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中华物理医学与康复杂志
中华物理医学与康复杂志

黄晓琳

月刊

0254-1424

cjpmr@tjh.tjmu.edu.cn

027-83662874

430030

湖北省武汉市解放大道1095号同济医院内

中华物理医学与康复杂志/Journal Chinese Journal of Physical Medicine and RehabilitationCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊主要内容包括：贯彻党和国家的卫生工作方针政策，理论与实践相结合，提高与普及相结合，积极倡导百花齐放、百家争鸣；全面介绍物理治疗、物理医学与康复领域内领先的科研成果和新理论、新技术、新方法、新经验以及对物理因子治疗、康复临床、疗养等有指导作用，且与康复医学密切相关的基础理论研究，同时密切关注国际康复医学发展的新动向。主要栏目包括论著、综述、研究报告、经验交流、继续教育、讲座、病例报告、会议纪要、书评、国内外学术动态、学术活动预告等。
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    中国吞咽障碍康复管理指南(2023版)

    窦祖林温红梅阮仕衡
    1057-1072页
    查看更多>>摘要：近10多年来，国内因吞咽障碍导致的误吸、吸入性肺炎、营养不良等临床问题日益受到重视，吞咽障碍的筛查、评估、治疗、营养和护理等创新性技术也层出不穷。《中国吞咽障碍评估与治疗专家共识(2013版、2017版)》在规范中国吞咽障碍的临床实践中起到了积极的促进作用，但这些基于专家经验的建议缺乏质量的证据评价和分级。本指南依据《世界卫生组织指南制定手册》，对相关问题进行了遴选和确定，经文献检索、筛选、提取证据后，按照WHO推荐意见分级的评估、制定和评价(GRADE)对证据质量进行了评价和分级，经过推荐意见形成等环节，围绕吞咽障碍的筛查与评估、干预治疗、营养管理、口腔护理4个方面，按PICO原则最终凝练形成了16个基于循证的临床问题。本指南通过提出问题、推荐意见和推荐意见说明共三个步骤，呈现了吞咽障碍筛查、评估、干预、营养与口腔护理的证据等级分级和推荐意见，旨在为吞咽障碍涉及的相关学科的医生、护士和治疗人员改善患者的吞咽功能和生活质量提供更加规范化的康复策略和综合管理建议。

    吞咽障碍筛查评估干预治疗营养口腔护理管理指南

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    鼻咽癌放疗后吞咽障碍患者不同部位最大舌压与口咽期活动的相关性研究

    赵妃吾米提·艾海提孙思明张耀文...
    1073-1077页
    查看更多>>摘要：目的 通过观察鼻咽癌放疗后吞咽障碍患者的最大舌压值和口咽期吞咽造影，探讨此类患者的舌前、舌中、舌后最大压力与口咽期吞咽功能的相关性。 方法 共纳入19例鼻咽癌放疗后吞咽障碍患者作为研究对象，采用新型柔性九位点舌压传感器测量患者舌体前、中、后三个部位的最大舌压值，随后进行吞咽造影检查，量化分析口腔运送时间、食道上括约肌(UES)开放持续时间和UES开放幅度等指标。分析舌前、舌中及舌后最大压力值与口腔运送时间、UES开放持续时间及UES开放幅度间的相关性。 结果 舌中、舌后最大压力值与口腔运送时间具有显著负相关性(P<0.05)，舌前最大压力值与口腔运送时间无显著相关性(P>0.05)；舌前、舌中、舌后最大压力值与UES开放持续时间、UES开放幅度均存在显著正相关性(P<0.05)。 结论 舌前、舌中及舌后最大压力值均与鼻咽癌放疗后吞咽障碍患者口咽期的活动功能高度相关。 Objective To observe the maximum tongue pressure and study the oropharyngeal activity during swallowing of patients with nasopharyngeal carcinoma (NPC) after radiotherapy so as to correlate the maximum tongue pressure with swallowing function. Methods The mean maximum tongue pressure of nineteen NPC patients with dysphagia was measured at the anterior (TA), middle (TM) and posterior (TP) positions, followed by video fluoroscopy. Oral transit time (OTT), upper esophageal sphincter(UES)opening time (UOT) and UES opening range (UOR) were correlated with the mean maximum tongue pressures. Results The maximum pressure at the TM and TP positions was significantly negatively correlated with OTT, but there was no significant correlation with the anterior readings. The maximum pressures at all three tongue positions were, however, positively correlated with UOT and UOR. Conclusion The maximum pressure at the TA, TM and TP positions is strongly correlated with the swallowing function of NPC patients.

