Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China.
Department of Rehabilitation Medicine, People' Hospital of Yangjiang, Guangzhou, P. R. China.
Brain Behav. 2023 Aug;13(8):e3161. doi: 10.1002/brb3.3161. Epub 2023 Jul 21.
This study aims to examine the characteristics of dysphagia in stroke patients with different lesion sites and explore the factors that impact the duration of nasogastric tube after post-stroke dysphagia (PSD).
Patients with PSD were screened for analysis. Stroke types and lesion sites were confirmed using MRI or CT scans. Included patients were categorized into two groups: supratentorial stroke group (including lobar and deep intracerebral stroke subgroups) and infratentorial stroke group (including brainstem and cerebellar stroke subgroups). Fiberoptic endoscopic evaluation of swallowing (FEES), Penetration-aspiration scale (PAS), Yale pharyngeal residue (PR) severity rating scale, Functional oral intake scale (FOIS), Murray secretion severity rating scale (MSS), laryngopharyngeal sensation, and vocal fold mobility were investigated to assess the swallowing function.
A total of 94 patients were included in the final analysis. Significant differences were found in PR scores (p < .001), PAS scores (p < .05), MSS scores (p < .05), and vocal fold mobility (p < .001) between infratentorial and supratentorial stroke groups. Moreover, lobar stroke showed significantly higher PR scores compared to the deep intracerebral stroke group (p < .05). Kaplan-Meier survival analysis indicated significant differences in the duration of nasogastric tube placement among the following groups: infratentorial versus supratentorial stroke, PAS ≤ 5 versus PAS > 5, PR ≥ 3 versus PR < 3, and normal vocal fold mobility versus vocal fold motion impairment group (p < .05).
The infratentorial stroke may lead to worse swallowing function as compared to a supratentorial stroke. Additionally, patients with infratentorial stroke, PAS > 5, PR ≥ 3, or vocal fold motion impairment may contribute to a longer duration of nasogastric tube placement.
本研究旨在探讨不同病变部位的脑卒中患者吞咽困难的特点，并探讨影响脑卒中后吞咽困难（PSD）患者鼻胃管留置时间的因素。
对 PSD 患者进行筛选分析。采用 MRI 或 CT 扫描确定脑卒中类型和病变部位。将纳入的患者分为两组：幕上卒中组（包括大脑半球和深部脑内卒中亚组）和幕下卒中组（包括脑干和小脑卒中亚组）。采用纤维光学内镜吞咽评估（FEES）、渗透-误吸量表（PAS）、耶鲁咽喉残留物（PR）严重程度评分量表、功能性口腔摄入量表（FOIS）、Murray 分泌严重程度评分量表（MSS）、喉咽部感觉和声带活动度评估吞咽功能。
共有 94 例患者纳入最终分析。幕上和幕下卒中组在 PR 评分（p<0.001）、PAS 评分（p<0.05）、MSS 评分（p<0.05）和声带活动度（p<0.001）方面存在显著差异。此外，大脑半球卒中组的 PR 评分明显高于深部脑内卒中组（p<0.05）。Kaplan-Meier 生存分析表明，鼻胃管置管时间在幕下与幕上卒中、PAS≤5 与 PAS>5、PR≥3 与 PR<3、声带运动正常与声带运动障碍组之间存在显著差异（p<0.05）。
与幕上卒中相比，幕下卒中可能导致更差的吞咽功能。此外，幕下卒中、PAS>5、PR≥3 或声带运动障碍可能导致鼻胃管留置时间延长。
