帕金森病与脑卒中患者吞咽障碍特点分析与比较OA

Objective To analyze and compare the characteristics of dysphagia in patients with Parkinson's disease(PD)and stroke.Methods A total of 58 inpatients with post-stroke dysphagia or PD-related dysphagia who met the inclusion criteria in the Department of Rehabilitation Medicine,the Second Affiliated Hospital of Xi'an Jiaotong University from March to December 2019 were enrolled.There were 46 patients in the stroke group and 12 patients in the PD group.The following signs of dysphagia were screened:impaired saliva control,prolonged meal time,need for change of food texture,weight loss or malnutrition,recurrent unex-plained fever or pulmonary infection,insufficient oral hydration,dyspnea after swallowing,and repeated swallowing to clear oropha-ryngeal residue.Swallowing function was evaluated using the water swallowing test(WST)and the standardized swallowing assess-ment(SSA).Data were collected through videofluoroscopic swallowing study(VFSS).Inadequate tongue movement in oral phase,poor bolus formation,premature leakage of food into pharyngeal cavity and aspiration,leakage,epiglottic valley residue,pyriform sinus residue,pharyngeal wall residue,pharyngeal reflux and achalasia of the upper esophageal sphincter during the pharyngeal phase were selected for qualitative analysis.Oral transit time(OTT),hyoid movement time(HMT),pharyngeal transit time(PTT),swallowing reaction time(SRT),hyoid maximum displacement(HMD),and pharyngeal constriction ratio(PCR)were employed for quantitative analysis.Results Compared with the PD group,the stroke group had a higher proportion of patients who required a change in food texture during eating(x2=7.45,P<0.05),a higher incidence of recurrent unexplained fever or pulmonary infection(x2=7.33,P<0.05),and a lower proportion of patients with inadequate oral hydration(x2=10.93,P<0.05).Compared with the PD group,the stroke group had a higher WST grade(P<0.05)and higher SSA score(P<0.05).Compared with the PD group,the stroke group had a lower proportion of patients with inadequate tongue movement(x2=5.57,P<0.05)and a higher proportion of patients with pen-etration(x2=6.73,P<0.05).Compared with the PD group,the stroke group had shorter OTT and HMT(P<0.05);there were no statis-tically significant differences between the two groups in PTT,SRT,HMD or PCR(P>0.05).Conclusion The clinical manifesta-tions of dysphagia in PD and stroke are not entirely consistent.Dysphagia in PD patients is more prominently characterized by oral-phase dysfunction,whereas dysphagia in stroke patients is mainly manifested by pharyngeal-phase dysfunction.