- 期刊
腦中風後靜默式吸入－病例報告
Silent Aspiration after Stroke: A Case Report
摘要
患有糖尿病和高血壓的58歲男性，因左側橋腦梗塞性中風後右側乏力、言語障礙、吞嚥困難。治療後移除鼻胃管但進食量不足致體重下降。完整檢查揭露個案有靜默式吸入之情形，給予語言治療師之擬定之個別化吞嚥訓練方案後吞嚥能力有明顯改善。吞嚥困難在腦中風的患者不在少數，若患者有哽噎、吞嚥後嗆咳、呼吸困難等外顯症狀，皆為明確之臨床診斷參考。但當吞嚥困難以靜默式吸入表現，便需藉由完整吞嚥評估才能發現此種潛在性問題。過去普遍認為靜默式吸入為腦中風所導致之神經性吞嚥障礙，此個案卻由於過去軍事訓練的經驗，主動抑制咳嗽的保護機轉，使其於影像學檢查中呈現出靜默式吸入狀態。因此，臨床吞嚥檢查除影像學結果外，更應含括醫師與語言治療師之臨床測試，才能達成個案之周全性評估。
並列摘要
A 58-year-old man with diabetes and hypertension suffered from right side hemiparesis, speech disorder, and dysphagia because of left pontine infarction. After treatment, the nasogastric tube was removed but decrease of food intake induced further body weight loss. A comprehensive evaluation revealed the condition of a silent aspiration, which improved after individualized training programs specially developed by speech-language pathologists for the patient. Dysphagia is a common condition in stroke patients and is easy to diagnose if the patients express symptoms such as choking, aspiration or, dyspnea after food intake. However, when dysphagia presents itself as a silent aspiration, a comprehensive evaluation is warranted to identify the potential problem. In the past, silent aspiration is well recognized as a result of a stroke. However, this patient has undergone military training which made him actively inhibited the cough reflex and resulted in a silent aspiration. Both evaluations from physician and speech-language pathologist combined with objective radiographic findings should be conducted for thoroughness.