Table of Content

20 March 2007, Volume 2 Issue 03

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述评

Stroke and Oropharyngeal Dysphagia

Jeri A. Logemann;Ruiying Ding

2007, 2(03):  187-201. 

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论著

Decreased Velocity of Larynx Elevation was an Independent Risk Factor of Aspiration after Stroke

ZHANG Jing;YU Dan-dan;YANG Bo;et al.

2007, 2(03):  204-207. 

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Objective To identify the correlation between amplitude of larynx elevation, velocity of larynxelevation, the time of larynx closure, delayed time of pharyngeal swallow and aspiration.Methods Total 63 consecutive stroke patients consulted to dysphagia rehabilitation group wereundertaken videofluoroscopic swallowing study after drinking 5 ml 60% w/v barium. Aspiration,amplitude of larynx elevation, velocity of larynx elevation, closure time of larynx and delayed timeof pharyngeal swallow were recorded. According to aspiration or not, patients were resigned into 2groups. The correlation between the four parameters and aspiration was investigated.Results There was significant difference in closure time of larynx(P =0.035) and velocity of larynxelevation(P =0.002)between patients groups with or without aspiration. Decreased velocity oflarynx elevation was an independent risk factor of aspiration among these parameters by Logisticregression analysis (OR 0.994, 95%CI 0.989-1.000, P = 0.046).Conclusion Decreased velocity of larynx elevation is an independent risk factor of aspiration afterstroke.

A Radiological Study of Penetration/Aspiration in Post-stroke Patients

LI Bing-jie;ZHANG Tong;LI Sheng-li.

2007, 2(03):  208-211. 

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Objective To explore the effects of videofluoroscopic swallowing study (VFSS) in the assessmentof penetration/aspiration in post-stroke patients, and study the frequency of penetration/aspirationfollowing stroke.Methods Total 70 post-stroke patients and 80 normal adults were assigned to study group andcontrol group respectively. VFSS was done during swallowing on them. Abnormal signs on VFSSwere compared between two groups. The frequency of penetration/aspiration and residue of oraland pharyngeal cavity were investigated.Results Aspiration wasn’t seen in control group. Penetration/aspiration were seen in swallowingall kinds of alimentary boluses. Most of them were moderate/severe penetration or aspiration. Silentaspiration was seen in 24.4% patients with aspiration. The frequency of moderate/severe pharyngealresidue was higher in severe penetration/aspiration group than in non-severe penetration/aspirationgroup (P <0.05).Conclusion Aspiration is common in convalescent patients with stroke in restoration stage.Aspiration can been seen in swallowing all kinds of alimentary boluses. VFSS can confirmpenetration/aspiration.

Enteral Nutrition for Old-aged Dysphagic Stroke Patients

ZHENG Tian-heng;WU Lin-pu;WANG Shao-shi.

2007, 2(03):  212-215. 

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Objective To discuss the clinical effects of early naso-gastric nutrition for old-aged dysphagicstroke patients.Methods Among 67 old-aged stroke patients (≥75 years)with dysphagia enrolled, 36 patients inthe intervention group received standard naso-gastric nutrition within 72 hours of admission, and31 patients in the control group received feeding supervised by family members. We observed thetotal lymphocyte count(TLC), the level of hemoglobin(Hb), albumin(Alb) and triglyceride (TG)between the two groups at 21 days. The hypoproteinemia(Alb<35 g/L), the frequency of infectivecomplications and neurological rehabilitation of the two groups were also compared.Results At 21 days, the TLC and the level of Hb, Alb in the intervention group were significantlyhigher than in the control group. Hypoproteinemia observed in the intervention group wassignificantly lower than in the control group (38.9% vs 67.7%, P =0.018), as well as the frequencyof infective complications (41.6% vs 71.0%, P =0.016). The proportion of better outcome in theintervention group was significantly higher than in the control group(72.2% vs 48.4%, P =0.045).Conclusion This study suggests that standardized naso-gastric nutrition is helpful for improvingnutritional status and clinical outcome, decreasing the frequency of infective complications in theold-aged dysphagic stroke patients.

Comparison of Central Activation between Volunteers and Ischemic Stroke Patients with Dysphagia during Swallow Tasks

ZHANG Jing;WEI Na;ZHANG Ya-qing;et al.

2007, 2(03):  216-220. 

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Objective To identify the change of swallow related central activation in ischemic stroke patientscompared with healthy volunteers in the same swallow tasks.Methods Five ischemic stroke patients with dysphagia and seven healthy adult volunteers werestudied utilizing blood oxygenation level-dependent technique on a 3.0 T magnetic resonancescanner(Seimens). Subjects swallowed 1 ml water bolus after it was infused into their oralcavity through a plastic catheter placed in the midline in certain interval time(20, 25 or 30 s inrandomized sequence) and total 11 boluses were injected. Patients also undertook videofluoroscopicexamination during drinking 5 ml 60% w/v barium.Results Videofluoroscopy investigation indicated significant delayed pharyngeal swallow withmedian latency time to be 0.09(0.03－0.15) s. Two patients had mild residue in epiglottic valleculaand one patient had decreased sensation of pharynx. There were no other significant abnormalitiesin videofluoroscopic examination. Patients had no insular activation but the anterior cingule wasactivated, while not in volunteers. The sites of activated motor cortex in patients were less thanthose in volunteers.Conclusion No insular activation indicates that voluntary control of swallow in patients isdecreased which may lead to delayed pharyngeal swallow. Activation areas of motor cortex inpatients smaller than volunteers may be associated with the voluntary control of swallowing injuredor weakness of swallowing muscles.

综述

Treatment of Oropharyngeal Dysphagia after Stroke

Vanoo Jayasekeran;Emilia Michou;Shaheen Hamdy（著）;ZHANG Jing（译）

2007, 2(03):  266-292. 

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