以電視螢光攝影檢查評估多發性硬化症患者之吞嚥障礙－病例報告

多發性硬化症是一個反覆復發與緩解的疾病，每次發作可影響中樞神經系統的不同部位，吞嚥障礙為其可能的症狀之一。其正確發生率目前仍不清楚，由文獻得知約為3%到33%之間。吞嚥障礙可以是多發性硬化症的早期症狀之一，它可以持續的存在，也可以間歇性的出現，症狀可由輕微到嚴重不等，甚至可以是病人主要的功能障礙。然而截至目前為止，文獻上所論及多發性硬化症患者吞嚥障礙的診斷與治療，仍侷限於以臨床評估為依據，缺乏其它客觀的檢查方法來做為輔助。本研究報告一個62歲之男性多發性硬化症患者，合併有嚴重的吞嚥障礙，除了理學檢查與臨床吞嚥功能評估之外，亦接受了電視螢光攝影檢查。電視華光攝影檢查無示其異常是在吞嚥過程的咽喉期，而以潛在吸入為主要症狀。經過復健治療後，患者之吞嚥功能有明顯進步，但仍無法達到由口進食的目標，而須借助鼻胃管維持營養。文中所提之電視螢光攝影檢查，為一客觀的檢查方法，可做為以後對多發性硬化症合併有吞鳴障礙的病人進行吞嚥評估與治療時，用來輔助臨床評估，以說定適當的治療計劃，及追蹤治療成果的客觀方法。

關鍵字

多發性硬化症；吞嚥障礙；電視螢光攝影檢查

並列摘要

Multiple sclerosis (MS) may involve different part of central nervous system and is characterized by remission and relapse clinically. However, dysphagia does not happen regularly. The incidence of dysphagia in MS is still in debate. It ranges from 3% to to 33% in limited reports. It could be a persistent or a intermittent symptom with various severity. In previous literature, the evaluation of this disorder was limited in clinical examination and lack of an objective method. We presented a 62-year-old man with MS and dysphagia. He underwent videofluoroscopic examination (VFE) and intensive swallowing training. The VFE demonstrated that the major disorder of swallowing disorder in this case occurred in pharyngeal stage and manifested by silent aspirationcombined with aspiration pneumonia. Intensive rehabilitation program does improve his ability of swallowing but the patient still needs nasogastric tube to meet his nutrition need. We conclude that VFE is an objective and helpful technique in evaluating and managing swallowing disorder of MS patients. It should be performed in every MS patients with dysphagia.

並列關鍵字

multiple sclerosis ； dysphagia ； videofluoroscopic examination

國際替代計量

以電視螢光攝影檢查評估多發性硬化症患者之吞嚥障礙－病例報告

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