脑干卒中导致吞咽障碍的临床特征及康复

doi:10.3969/j.issn.1006-9771.2023.04.012

Abstract

Abstract:

Objective To investigate the clinical characteristics of dysphagia after brainstem stroke, and rehabilitation effect and influencial factors for it.
Methods A retrospectively analysis was conducted in patients who were diagnosed as dysphagia after brainstem stroke in the Beijing Bo'ai Hospital from April, 2018 to December, 2021. The following data were collected: the general information (gender, age, course of disease, and time of treatment), the result of videofluoroscopic swallowing study (VFSS), the Dysphagia Severity Scale (DSS) score before and after treatment, the scores of Fugl-Meyer Assessment (FMA), FMA-Balance (FMA-B), National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI), Mini-Mental State Examination (MMSE), and whether oral feeding. Based on the result of VFSS, all patients were divided into non-cricopharyngeal achalasia group (control group) and cricopharyngeal achalasia group (observation group).
Results A total of 60 patients were collected, with 29 in the control group and 31 in the observation group. The scores of FMA, FMA-B, BI and MMSE were higher (|t| > 3.281, P < 0.01), and the NIHSS score was lower (t = 4.390, P < 0.001) in the observation group than in the control group. Before treatment, the score of DSS was significantly lower in the observation group than in the control group (t = 5.785, P < 0.001); after treatment, the scores improved in both groups (|t| > 5.387, P < 0.001), and no significant difference was found between two groups (t = 1.675, P = 0.099); however, the d-value was more in the observation group than in the control group (t = -2.729, P = 0.008). There was no significant difference in the rate of oral feeding (χ² = 2.742, P = 0.098). In the control group, there were differences in the scores of NIHSS, FMA-B, BI and DSS between patients with oral feeding and those with nasal feeding (|t| > 2.429, P < 0.05); however, no significant difference was found in all factors in the observation group (P > 0.05). The DSS score was the influence factor of oral feeding in the control group (OR = 3.947, 95%CI 1.361 to 11.450, P = 0.012), and no influencing factor was found in the observation group.
Conclusion Among the patients with dysphagia after brainstem stroke, less accompanying disorders and more severe dysphagia were found in those with cricopharyngeal achalasia. All patients improved in dysphagia after treatment, and the rehabilitation effect of cricopharyngeal achalasia was better. The score of DSS relates with oral feeding in non-cricopharyngeal achalasia patients, and there was no specific influencing factor in cricopharyngeal achalasia patients.

Key words: stroke, dysphagia, rehabilitation, influencing factor

CLC Number:

R743.3

GAO Fei, LIU Lixu, YUAN Yongxue. Clinical characteristics and rehabilitation of dysphagia after brainstem stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(4): 465-471.

