皮肌炎症患者之吞嚥障礙：病例報告及文獻回顧

Dermatomyositis Associated with Dysphagia ：A Case Report and Literatures Review

趙耿裕(Keng-Yu Chao) ； 王亭貴(Tyng-Guey Wang) ； 張允中(Yeun-Chung Chang)

《中華民國復健醫學會雜誌》 27卷3期 (1999/09) Pp. 145-149

摘要

皮肌炎症患者常合併吞嚥功能異常，肇因於疾病侵犯咽喉或食道肌。由於吞嚥障礙並非這類患者的主要問題，且其症狀會隨疾病的舒緩而改善，因此常被忽略或誤診，而造成嚴重的合併症。本研究報告一名31歲的皮肌炎症女性患者，於疾病治療過程中出現吞嚥障礙。患者無法吞食固態食物，而且進食液態食物有鼻逆流及嗆咳現象。由於其食道攝影正常而被診斷為心因性吞嚥障礙，進而轉介至復健部。於復健部，其電視螢光錄影攝影檢查僅發現有口腔內鋇劑滯留現象，其吞嚥障礙隨著全身肌力的進步及紅斑消失而有明顯的改善。由文獻回顧得知，皮肌炎症患者常因咽喉部及食道肌肉受侵犯而會有不同之吞嚥功能異常，復健科醫師身為處理吞嚥障礙之重要臨床人員，實應多了解此類患者之吞嚥功能。本研究提供了這類疾病患者不需積極吞嚥復健之治療模式之參考。

關鍵字

皮肌炎症 ； 吞嚥 ； 吞嚥障礙 ； 吞嚥螢光錄影檢查

並列摘要

Dysphagia frequently occurs in patients inflicted with dermatomyositis. Dysphagia in dermatomyositis patients is occasionally overlooked and misdiagnosed since it is not a major clinical manifestation. This article presented on a 31 years old woman inflicted with dermatomyositis. Dysphagia developed during her hospitalization, as evidenced by her difficulty in swallowing solid food and choking with nasal regurgitation while taking liquids. Psychogenic dysphagia was diagnosed simply owing to the lack of positive findings of esophagogram. The patient subsequently visited OPD of Physical Medicine and Rehabilitation Department. Although videofluoroscopic examination of swallowing study in our department revealed only mild oral stasis without aspiration, we instructed her on how to swallow safely to avoid potential aspiration. Her dysphagia gradually subsided after the recovery of the muscle power of four limbs and the disappearance of her skin rash. We believe that this case provides a rehabilitation model for the patients diagnosed as dysphagia and do not actively participate in a rehabilitation program. The physiatrist, as a specialist in dealing with the dysphagia, should become more familiar with this issue.

並列關鍵字

dermatomyositis ； swallowing ； dysphagia ； videofluroscopic swallowing study