    鼻咽癌吞咽困难最大舌压值吞咽造影

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    脑卒中吞咽障碍患者食管清除功能异常与口咽期吞咽生理及渗漏误吸的相关性分析

    邓宝梅梁丽丝赵嘉欣郑海清...
    1078-1083页
    查看更多>>摘要：目的 对脑卒中吞咽障碍患者食管清除功能异常的发生率及严重程度进行回顾性分析，探讨脑卒中后食管清除功能异常患者的临床特点，并分析食管清除功能异常与口咽期吞咽生理及渗漏误吸间的相关性。 方法 选取2019年10月至2023年4月期间在我院康复科住院、并完成吞咽造影检查(含正位像食管清除观察)的174例脑卒中患者作为研究对象，从其医疗记录中收集临床资料数据，并针对患者吞咽5 ml高稠度食物的正位像及侧位像造影结果进行分析。采用改良钡剂吞咽障碍造影评估量表(MBSImP)的食管清除(EC)项目对患者的食管清除功能进行评级，并对其口腔期及咽期的各吞咽生理成分进行评分。采用Rosenbek渗漏误吸量表对患者进食的安全性进行评级。 结果 在174例入选患者中，共发现70例(40.23%)患者有食管清除功能异常，且大部分(共43例)患者表现为食管中到远端滞留。与食管清除正常组患者比较，食管清除异常组患者的平均年龄更高、咽期总体障碍程度更严重(P<0.001)。通过相关性分析发现，入选患者食管清除功能与口腔期范畴的各吞咽生理成分及渗漏误吸评级均无显著相关性(P>0.05)，而与咽期范畴的喉上抬(r＝0.229，P＝0.002)、舌骨前移运动(r＝0.244，P＝0.001)、咽蠕动(r＝0.521，P<0.001)、咽收缩(r＝0.309，P<0.001)、食管上括约肌开放(r＝0.337，P<0.001)、舌根收缩(r＝0.261，P＝0.001)及咽部残留(r＝0.260，P＝0.001)均具有显著正相关性。 结论 脑卒中吞咽障碍患者可同时合并食管清除功能障碍。食管清除功能异常与年龄及咽期吞咽障碍严重程度相关。咽期吞咽生理异常可能伴随更高的食管清除异常发生率，咽蠕动减弱常提示伴随更严重的食管清除异常。将正位像食管清除观察纳入常规吞咽造影检查中，有助于筛查食管功能异常以早期识别临床问题，提高吞咽评估的全面性及系统性。 Objective To explore the incidence and severity of esophageal clearance impairment in stroke survivors with dysphagia, the clinical characteristics of patients with abnormal esophageal clearance, and their relationship with swallowing physiology, penetration and aspiration. Methods Clinical data were collected describing 174 stroke survivors whose swallowing had been studied videofluoroscopically. In each selected case there was a good anterior-posterior view of esophageal clearance. Their anterior-posterior and lateral imaging results while swallowing 5ml of high-consistency food were analyzed. The esophageal clearance item of the modified barium swallow impairment profile was then used to rate each subject′s esophageal clearance and each physiological component of swallowing in the oral and pharyngeal phases. The Rosenbek penetration aspiration scale was employed evaluate the safety of their swallowing. Results Seventy of the patients (40.2%) displayed abnormal esophageal clearance, and more than half of the 70 (43 patients, 24.7%) showed mid- to distal esophageal retention. Those with abnormal esophageal clearance had a higher average age and more severe overall impairment in the pharyngeal phase of swallowing. Esophageal clearance was not, however, significantly correlated with swallowing physiology in the oral phase or with penetration or aspiration grade. There were, however, significant positive correlations with laryngeal elevation, anterior hyoid excursion, pharyngeal stripping waves, pharynx contraction, upper esophageal sphincter opening, tongue base retraction and pharyx residue. Conclusion Stroke survivors with dysphagia may display abnormal esophageal clearance. The risk is closely related to age and the severity of the dysphagia. Abnormal physiology during the pharyngeal phase of swallowing and reduced pharyngeal stripping may predict abnormal esophageal clearance. Swallowing assessment can be made more comprehensiveness and systematic by incorporating anterior-posterior videography in routine barium swallowing studies.