Figures/Tables 5

References 31

[1]	中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识(2017年版)第一部分评估篇[J]. 中华物理医学与康复杂志, 2017, 39(12): 881-892.
[2]	恽晓平. 康复疗法评定学[M]. 北京: 华夏出版社, 2005: 519-532.
	YUN X P. Assessment of rehabilitation therapy[M]. Beijing: Huaxia Publishing House, 2005: 519-532.
[3]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682.
	Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol, 2018, 51(9): 666-682.
[4]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019)[J]. 中华神经科杂志, 2019, 52(12): 994-1005.
	Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute intracerebral hemorrhage 2019[J]. Chin J Neurol, 2019, 52(12): 994-1005.
[5]	饶明俐. 中国脑血管病防治指南[M]. 北京: 人民卫生出版社, 2007: 83-84.
	RAO M L. China guidrline for cerebrovascular disease prevention and treatment[M]. Beijing: People's Health Publishing House, 2007: 83-84.
[6]	陈卓铭. 语言治疗学[M]. 北京: 人民卫生出版社, 2018: 254.
	CHEN Z M. Language therapy[M]. Beijing: People's Health Publishing House, 2018: 254.
[7]	李胜利. 言语治疗学[M]. 2版. 北京: 华夏出版社, 2014: 193-194.
	LI S L. Speech therapy[M]. 2nd ed. Beijing: Huaxia Publishing House, 2014: 193-194.
[8]	张婧, 周筠, 赵性泉, 等. 延髓背外侧综合征所致吞咽障碍的特点及相关机制[J]. 中华物理医学与康复杂志, 2006, 28(11): 770-773.
	ZHANG J, ZHOU Y, ZHAO X Q, et al. The characteristics and mechanisms of dysphagia in patients with dorsolateral medullary syndrome[J]. Chin J Phys Med Rehabil, 2006, 28(11): 770-773.
[9]	ROTH E J, LOVELL L, HARVEY R L, et al. Incidence of and risk factors for medical complications during stroke rehabilitation[J]. Stroke, 2001, 32(2): 523-529. doi: 10.1161/01.str.32.2.523 pmid: 11157192
[10]	STEINHAGEN V, GROSSMANN A, BENECKE R, et al. Swallowing disturbance pattern relates to brain lesion location in acute stroke patients[J]. Stroke, 2009, 40: 1903-1906. doi: 10.1161/STROKEAHA.108.535468 pmid: 19286597
[11]	YANG H, YI Y, HAN Y, et al. Characteristics of cricopharyngeal dysphagia after ischemic stroke[J]. Ann Rehabil Med, 2018, 42(2): 204-212. doi: 10.5535/arm.2018.42.2.204 pmid: 29765873
[12]	WAN P, CHEN X, ZHU L, et al. Dysphagia post subcortical and supratentorial stroke[J]. J Stroke Cerebrovasc Dis, 2016, 25(1): 74-82. doi: 10.1016/j.jstrokecerebrovasdis.2015.08.037 pmid: 26508684
[13]	KIM J Y, YOON S Y, KIM J, et al. Neural correlates of cricopharyngeal dysfunction after supratentorial stroke: a voxel-based lesion-symptom mapping with propensity score matched case-control[J]. Int J Stroke, 2022, 17(2): 207-217. doi: 10.1177/17474930211006300
[14]	胡佑红, 卫小梅, 窦祖林. 导管球囊扩张治疗环咽肌功能障碍的机制[J]. 中华脑科疾病与康复杂志(电子版), 2011, 1(1): 59-63.
	HU Y H, WEI X M, DOU Z L. Mechanisms of Catheter balloon dilatation therapy for crieopharyngeal dysfunction[J]. Chin J Brain Dis Rehabil (Electr Ed), 2011, 1(1): 59-63.
[15]	ERTEKIN C, AYDOGDU I, TARLACI S, et al. Mechanisms of dysphagia in suprabulbar palsy with lacunar infarct[J]. Stroke, 2000, 31(6): 1370-1376. doi: 10.1161/01.str.31.6.1370 pmid: 10835459
[16]	PERIE S, COIFFIER L, LACCOURREYE L, et al. Swallowing disorders in paralysis of the lower cranial nerves: a functional analysis[J]. Ann Otol Rhinol Laryngol, 1999, 108(6): 606-611. doi: 10.1177/000348949910800614
[17]	张冉, 蔡卫新, 董丽丽, 等. 缺血性卒中患者吞咽障碍危险因素的Meta分析[J]. 中国卒中杂志, 2021, 16(12): 1235-1241.
	ZHANG R, CAI W X, DONG L L, et al. A meta-analysis of risk factors for dysphagia among patients with ischemic stroke[J]. Chin J Stroke, 2021, 16(12): 1235-1241. doi: 10.3969/j.issn.1673-5765.2021.12.007
[18]	王相明, 张月辉, 林文. 急性脑卒中后吞咽障碍程度相关因素分析[J]. 四川医学, 2013, 34(11): 1631-1633.
	WANG X M, ZHANG Y H, LIN W. Analysis of the related factors influencing dysphagia severity following acute stroke[J]. Sichuang Med, 2013, 34(11): 1631-1633.
[19]	何容, 郭艳芹, 王怀林, 等. 环咽肌失弛缓的诊断与治疗发展现状[J]. 牡丹江医学院学报, 2012, 33(4): 50-52.
	HE R, GUO Y Q, WANG H L, et al. Current status of diagnosis and treatment of cricopharyngeal achalasia[J]. J Mudanjiang Med Univ, 2012, 33(4): 50-52.
[20]	汪敏, 姚滔涛, 李嘉茵, 等. 重复经颅磁刺激治疗卒中后吞咽障碍的研究进展[J]. 中国康复理论与实践, 2020, 26(5): 555-558. doi: 10.3969/j.issn.1006-9771.2020.05.012
	WANG M, YAO T T, LI J Y, et al. Advance in repeatitive transcranial magnetic stimulation for dysphagia after stroke (review)[J]. Chin J Rehabil Theory Pract, 2020, 26(5): 555-558.
[21]	PISEGNA J M, KANEOKA A, PEARSON W G, et al. Effects of noninvasive brain stimulation on post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled trials[J]. Clin Neurophysiol, 2016, 127(1): 956-968. doi: 10.1016/j.clinph.2015.04.069
[22]	李安, 夏艳秋, 傅建玲, 等. 经颅直流电刺激在卒中后吞咽障碍康复治疗中的应用研究进展[J]. 中国卒中杂志, 2021, 16(8): 855-860.
	LI A, XIA Y Q, FU J L, et al. Progress of transcranial direct current stimulation in rehabilitation of post-stroke dysphagia[J]. Chin J Stroke, 2021, 16(8): 855-860.
[23]	中国医师协会神经调控专业委员会电休克与神经刺激学组. 重复经颅磁刺激治疗专家共识[J]. 转化医学杂志, 2018, 7(1): 4-9.
	Chinese Society of ECT ＆ Neurostimulation. Chinese experts consensus on repetitive transcranial tagnetic stimulation[J]. J Transla Med, 2018, 7(1): 4-9. doi: 10.1186/1479-5876-7-4
[24]	中国经颅直流电刺激脑卒中康复临床应用专家共识组. 经颅直流电刺激技术应用于脑卒中患者康复治疗的专家共识[J]. 中华物理医学与康复杂志, 2021, 43(4): 289-294.
[25]	马艳平, 宋成忠, 岳寿伟, 等. 脑卒中后真性延髓麻痹吞咽障碍的综合治疗[J]. 中国康复医学杂志, 2010, 25(2): 165-166.
[26]	窦祖林, 兰月, 于帆, 等. 吞咽造影数字化分析在脑干卒中后吞咽障碍患者疗效评估中的应用[J]. 中国康复医学杂志, 2013, 28(9): 799-805.
	DOU Z L, LAN Y, YU F, et al. Application of videofluoroscopy digital analysis in swallowing function assessment for brainstem stroke patients with dysphagia[J]. Chin J Rehabil Med, 2013, 28(9): 799-805.
[27]	金琳娜, 廖志平, 邹朝君. 导管球囊扩张术治疗脑卒中患者环咽肌功能障碍的研究进展[J]. 中华物理医学与康复杂志, 2018, 40(12): 957-960.
	JIN L N, LIAO Z P, ZOU C J. Research progress of balloon catheter dilation in the treatment of cricopharyngeal dysfunction in stroke[J]. Chin J Phys Med Rehabil, 2018, 40(12): 957-960.
[28]	袁春兰, 彭化生. 导尿管球囊扩张术不同介入时机对脑卒中后环咽肌失弛缓症疗效的影响[J]. 中华物理医学与康复杂志, 2013, 35(2): 126-129.
	YUAN C L, PENG H S. Effects of the timing of catheter balloon dilation therapy on cricopharyngeal achalasia after stroke[J]. Chin J Phys Med Rehabil, 2013, 35(2): 126-129.
[29]	袁永学, 张庆苏. 环咽肌功能障碍患者康复结局的影响因素[J]. 中国康复理论与实践, 2021, 27(8): 973-977. doi: 10.3969/j.issn.1006-9771.2021.08.013
	YUAN Y X, ZHANG Q S. Factors related to rehabilitation outcome of dysphagia for patients with cricopharyngeal dysfunction[J]. Chin J Rehabil Theory Pract, 2021, 27(8): 973-977.
[30]	刘玲玲, 帅浪, 张纯, 等. 一种吞咽障碍压力测定与扩张治疗仪对脑卒中后环咽肌失弛缓症患者的临床疗效分析[J]. 中国康复医学杂志, 2019, 34(6): 636-641.
	LIU L L, SHUAI L, ZHANG C, et al. Clinical effects of a swallowing disorder pressure measurement and treatment equipment for patients with cricopharyngeal achalasia after stroke[J]. Chin J Rehabil Med, 2019, 34(6): 636-641.
[31]	张祎辰, 高正玉, 王强, 等. 环咽肌失弛缓症的A型肉毒毒素注射研究进展[J]. 中华物理医学与康复杂志, 2020, 42(2): 189-192.
	ZHANG Y C, GAO Z Y, WANG Q, et al. Research progress of Botulinum toxin type A injection in cricopharyngeal achalasia[J]. Chin J Phys Med Rehabil, 2020, 42(2): 189-192.

