 6 months after onset, and group C-could not remove NGT until 6 months after onset. The CBT were reconstructed, and fractional anisotropy (FA) and tract volume (TV) values were determined. The FA of the CBT in the affected hemisphere in group A was lower than in the control group (p < 0.05). The FA and TV of the CBT in the affected hemisphere in group B were lower than those in the control group (p < 0.05). In group C, the FA and TV in the affected hemisphere and unaffected hemispheres were lower than in the control group (p < 0.05). The TV of the CBT in the affected hemisphere in group B showed a moderate negative correlation with the length of time until NGT removal (r = 0.430, p < 0.05). We found that patients with CBT injuries in both hemispheres were not able to remove the NGT until 6 months after onset, whereas patients who were injured only in the affected hemisphere were able to remove NGT within 6 months of onset. The severity of injury to the CBT in the affected hemisphere appeared to be related to the length of time until NGT removal.
我们采用弥散张量纤维束成像技术研究了脑出血（ICH）早期皮质延髓束（CBT）对吞咽困难的预测价值。招募了42例自发性ICH±脑室内出血（IVH）患者和22例对照者。将患者分为三组：A组-在ICH急性期可拔除鼻胃管（NGT）；B组-发病后6个月内可拔除NGT；C组-发病后6个月后才能拔除NGT。重建CBT，并测定分数各向异性（FA）和纤维束体积（TV）值。A组患侧半球CBT的FA低于对照组（p<0.05）。B组患侧半球CBT的FA和TV低于对照组（p<0.05）。C组患侧半球和未患侧半球的FA和TV均低于对照组（p<0.05）。B组患侧半球CBT的TV与拔除NGT前的时间长度呈中度负相关（r=0.430，p<0.05）。我们发现，双侧CBT损伤的患者在发病后6个月才能拔除NGT，而仅患侧半球受损的患者在发病后6个月内能够拔除NGT。患侧半球CBT损伤的严重程度似乎与拔除NGT前的时间长度有关。