    食管期吞咽障碍食管清除脑卒中MBSImP吞咽生理成分渗漏误吸

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    缺血性脑卒中患者吞咽障碍与病变部位的关系

    李振亚孙洁王光明阮仕衡...
    1084-1087页
    查看更多>>摘要：目的 探讨缺血性脑卒中患者吞咽障碍与病变部位的关系。 方法 选取2015年1月至2022年3月在徐州市中心医院住院治疗的脑梗死患者178例，依据脑梗死的部位，将其分为幕上脑梗死组(幕上组)111例，和幕下脑梗死组(幕下组)67例，幕上组再根据其脑梗死的侧别，分为左侧大脑半球梗死组59例，右侧大脑半球梗死组34例，双侧大脑半球梗死组18例，共3个亚组。对所有入选患者的吞咽造影录像资料进行回顾性分析。所有患者均接受吞咽造影录像检查，对其唇闭合、食团成形、吞咽失用、舌与硬腭接触、食团后漏、口腔运送时间、咽期吞咽启动、会厌谿残留、喉上抬、梨状隐窝滞留、咽后壁残留、咽期通过时间、误吸、渗漏等14项指标进行分析和比较。 结果 幕上组与幕下组患者在食团成型(χ2＝5.116，P＝0.024)、吞咽失用(χ2＝7.928，P＝0.005)、口腔运送时间(χ2＝14.152，P<0.01)、咽期吞咽启动(χ2＝5.558，P＝0.018)、喉上抬(χ2＝19.424，P<0.01)、误吸(χ2＝4.212，P＝0.040)等方面，组间差异均有统计学意义(P<0.05)。左侧大脑半球梗死患者、右侧大脑半球梗死患者和双侧大脑半球梗死患者的误吸发生率(χ2＝10.277，P＝0.006)，组间差异有统计学意义(P<0.05)；两两比较，双侧大脑半球梗死患者与左侧大脑半球梗死患者在误吸方面，组间差异有统计学意义(P<0.017)。 结论 幕上脑梗死患者较幕下脑梗死患者更易发生口期吞咽障碍，包括食团成型障碍、吞咽失用及口腔运送时间延长；幕下脑梗死患者较幕上脑梗死患者更易发生咽期吞咽障碍，包括咽期吞咽启动延迟、喉上抬障碍及误吸。双侧大脑半球梗死患者较左侧大脑半球梗死患者更易发生误吸。 Objective To explore the relationship between dysphagia and the lesion site after an ischemic stroke. Methods The records of 178 cerebral infarction patients were divided into a supratentorial group of 111 and an infratentorial group of 67, according to the site of their lesions. The supratentorial group was further divided into left, right and bilateral groups of 59, 34 and 18, respectively. Fluoroscopic videos of the patients′ swallowing were used to measure lip closure, bolus formation, apraxia, tongue-to-palate contact, premature bolus loss, oral transit time, triggering of pharyngeal swallowing, vallecular residue, larynx elevation, pyriform sinus residue, pharynx wall coating, pharynx transit time, aspiration, and leakage. Results There were significant differences between the supratentorial and infratentorial groups in bolus formation, apraxia, oral transit time, triggering of pharyngeal swallowing, larynx elevation, and aspiration. Moreover, significant differences were found in the incidence of aspiration among the left, right and bilateral supratentorial groups. Conclusions Patients with supratentorial infarction are more likely than those with infratentorial infarction to develop oral dysphagia, including poor bolus formation, apraxia and prolonged oral transit time. Those with infratentorial infarction are more likely to have pharyngeal dysphagia, including poor triggering of pharyngeal swallowing, obstructed larynx elevation, and aspiration. Those with bilateral cerebral hemisphere infarction are more likely to aspirate than those with an infarct in the left cerebral hemisphere.