组别	n	性别(男/女)/n	年龄/岁	病程/d	治疗时间/d
对照组	29	22/7	61.86±14.01	68.66±63.67	52.21±28.58
观察组	31	25/6	55.23±10.99	43.23±43.67	46.94±25.10
t/χ²值		0.653	2.048	1.814	0.760
P值		0.758	0.045	0.075	0.450

组别	n	FMA评分	FMA-平衡功能评分	NIHSS评分	BI评分	MMSE评分
对照组	29	50.48±32.30	5.38±4.45	7.86±5.01	40.00±23.19	20.14±10.25
观察组	31	91.52±15.99	9.68±3.12	3.55±2.13	67.42±19.27	26.90±4.33
t值		-6.298	-4.352	4.390	-4.994	-3.281
P值		< 0.001	< 0.001	< 0.001	< 0.001	0.002

组别	n	DSS评分			经口进食/n	t值^a	P值^a
组别	n	治疗前	治疗后	差值	经口进食/n	t值^a	P值^a
对照组	29	3.41±1.57	4.62±1.78	1.21±1.21	21	-5.387	< 0.001
观察组	31	1.71±0.46	3.90±1.54	2.19±1.58	16	-7.733	< 0.001
t/χ²值		5.785	1.675	-2.729	2.742
P值		< 0.001	0.099	0.008	0.098

