Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China.
J Stroke Cerebrovasc Dis. 2024 Jun;33(6):107682. doi: 10.1016/j.jstrokecerebrovasdis.2024.107682. Epub 2024 Mar 23.
To assess the correlation between lesion location and swallowing function characteristics in post-stroke dysphagia (PSD) patients.
We enrolled 133 PSD. The patients were divided into supratentorial and infratentorial stroke groups. We compared the measurements in the videofluoroscopic swallowing study (VFSS) with 3ml and 5 ml of diluted and thickened barium liquid data between supratentorial and brainstem stroke groups. We further compared the difference of VFSS measurements between patients with left hemispheric or right hemispheric lesions (further divided into unilateral hemispheric cortical and subcortical subgroups) and brianstem leison stroke group.To explore the lesion location's effect on different bolus volume, the VFSS measurements of 3ml and 5ml in each subgroups were compared respectively. The measurements of VFSS included the oral transit time, soft palate elevation duration, hyoid bone movement duration (HMD), UES opening duration, pharyngeal transit duration (PTD), stage of ansition duration, and laryngeal closure duration (LCD), the upper esophageal sphincter opening (UESO), hyoid bone superior horizontal displacement, and hyoid bone anterior horizontal displacement. General swallowing function was assessed using the Penetration Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS). We performed the paired t-test, Spearman's correlation, and Kruskal-Wallis test analysis to characterize the parameters among the groups.
Fifty-eight patients were assessed in the final analysis. The HMD (p = 0.019), PTD (p = 0.048) and LCD (p = 0.013) were significantly different between the supratentorial and brainstem lesion groups in 5ml volume. The HMD was significantly different (p = 0.045) between the left cortical and brainstem lesion groups. Significant differences in the HMD (p = 0.037) and LCD (p = 0.032) between the left subcortical and brainstem lesion groups were found in 5ml volume bolus. There was no group different when taking the 3ml volume bolus. Regarding the relationship between food bolus volume and swallowing functions, only the UESO demonstrated a significant difference in the subcortical lesion of the right hemisphere (p = 0.0032) compared the 3 ml and 5 ml volume bolus. The PTD demonstrated a moderate correlation with the PAS scores (r = 0.38, p = 0.0044). The HMD (r = 0.32, p = 0.018) and LCD (r = 0.29, p = 0.039) demonstrated weak correlations with the PAS scores. We did not identify any correlation between the VFSS parameters and FOIS scores in each subgroup level.
The PSD with brainstem lesion shows more sever dysfunction in the pharyngeal phases. The left hemisphere was engaged in both the oral and pharyngeal phases. Lesions in the bilateral cortical, subcortical, and brainstem regions may impair sensory input.
评估脑卒中后吞咽障碍（PSD）患者的病灶位置与吞咽功能特征之间的相关性。
我们纳入了 133 例 PSD 患者。根据病灶位置将患者分为幕上组和幕下组。比较幕上和脑干部位脑卒中患者在视频荧光吞咽检查（VFSS）中 3ml 和 5ml 稀释和增稠钡剂的测量值。进一步比较左半球或右半球病变（进一步分为单侧半球皮质和皮质下亚组）与脑干部位病变患者 VFSS 测量值的差异。为了探讨不同容积的病变位置对吞咽功能的影响，分别比较了各亚组 3ml 和 5ml 容积的 VFSS 测量值。VFSS 测量值包括口腔通过时间、软腭抬高持续时间、舌骨运动持续时间（HMD）、UES 开放持续时间、咽部通过时间（PTD）、过渡阶段持续时间和喉闭合持续时间（LCD）、UES 开放（UESO）、舌骨上水平位移和舌骨前水平位移。采用渗透吸痰量表（PAS）和功能性口腔摄入量表（FOIS）评估一般吞咽功能。采用配对 t 检验、Spearman 相关分析和 Kruskal-Wallis 检验分析对各参数进行比较。
最终分析了 58 例患者。5ml 时，幕上组和脑干部位病变组的 HMD（p=0.019）、PTD（p=0.048）和 LCD（p=0.013）差异均有统计学意义。左皮质与脑干部位病变组的 HMD 差异有统计学意义（p=0.045）。左皮质下与脑干部位病变组 5ml 容积的 HMD（p=0.037）和 LCD（p=0.032）差异有统计学意义。在 3ml 容积时，各亚组之间没有组间差异。关于食物容积与吞咽功能的关系，仅右侧皮质下病变的 UESO 在 3ml 和 5ml 容积时差异有统计学意义（p=0.0032）。PTD 与 PAS 评分呈中度相关（r=0.38，p=0.0044）。HMD（r=0.32，p=0.018）和 LCD（r=0.29，p=0.039）与 PAS 评分呈弱相关。在各亚组水平，均未发现 VFSS 参数与 FOIS 评分之间存在相关性。
脑干部位病变的 PSD 患者在咽部阶段的功能障碍更为严重。左半球参与口腔和咽部阶段。双侧皮质、皮质下和脑干部位病变可能会损害感觉输入。