    脑卒中吞咽障碍吞咽造影录像检查误吸

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    脑卒中后咽期吞咽障碍的相关危险因素研究

    李玲董旭吴晔孙洁...
    1088-1093页
    查看更多>>摘要：目的 分析脑卒中后咽期吞咽障碍患者的临床和吞咽生理指标的特点，探讨咽期吞咽障碍的危险因素及其预测价值。 方法 选取符合纳入标准且疑似脑卒中后有吞咽障碍的患者169例，收集每例入组患者的临床资料，包括年龄、性别、病程、脑卒中部位、脑卒中类型、烟酒史、留置胃管、气管切开、既往病史、洼田饮水试验、咽反射情况、美国国立卫生研究院脑卒中量表(NHISS)评分及改良曼恩吞咽能力(MMASA)评分。入组患者1周内完善吞咽造影(VFSS)及纤维内镜吞咽功能(FEES)检查，根据VFSS结果将169例患者分为咽期吞咽障碍组(92例)及非咽期吞咽障碍组(77例)，分别比较2组患者间的临床和吞咽生理指标差异。采用多因素Logistic回归分析明确咽期吞咽障碍的独立危险因素；利用受试者工作特征(ROC)曲线分析各危险因素对咽期吞咽障碍的预测价值。 结果 咽期吞咽障碍组与非咽期吞咽障碍组的病程、脑卒中部位、气管切开状态、留置胃管、洼田饮水试验、改良曼恩吞咽能力(MMASA)评分、渗漏-误吸评级(PAS)、耶鲁咽部残留物严重程度分级评定量表(YPR-SRS)、会厌翻折、咽启动、舌骨上移最大距离、咽感觉、咽分泌物水平等经统计学分析比较，组间差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示，渗漏-误吸、咽部残留和咽分泌物是脑卒中后咽期吞咽障碍的独立影响因素(P<0.05)；ROC曲线分析显示，渗漏-误吸评级、咽部残留分级、咽分泌物评分预测脑卒中后咽期吞咽障碍的曲线下面积(AUC)分别为0.890[95% CI(0.838~0.942)]、0.741[95% CI(0.669~0.806)]、0.874[95% CI(0.814~0.920)]，敏感度分别为75.0%、52.2%、84.8%，特异度分别为96.1%、94.8%、85.7%，最佳临界值分别为2级、1分、1级。 结论 渗漏-误吸、咽部残留和咽分泌物为咽期吞咽障碍的独立危险因素；渗漏-误吸评级、咽部残留分级、咽分泌物评分对咽期吞咽障碍具有一定的诊断和预测价值。 Objective To analyze the physiological components of swallowing among stroke survivors with pharyngeal dysphagia, and to identify the risk factors and their utility for predicting pharyngeal dysphagia. Methods The records of 169 stroke survivors suspected of having dysphagia were collected. The data analyzed were age, sex, course of disease, stroke site, stroke type, tobacco and alcohol history, intubation, tracheotomy, past medical history, Kota water test results, pharyngeal reflex, as well as the scores on the National Institutes of Health Stroke Scale and the modified Mann Assessment of Swallowing Ability (mMASA). All of the patients had been imaged videofluoroscopically and fiber endoscoped. The data were used to divide the subjects into a pharyngeal dysphagia group (n=92) and a no pharyngeal dysphagia group (n=77). The physiological components of swallowing were compared between the two groups. Multivariate logistic regressions were evaluated to identify the independent risk factors for dysphagia, while the receiver operating characteristic curve was used to assess the predictive value of the risk factors. Results There were significant differences between the groups on average in terms of the course of disease, stroke site, history of tracheostomy, intubation, water swallowing test results, mMASA scores, penetration-aspiration ratings, Yale Pharyngeal Residue Severity Scale (YPR-SRS) ratings, epiglottis turnover, pharyngeal initiation, maximum displacement of the superior hyoid bone, pharyngeal sensation and pharyngeal secretion. Multivariate logistic regression analysis showed that leakage-aspiration, pharyngeal residue and pharyngeal secretions were independent factors influencing dysphagia after a stroke. According to the ROC curve, the PAS score had an area under the curve (AUC) of 0.89, with 75% sensitivity and 96% specificity when level 2 was chosen as the optimal cut-off value. The Marianjoy secretion scale scores had an AUC of 0.87 with 85% sensitivity and 86% specificity when 1 point was chosen as the optimal cut-off value. YPR-SRS ratings had an AUC of 0.74 with a sensitivity of 52% and 95% specificity when level 1 was chosen as the optimal cut-off value. Conclusions Penetration-aspiration, pharyngeal residue and pharyngeal secretions are independent risk factors for dysphagia after a stroke. Leakage-aspiration rating, pharyngeal residual grading and pharyngeal secretion scoring are valuable in the diagnosis and prediction of pharyngeal dysphagia.