项目	经口	鼻饲	t/χ²值	P值
性别(男/女)/n	15/6	7/1	0.817	0.635
年龄/岁	60.00±14.42	66.75±12.41	-1.167	0.253
病程/d	59.57±54.80	92.50±82.11	-1.258	0.219
MMSE评分	23.14±7.20	12.25±13.19	2.210	0.050
FMA评分	57.05±28.40	33.25±37.41	1.848	0.076
FMA-平衡功能评分	6.52±4.24	2.38±3.70	2.432	0.022
NIHSS评分	6.14±2.52	12.38±7.09	-2.429	0.043
BI评分	46.43±21.34	23.13±19.99	2.671	0.013
入院时DSS评分	3.95±1.40	2.00±1.07	3.563	0.001
治疗时间/d	45.86±25.91	68.89±30.19	-2.045	0.051

项目	经口	鼻饲	t/χ²值	P值
性别(男/女)/n	11/5	14/1	2.998	0.172
年龄/岁	53.70±12.16	56.87±9.75	-0.800	0.430
病程/d	46.63±49.90	39.60±37.31	0.442	0.662
MMSE评分	26.94±4.28	27.07±4.46	0.050	0.961
FMA评分	88.70±21.74	94.53±4.81	-1.017	0.317
FMA-平衡功能评分	9.69±3.03	9.67±3.33	0.018	0.986
NIHSS评分	3.63±2.42	3.47±1.85	0.204	0.840
BI评分	69.70±15.76	65.00±22.76	0.670	0.508
入院时DSS评分	1.69±0.48	1.73±0.46	-0.272	0.787
治疗时间/d	55.06±25.86	38.27±21.85	1.947	0.061

Clinical characteristics and rehabilitation of dysphagia after brainstem stroke

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 31

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LUO Lihua, WANG Yusheng, LI Jianfeng, DONG Jige. Effect of early postoperative comprehensive rehabilitation on children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 105-110.
[2]	WANG Zihao, LI Xinhua, JIANG Huiping, GUO Sainan, LIANG Qiuman, SHI Tingqi. Short-term knee function after total knee arthroplasty and related factors [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 111-118.
[3]	LIN Na, GAO Hanlu, LU Huiping, CHEN Yanqing, ZHENG Junfan, CHEN Shurong. Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 61-67.
[4]	WANG Haoyi, SHI Yawei, LU Jun, XU Guangxu. Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 68-73.
[5]	CHEN Junwen, CHEN Qian, CHEN Cheng, LI Shuyue, LIU Lingling, WU Cunshu, GONG Xiang, LU Jun, XU Guangxu. Effect of modified Baduanjin exercise on cardiopulmonary function, motor function and activities of daily living for stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 74-80.
[6]	HU Yonglin, MA Ying, DOU Chao, LU Anmin, JIANG Xiaoge, SONG Xinjian, XIAO Yuhua. Effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 81-86.
[7]	WANG He, HAN Liang, KAN Mengfan, YU Shaohong. Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1048-1056.
[8]	SHI Jiawei, LI Lingyu, YANG Haojie, WANG Qinlu, ZOU Haiou. Effect of preoperative prerehabilitation training on total knee arthroplasty: a systematic review of systematic reviews [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1057-1064.
[9]	CAI Huanian, FEI Sixian, ZHANG Yichen, SUN Qing, GUO Shuai, SONG Tao. Motion assistance analysis for robot-assisted tele-rehabilitation based on bilateral admittance control [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1104-1109.
[10]	SUN Tengfang, REN Mengting, YANG Lin, WANG Yaoting, WANG Hongyu, YAN Xingzhou. Effect of hyperbaric oxygen therapy combined with repetitive peripheral magnetic stimulation on ankle motor function and balance of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 875-881.
[11]	WANG Ya'nan, LIU Xihua. Correlation and predictive effect of subjective and objective balance function measurements in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 890-895.
[12]	WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun. Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 919-925.
[13]	CHEN Yiting, WANG Qian, CUI Shenhong, LI Yingcai, ZHANG Siyu, WEI Yanxu, REN Hui, LENG Jun, CHEN Bin. Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 926-932.
[14]	LI Zhenya, SUN Jie, GUO Pengfei, WANG Guangming. Correlation between changes of swallowing function in oral and pharyngeal phases, and aspiration in stroke patients based on videofluroscopic swallowing study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 933-939.
[15]	LIU Yang, ZHANG Peng, HUANG Ying, CHEN Han, XU Chen, LI Min. Path analysis of mediating effect of perceived stress affecting impact of event in rehabilitation patients with traumatic injury [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 954-960.