巴金森氏病患之吞嚥障礙及電視螢光錄影檢查

Dysphagia and Videofluoroscopic Examination in Parkinson's Disease

潘信良(Shin-Liang Pan) ； 王亭貴(Tyng-Guey Wang) ； 張允中(Yeun-Chung Chang)

《中華民國復健醫學會雜誌》 26卷4期 (1998/12) Pp. 151-160

摘要

本文回顧有關巴金森氏病其吞嚥障礙之發生率、臨床症狀以及電視螢光錄影檢查之文獻，並討論藥物及復健治療之角色。巴金森氏病患自覺有吞嚥障礙症狀之比率由31%至72%不等，而且患者的自覺症狀並無法反應其吞嚥障礙的實際狀況。巴金森氏病患之電視螢光錄影檢查，口腔期異常者有31~92%，咽喉期異常者有15~97%。巴金森氏病患於電視螢光錄影檢查發生吸入現象的機會達16%至46%，並且部份是屬於潛在性吸入。在電視螢光錄影檢查所見的吞嚥異常是全面性的，而且在吞食液體時比較嚴重。大約只有一半的巴金森氏患者其吞嚥異常對藥物治療有反應，復健訓練的效果則仍有爭議。為了早期發現巴金森氏病患之吞嚥障礙並預防其併發症，電視螢光錄影檢查是必要的措施。

關鍵字

巴金森氏病 ； 吞嚥障礙 ； 治療 ； 電視螢光錄影檢查

並列摘要

Parkinson's disease (PD) is a degenerative disorder of the nigrostriatal system, and frequently complicated with swallowing difficulties. This paper reviewed the current studies on the scope of the incidence, the clinical symptoms, the use of videofluoroscopic swallowing study (VFSS), and the management of dysphagia in PD. The awareness of dysphagia in PD patients in previous studies was around 31 to 72 %, however, this figure does not reflect the actual severity of swallowing disorders in this group patients. We found a great variability in the incidence of swallowing disorder on VFSS, depending on the patients selected. Around 31 to 92% of patients with PD had abnormal swallowing function in the oral phase and 15 to 97 % in the pharyngeal phase. Aspirations were detected on 16 to 46 % patients by VFSS and most of them were silent. The swallowing abnormalities in VFSS were generalized and worse in the liquid barium. The motor function of PD patients was a poor predictor for the severity of swallowing disorder. The swallowing function improved after treatment with anti-parkinsonism medication, such as levodopa, in half of the PD patients with dysphagia, especially in the patients with oral phase disorders. For patients with dysphagia related to cricopharyngeal muscle dysfunction, myotomy was found to relieve this problem in several reports. The role of rehabilitation is still being debated because of the lack of scientific training programs and related research. The use of VFSS for early detection of aspiration and other swallowing disorders is mandatory to prevent the complications of dysphagia in PD patients.

並列關鍵字

Parkinson's disease ； dysphagia ； treatment ； videofluoroscopic examination of swallowing