    脑卒中咽期吞咽障碍危险因素预测

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    脑卒中真性球麻痹患者营养状况及影响因素分析

    刘莲莲张芳权曾西李一...
    1094-1098页
    查看更多>>摘要：目的 探讨我院康复医学科收治的脑卒中真性球麻痹患者营养不良的发生率及相关影响因素，并构建营养不良风险预测模型。 方法 采用回顾性调查方法，共纳入符合入选标准的脑卒中患者325例。对比入选脑卒中患者及其中真性球麻痹患者的营养状况；对脑卒中真性球麻痹患者营养不良的危险因素进行单因素分析和多因素Logistic回归分析，建立真性球麻痹患者营养不良风险预测模型并绘制受试者工作特征曲线(ROC)。 结果 与入选脑卒中患者整体比较，脑卒中真性球麻痹患者其营养不良发生率明显升高(66.3% vs 52.0%，P<0.05)。营养正常与营养不良的真性球麻痹患者在年龄、美国国立卫生研究院卒中量表(NIHSS)评分、血红蛋白水平、日常生活活动能力(ADL)、肺部感染方面组间差异均具有统计学意义(P<0.05)。通过多因素Logistic回归分析发现肺部感染、高NIHSS评分、低血红蛋白水平为脑卒中真性球麻痹患者营养不良的独立危险因素。基于上述3项指标建立脑卒中真性球麻痹患者营养不良的风险预测模型，发现该模型的ROC曲线下面积(AUC)为0.860(95%CI：0.778－0.943，P<0.05)，灵敏度为0.789，特异度为0.828，Hosmer-Lemeshow检验提示模型校准良好，表明该模型具有较好的预测价值。 结论 在康复医学科治疗的脑卒中真性球麻痹患者其营养不良发生率较高。肺部感染、高NIHSS评分、低血红蛋白水平是脑卒中真性球麻痹患者营养不良的独立危险因素，医护人员应重视真性球麻痹患者的营养状况及相关危险因素管理。 Objective To explore the prevalence of malnutrition among stroke survivors with bulbar palsy and the risk factors involved, and to construct a prediction model. Methods This was a retrospective study of 325 stroke survivors. The nutritional status of those with and without bulbar palsy was compared. Univariate and multivariate logistic regressions were evaluated to highlight risk factors. A risk prediction model was constructed and a receiver operating characteristics (ROC) curve was drawn. Results The prevalence of malnutrition among the stroke survivors with bulbar palsy was 66%, significantly greater than among all patients (52%). Among the stroke survivors with bulbar palsy there were significant differences between the normal nutrition group and the malnutrition group in terms of age, National Institutes of Health Stroke Scale (NIHSS) scores, hemoglobin, daily activities and pulmonary infection. The multivariate logistic regressions showed that pulmonary infection, a higher NIHSS score and lower hemoglobin were independent risk factors predicting malnutrition among stroke survivors with bulbar palsy. A risk prediction model for malnutrition was constructed based on the 3 major indicators and the area under the ROC curve was 0.86, with sensitivity of 0.79 and specificity of 0.83. A Hosmer-Lemeshow test indicated that the model was well calibrated, indicating that it would have good predictive value. Conclusions Malnutrition is prevalent among stroke survivors with bulbar palsy. Pulmonary infection, a high NIHSS score and low hemoglobin are independent risk factors. They should be treated as important by medical staff.

