中風患者螢光吞嚥攝影檢查嗆入、吸入與否與喉上抬能力之關係

Comparison of Laryngeal Excursion in Stroke Patients with and without Penetration/Aspiration by Videofluoroscopy Swallowing Study

李昀芳(Yun-Fang Lee) ； 齊永均(Yung-Chun Chi) ； 張時中(Shih-Chung Chang)

《台灣復健醫學雜誌》 46卷1期 (2018/06) Pp. 9-17

https://doi.org/10.6315/TJPMR.201806-46(1).02

摘要

研究目的：中風後吞嚥障礙可能造成患者營養不良、脫水或吸入性肺炎等併發症。本次研究以螢光吞嚥攝影檢查(videofluoroscopy swallowing study，VFSS)比較有嗆入/吸入及無嗆入/吸入吞嚥障礙腦中風患者吞嚥時之喉部動作，以做為中風後吞嚥復健訓練之參考。研究方法：本研究以回溯性研究方式，收集2015年10月至2017年4月間中風住院患者之螢光吞嚥攝影檢查資料，依據8-point penetration-aspiration scale (PAS)作為判斷標準，將個案分為有嗆入/吸入組(PAS ≥ 3)及無嗆入/吸入組(PAS ≤ 2)，並進一步比較兩組患者在吞嚥過程中舌骨及甲狀軟骨之反應時間、移動程度及移動速度是否有顯著差異。結果：本研究共納入60位患者，兩組研究對象在年齡、性別、中風天數、中風類型及偏癱側間之比較皆未達顯著差異。有嗆入/吸入組在喉上抬到最高點時間、喉上抬及返回時間、甲狀軟骨垂直速度及甲狀軟骨往返向量速度均較無嗆入/吸入組慢，但兩組患者舌骨與甲狀軟骨之水平/垂直移動程度百分比、移動向量百分比、舌骨之水平/垂直速度、甲狀軟骨水平速度及舌骨與甲狀軟骨之移動向量速度等皆未達顯著差異。結論：有嗆入/吸入吞嚥障礙之腦中風患者，其吞嚥時喉部上抬所花費的時間較長、甲狀軟骨上抬的垂直速度與甲狀軟骨上抬往返向量速度均較無嗆入/吸入之中風患者慢，但舌骨與甲狀軟骨在吞嚥時的移動程度兩組患者無顯著差異。加強對吞嚥障礙中風患者喉部垂直上抬相關肌肉之收縮反應訓練是否可以減少嗆入/吸入的危險，則仍需再進一步之研究。

關鍵字

腦中風(stroke) ； 螢光吞嚥攝影檢查(videofluroscopy swallowing study) ； 嗆入(penetration) ； 吸入(aspiration) ； 喉上抬(laryngeal excursion)

並列摘要

Objective: Post-stroke dysphagia is associated with increased morbidity and mortality in acute stroke patients due to malnutrition or aspiration. This study compares the hyolaryngeal movement during swallowing between post-stroke dysphagia patients with and without penetration/aspiration by videofluoroscopy swallowing study (VFSS). The goal was to find out possible defects in swallow mechunism for improving post-stroke dysphagia swallowing training. Method: We retrospectively collected VFSS images from stroke in-patients in a medical center in Central Taiwan from October 2015 to April 2017. The subjects were subdivided according to the VFSS results and 8-point penetration-aspiration scale (PAS) into those with penetration/aspiration (PAS ≥ 3) and those without penetration/aspiration (PAS ≤ 2). The time expenditure of laryngeal excursion, the percentage of hyoid/thyroid cartilage displacement, and the velocity of hyoid and thyroid cartilage movement were compared between the two groups. Results: A total of 60 patients were recruited in the study. There were no significant differences between the two groups in age, sex, interval between stroke onset and VFSS, type of stroke, and hemiplegic side. The penetration/aspiration group showed slurred laryngeal elevation and reposition slower vertical movement, and slower back-and-forth vector velocity of thyroid cartilage. There were no significant difference between the two groups in terms of horizontal/vertical displacement percentage of hyoid/thyroid cartilage, percentage of hyoid/thyroid cartilage movement vectors, horizontal/vertical movement velocity of the hyoid, horizontal movement velocity of thyroid cartilage, and vector velocities of hyoid and thyroid cartilage. Conclusions: Post-stroke dysphagia patients with penetration/aspiration showed slower laryngeal excursion, slower vertical velocity of the thyroid cartilage, and slower back-and-forth vector velocity of the thyroid cartilage than patients without aspiration/penetration. Future studies should investigate methods for enhancing the efficiency of the muscles involved in vertical laryngeal movement to prevent penetration/aspiration.

並列關鍵字

stroke ； videofluroscopy swallowing study ； penetration ； aspiration ； laryngeal excursion

參考文獻

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