CAJ | 학술논문

目的使用高分辨率固态测压方法观察改良球囊扩张治疗对脑干卒中后吞咽障碍患者上食管括约肌(UES)功能的影响,并探讨其作用的生物力学机制.方法选取中山大学附属第三医院康复科2011年9月至2012年3月30例脑干卒中后经吞咽造影确诊为咽期吞咽障碍的住院患者,分为球囊扩张治疗组与吞咽常规治疗组.球囊扩张组给予球囊扩张治疗及常规吞咽康复治疗；吞咽常规治疗组仅给予常规吞咽康复训练.在治疗前、拔除鼻饲管或治疗已达3周后,进行吞咽功能评估及UES测压检查.评估的指标包括:UES松弛残余压,UES松弛持续时间及UES静息压.结果球囊扩张组15例患者治疗后12例拔除了鼻饲管,吞咽水(P =0.008)、浓流质(P=0.004)及糊状食物时(P=0.001) UES松弛残余压较治疗前明显下降,治疗后吞咽水(P =0.006)、浓流质(P =0.002)及糊状食物(P＜0.001)时UES松弛持续时间也较治疗前明显延长,差异均有统计学意义.UES静息压也有所恢复[治疗前(30±3)mm Hg治疗后(59±6) mm Hg,P＜0.001].球囊扩张组患者治疗后FOIS评分均值较治疗前增加3.5分,差异有统计学意义(P=0.001).常规治疗组15例患者治疗后2位拔除了鼻饲管,吞咽3种食物时UES松弛残余压与持续时间改善不明显(P＞0.05).常规治疗组患者治疗后FOIS评分均值较治疗前增加0.63分,差异有统计学意义(P =0.026).结论 UES松弛功能受损是脑干卒中患者吞咽障碍的重要表现.改良球囊扩张术对UES松弛功能有益处；对恢复UES的静息压也有帮助.
목적 사용고분변솔고태측압방법관찰개량구낭확장치료대뇌간졸중후탄인장애환자상식관괄약기(UES)공능적영향,병탐토기작용적생물역학궤제.방법 선취중산대학부속제삼의원강복과2011년9월지2012년3월30례뇌간졸중후경탄인조영학진위인기탄인장애적주원환자,분위구낭확장치료조여탄인상규치료조.구낭확장조급여구낭확장치료급상규탄인강복치료；탄인상규치료조부급여상규탄인강복훈련.재치료전、발제비사관혹치료이체3주후,진행탄인공능평고급UES측압검사.평고적지표포괄:UES송이잔여압,UES송이지속시간급UES정식압.결과 구낭확장조15례환자치료후12례발제료비사관,탄인수(P =0.008)、농류질(P=0.004)급호상식물시(P=0.001) UES송이잔여압교치료전명현하강,치료후탄인수(P =0.006)、농류질(P =0.002)급호상식물(P＜0.001)시UES송이지속시간야교치료전명현연장,차이균유통계학의의.UES정식압야유소회복[치료전(30±3)mm Hg치료후(59±6) mm Hg,P＜0.001].구낭확장조환자치료후FOIS평분균치교치료전증가3.5분,차이유통계학의의(P=0.001).상규치료조15례환자치료후2위발제료비사관,탄인3충식물시UES송이잔여압여지속시간개선불명현(P＞0.05).상규치료조환자치료후FOIS평분균치교치료전증가0.63분,차이유통계학의의(P =0.026).결론 UES송이공능수손시뇌간졸중환자탄인장애적중요표현.개량구낭확장술대UES송이공능유익처；대회복UES적정식압야유방조.
Objective To explore the effects of balloon dilation intervention on function of upper esophageal sphincter (UES) in brainstem stroke patients with dysphagia before and after treatment by high-resolution solid-state manometry.Methods Thirty brainstem stroke patients with pharyngeal dysphagia were recruited.The dilatation treatment group (n =15) completed a 3-week regimen of modified balloon dilatation and traditional swallowing including E-stim,Mendelsohn Maneuver and supraglottic swallowing.And the control group (n =15) only completed 3 weeks of traditional swallowing therapy.Before,and after dilatation,the nadir of UES and its duration were measured during swallowing of thin liquid,thick liquid and pasty material in 3-ml volumes.The results of both groups were compared for identical parameters.Results In the experimental group,post-treatment UES residual pressure (for water,P =0.008 ; for thick liquid,P =0.004 ; for paste,P =0.001) and relaxation duration (for water,P =0.006 ; for thick liquid,P =0.002 ; for paste,P ＜ 0.001) both significantly improved for all three materials.UES resting pressure approximated normal(Pre-treatment 30 ± 3 mm Hg; post-treatment 59 ± 6 mm Hg,P ＜ 0.001).In the control group,there was no improvement in post-treatment UES residual pressure and relaxation duration for all three materials (P ＞ 0.05).In the experimental group,feeding tube was removed in 12 / 15 versus 2/15 patients in the control group.The experimental group had 3.5 points improvement (P =0.001) while the control group improved by a mere 0.63 point (P =0.026) in FOIS scores.Conclusion Failed UES is a major cause of dysphagia in brainstem stroke patients.Dysphagia therapy with dilatation improves relaxation of UES.Moreover,it is helpful for restoring UES resting pressure.Traditional swallowing therapy has no positive effect on UES.