    脑卒中真性球麻痹营养不良危险因素

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    颈髓损伤患者吞咽障碍危险因素分析

    许戌鸾谢咏祺张庆苏杨德刚...
    1099-1103页
    查看更多>>摘要：目的 分析颈髓损伤患者发生吞咽障碍的影响因素，为临床筛查和干预提供依据。 方法 选取符合纳入标准的颈髓损伤患者病例资料110例，根据功能性经口进食量表评估颈髓损伤患者吞咽功能，分为重度吞咽障碍组(19例)、轻度吞咽障碍组(35例)和正常吞咽功能组(56例)，颈髓损伤后吞咽障碍的发生率为49.1%(54/110)。收集110例患者的性别、年龄、损伤平面、损伤程度、损伤时间、损伤原因、手术方式、气管切开状态、是否发生肺炎、是否发生咽部肿胀等相关临床资料；对可能影响颈髓损伤患者吞咽功能的资料进行单因素和多因素Logistic回归分析。 结果 单因素Logistic回归分析显示，患者的损伤严重程度、气管切开状态、住院期间是否发生肺炎以及是否发生咽部肿胀可能会影响颈髓损伤患者吞咽功能(P<0.05)。将上述单因素分析中P<0.01的变量(气管切开状态、是否发生肺炎、是否发生咽部肿胀)纳入无序多分类Logistic回归分析，结果显示，气管切开状态[OR＝12.927，95% CI＝(2.034，82.177)]、住院期间发生肺炎[OR＝5.537，95% CI＝(1.258，24.367)]是颈髓损伤患者发生重度吞咽障碍的独立危险因素(P<0.05)。 结论 患者气管切开状态、有肺部炎症可能是颈髓损伤重度吞咽障碍患者的危险因素。 Objective To analyze the factors influencing dysphagia after an injury to the cervical spinal cord (CPCI) to provide a basis for clinical screening and intervention. Methods A total of 110 CPCI patients with dysphagia were divided into a severe dysphagia group (n=19), a mild dysphagia group (n=35), and a control group (n=56) according to their functional oral intake scale scores. Data on gender, age, level of injury, degree of damage, duration of injury, causes of injury, surgical mode, tracheotomy status, occurrence of pneumonia and pharynx swelling were collected. Univariate and multivariate logistic regressions were evaluated to identify factors affecting swallowing. Results The regressions highlighted age, the severity of the spinal cord injury, tracheotomy status, and the occurrence of pneumonia and pharyngeal swelling during hospitalization as the best predictors of swallowing difficulties. Multifactoral logistic regression analysis revealed that undergoing tracheotomy and catching pneumonia during hospitalization were major risk factors for severe dysphagia. Conclusions Tracheotomy and pneumonia during hospitalization are useful predictors of severe dysphagia after a cervical spinal cord injury.

