Qiao Jia, Wu Zhi-Min, Ye Qiu-Ping, Dai Meng, Dai Yong, He Zi-Tong, Dou Zu-Lin
Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Neurosci. 2022 Aug 24;16:944688. doi: 10.3389/fnins.2022.944688. eCollection 2022.
This study aims to compare the characteristics of dysphagia among different lesion sites and explore the possible risk factors that are relevant to penetration and aspiration after stroke.
Data on patients with post-stroke dysphagia were collected. Major measures of the videofluoroscopic swallowing study included pharyngeal transit duration (PTD), pharyngeal response duration (PRD), soft palate elevation duration (SED), stage transition duration (STD), hyoid bone anterior-horizontal displacement (HAD), hyoid bone superior-horizontal displacement (HSD), upper esophageal sphincter opening (UESO), Pharyngeal Residual Grade (PRG), and Penetration Aspiration Scale (PAS). Included patients were divided into supratentorial (deep or lobar intracerebral) and infratentorial stroke groups. The Kruskal-Wallis test, Spearman's correlation analysis, and multivariate logistic regression analyses were used to test the difference and the correlation between those measures. Time-to-event endpoints (oral feeding) were analyzed by the Kaplan-Meier method.
A total of 75 patients were included in this study. Significant differences were demonstrated in PTD, PRD, SED, STD, HAD, HSD, UESO, PAS, and PRG between supratentorial and infratentorial stroke groups ( < 0.05). The PRG score of the lobar intracerebral subgroup was significantly higher ( < 0.05) than that of the deep intracerebral and lobar + deep intracerebral stroke subgroups, while HSD was significantly shorter ( < 0.01). Spearman's correlation analysis revealed that PAS was related to PTD, PRG, HAD, and UESO ( < 0.05). Multivariate logistic regression analysis demonstrated that HAD and PRG may be risk factors for penetration and aspiration ( < 0.05). Kaplan-Meier survival plot showed that there was a significant difference in time to oral feeding between supratentorial and infratentorial stroke groups ( < 0.01).
Infratentorial stroke may lead to worse swallowing function as compared with supratentorial stroke, and lobar intracerebral stroke may be worse than deep intracerebral stroke. Suitable preventive measures may be considered for patients with higher PRG scores and shorter HSD to avoid penetration and aspiration.
本研究旨在比较不同病变部位吞咽困难的特征，并探讨与卒中后渗透和误吸相关的可能危险因素。
收集卒中后吞咽困难患者的数据。电视荧光吞咽造影研究的主要测量指标包括咽部通过时间（PTD）、咽部反应时间（PRD）、软腭抬高时间（SED）、阶段转换时间（STD）、舌骨前水平位移（HAD）、舌骨上水平位移（HSD）、食管上括约肌开口（UESO）、咽部残留分级（PRG）和渗透误吸量表（PAS）。纳入的患者分为幕上（深部或脑叶内）和幕下卒中组。采用Kruskal-Wallis检验、Spearman相关性分析和多因素逻辑回归分析来检验这些测量指标之间的差异和相关性。采用Kaplan-Meier法分析事件发生时间终点（经口进食）。
本研究共纳入75例患者。幕上和幕下卒中组在PTD、PRD、SED、STD、HAD、HSD、UESO、PAS和PRG方面存在显著差异（<0.05）。脑叶内亚组的PRG评分显著高于深部脑内和脑叶+深部脑内卒中亚组（<0.05），而HSD显著缩短（<0.01）。Spearman相关性分析显示，PAS与PTD、PRG、HAD和UESO相关（<0.05）。多因素逻辑回归分析表明，HAD和PRG可能是渗透和误吸的危险因素（<0.05）。Kaplan-Meier生存曲线显示，幕上和幕下卒中组经口进食时间存在显著差异（<0.01）。
与幕上卒中相比，幕下卒中可能导致更差的吞咽功能，脑叶内卒中可能比深部脑内卒中更差。对于PRG评分较高且HSD较短的患者，可考虑采取适当的预防措施以避免渗透和误吸。
