神經功能缺損孩童流涎之探討

Drooling in the Children with a Neurological Deficit

陳立蓉(Li-Rong Chen) ； 黃美涓(May-Kuen Wong) ； 張春琴(Choon-Khim Chong) ； 王錦滿(Chin-Man Wang)

《中華民國復健醫學會雜誌》 26卷2期 (1998/06) Pp. 61-66

摘要

流涎是許多神經性功能缺損孩童，例如腦性麻痺、智能不足等兒童持續性之困擾。本研究為建立神經性功能缺損孩童流涎盛行率及探討神經性功能缺損孩童流涎的相關因子，共收錄本院２－８歲兒童７２例進行流涎評估及口水量測定。其中包括腦性麻痺兒童３４例，其他神經功能障礙兒童１９例及無任何神經功能缺損兒童（正常控制組）１９例。
流涎評估採修改（modified）之Thomas-Stonell & Greenberg問卷式分級評估系統。口水量之測定是測孩童二分鐘之總受激口水量（whole stimulated saliva），即在外界刺激下主要和次要唾液腺（main and minor salivary glands）所分泌的全部唾液量。
結果顯示，百分之二十六（２６%）腦性麻痺兒童及百分之二十（２０%）之所有神經功能缺損兒童有重度或持續性之流涎。流涎程度與口水量分泌多寡無正相關，而和進食（oral feeding）、說話（speech）、構音（articulation）、發聲（phonation）及智力（mentality）和癲癇併發（seizure）有統計學上之相關性。其他如肌肉張力種類、腦性麻痺嚴重度、致病原因與流涎無統計學上之相關性。目前流涎治療對策包括：行為治療、口部運動誘發、電針刺激或耳針治療、藥物治療及手術治療，在本文中有相關之討探。

關鍵字

流涎 ； 神經功能缺損 ； 受激口水

並列摘要

Drooling is a common problem among children with a neurological deficit. To establish the incidence of drooling and to determine the factors related to drooling in a population of the children with a neurological deficit, seventy-two children of Chang Gung Children Hospital were analyzed, prospectively. They were aged from 2 to 8 years. Of the seventy-two children, thirty-two children had cerebral palsy (CP), nineteen children had other neurological deficits, and nineteen children, without any neurological deficits, were used as the control group.
All the children underwent two assessments for drooling:
(1) the direct quantitative measurement of the amount of whole stimulated saliva
(2) the clinical interview for drooling severity and frequency with the modified Thomas-Stonell & Greenberg scoring system.
The results showed that 26% of the children with a neurological deficit had severe or constant drooling. The severity and frequency of drooling was not related to the amount of stimulated saliva. From the clinical interviews and chart review, oral feeding, speech output, articulation, phonation, mentality, and seizure history were closely related to the severity and the frequency of drooling. In contrast, the etiology of the neurological deficit, the severity of morbidity, and the muscle tone of CP
may not be related to the severity of drooling . Present management for drooling including behavioral treatment, oromotor facilitation, electroacupunture or ear acupunture, medication treatment and surgical intervention are also discussed in this paper.

並列關鍵字

drooling ； sialorrhea ； neurological deficit ； stimulated saliva