    颈髓损伤吞咽障碍危险因素回归分析

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    基于近红外脑功能成像的健康人吞咽热水和冰水过程中脑血流动力学信号的变化

    张耀文黄文浩李鑫赵妃...
    1104-1109页
    查看更多>>摘要：目的 通过fNIRS探究在吞咽热水和冰水时健康受试者脑血流变化情况，以验证fNIRS对于不同温度液体吞咽任务识别的敏感性，为今后应用fNIRS对吞咽障碍患者进行中枢诊断及干预辅助提供理论依据。 方法 纳入符合入组条件的健康受试对象16例，按照随机顺序进行吞咽热水和冰水的任务，并采用fNIRS对任务过程进行记录，配对比较静息状态、吞咽热水和吞咽冰水状态两两之间不同脑区激活程度的差异。 结果 相较于静息状态，吞咽热水和冰水时均有19个通道激活，共同激活的皮质包括S1、M1、PMC、SMA、Wernicke区、体感联合皮质、视觉联合皮质和额叶眼动区，DLPFC仅在吞咽热水时激活，中央下区仅在吞咽冰水时激活。SMA和PMC在吞咽热水比吞咽冰水时激活程度更高，差异具有统计性。 结论 健康受试者的多个脑区都有激活并参与了吞咽热水和冰水的调控，且吞咽热水比吞咽冰水能够更好的激活健康受试者的PMC和SMA。 Objective To explore the change in cerebral blood flow when healthy subjects swallow hot and ice water, and to verify the sensitivity of functional near-infrared spectroscopy (fNIRS) in identifying liquid temperatures while swallowing as a basis for applying it in diagnosis and intervention. Methods Sixteen healthy subjects swallowed hot and ice water in randomized order while the process was recorded using fNIRS. The activation at rest and when swallowing hot and ice water was compared pairwise. Results Compared with the resting state, 19 channels were activated during the swallowing of the hot and ice water. The common activated areas were S1, M1, PMC, SMA, Wernicke′s area, the somatosensory association cortex, the visual association cortex and the frontal eye field. However, the dorsal lateral prefrontal cortex was activated only when swallowing hot water, and the subcentral area was activated only when swallowing ice water. The SMA and PMC were significantly more activated when swallowing hot water than ice water. Conclusions Multiple brain regions are activated and participate in regulating swallowing. The PMC and SMA areas can distinguish hot water from ice water swallowing.

    吞咽近红外脑功能成像皮质激活

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    简易咳嗽反射诱发试验预测吞咽障碍患者隐性误吸的敏感性及特异性评价

    谢纯青赵妃杨晨窦祖林...
    1110-1113页
    查看更多>>摘要：目的 探讨简易咳嗽反射诱发试验预测吞咽障碍患者隐性误吸的敏感性及特异性。 方法 选取115例经吞咽造影检查确定存在误吸的吞咽障碍患者，均在吞咽造影检查后当日进行简易咳嗽反射诱发试验。以吞咽造影检查结果(显性误吸/隐性误吸)为标准，分析不同评价标准下简易咳嗽反射诱发试验预测隐性误吸的敏感性及特异性。 结果 经吞咽造影检查发现，115例误吸患者中，显性误吸44例，隐性误吸71例。经简易咳嗽反射诱发试验发现，咳嗽反射正常36例、减弱22例、缺失57例。以未发生咳嗽作为吞咽异常的判断标准时，简易咳嗽反射诱发试验预测患者发生隐性误吸的敏感度为70.42%，特异度为84.09%，Youden指数为0.545；以咳嗽减弱及未发生咳嗽作为吞咽异常的判断标准时，简易咳嗽反射诱发试验预测患者发生隐性误吸的敏感度为85.92%，特异度为59.09%，Youden指数为0.45。 结论 利用简易咳嗽反射诱发试验识别吞咽障碍患者存在隐性误吸的敏感度及特异度较高。以发生强烈咳嗽作为吞咽正常的判断标准时，其识别隐性误吸的敏感度更高。 Objective To explore the sensitivity and specificity of the simplified cough provoking test in predicting aspiration among patients with dysphagia. Methods A total of 115 aspirating patients were evaluated using the simplified cough provoking test. Based on the overt and silent aspiration observed through video fluorography, the sensitivity and specificity of the test for predicting each type were quantified. Results The subjects presented 44 cases of overt aspiration and 71 of silent aspiration. The simplified cough provoking test found that 36 had a normal cough reflex, 22 had a weakened reflex and 57 had none. When the cough′s strength indicated a normal cough reflex, the sensitivity of the simplified cough provoking test predicting silent aspiration was 70.4% and its specificity was 84.1%. The Youden coefficient was 0.545. When the cough reflex was adjudged as abnormal, the test′s sensitivity was 85.9% in predicting silent aspiration and its specificity was 59.1% with a Youden coefficient of 0.45. Conclusion The simplified cough provoking test has good sensitivity and specificity in identifying silent aspiration. It can effectively screen populations at risk of dysphagia.

    咳嗽反射误吸敏感性特异性

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    基于BiSSkiT理论的强化咽喉上升电子生物反馈训练联合表面肌电生物反馈对脑卒中恢复期患者吞咽障碍的影响

    孟阳胡川王珊珊王欣...
    1114-1118页
    查看更多>>摘要：目的 观察基于力量和技能训练生物反馈(BiSSkiT)理论的强化咽喉上升电子生物反馈训练联合表面肌电生物反馈对脑卒中恢复期患者吞咽障碍的影响。 方法 选取脑卒中恢复期吞咽障碍患者60例，采用随机数字表法将其分为生物反馈组、咽喉上升组和联合组，每组患者20例。3组患者均给予常规吞咽功能训练，生物反馈组在此基础上增加表面肌电生物反馈训练(每日1次，每次20 min)，咽喉上升组在常规吞咽功能训练的基础上增加基于BiSSkiT理论的咽喉上升强化训练器的训练(每日1次，每次20 min)，联合组则在吞咽功能训练的基础上增加表面肌电生物反馈训练和基于BiSSkiT理论的咽喉上升强化训练仪的训练。于治疗前和治疗4周后(治疗后)对3组患者进行X光荧光透视检查(VFSS)检查，并采用VFSS量表、吞咽功能评定量表(SSA)、吞咽功能障碍预后和严重程度量表(DOSS)评估3组患者的吞咽功能。 结果 治疗后，3组患者的VFSS评分、SSA评分和DOSS评分较组内治疗前均显著改善(P<0.05)。治疗后，联合组患者的VFSS评分、SSA评分和DOSS评分分别为(5.85±0.88)分、(35.45±1.90)分和(4.1±1.10)分，均显著优于生物反馈组和咽喉上升组治疗后(P<0.05)，而咽喉上升组的VFSS评分、SSA评分和DOSS评分亦均显著优于生物反馈组治疗后，差异均有统计学意义(P<0.05)。 结论 基于BiSSkiT理论的强化咽喉上升电子生物反馈训练联合表面肌电生物反馈可显著改善脑卒中恢复期患者的吞咽功能。 Objective To observe any effect of combining surface electromyography biofeedback with intensive pharyngeal ascending e-biofeedback training on dysphagia among stroke survivors. Methods Sixty stroke survivors with dysphagia were randomly divided into a biofeedback group, a pharyngeal ascending group and a combination group, each of 20. In addition to routine swallowing training, the biofeedback group received 20 minutes of surface electromyographic biofeedback training daily while the pharyngeal ascending group did pharyngeal rising reinforcement training based on biofeedback for strength and skill training (BiSSkiT) theory. The combination group was given both. Before and after 4 weeks of the interventions, videofluoroscopy was used to evaluate everyone′s swallowing. The Swallowing Function Assessment Scale (SSA) and the Dysphagia Outcome and Severity Scale (DOSS) were also applied. Results Significant improvement was observed in all 3 groups in terms of their average VFSS, SSA and DOSS scores. The average videofluoroscopy, SSA and DOSS results of the combination group were then significantly better than the other two groups′ averages, and those of the pharyngeal ascending group were significantly superior to those of the biofeedback group. Conclusion Combining intensive pharyngeal ascending electronic biofeedback training with surface EMG biofeedback can significantly improve the swallowing function of stroke survivors.

    脑卒中吞咽障碍强化咽喉上升电子生物反馈表面肌电生物反馈力量和技能训练生物反馈

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