摘要:目的:探索可靠的卒中患者床旁吞咽评估方法。方法：61例住院卒中患者均进行各种床旁吞咽评估筛查及电视透视检查，以后者为金标准探讨各方法的敏感度、特异度及阳性、阴性预测值。结果:六种独立床旁吞咽评估方法与金标准相比较的敏感度在60%～87%之间，特异度在76%～89%之间，阳性预测值在50%～69%之间，阴性预测值在86%～95%之间；几种评估方法作为平行试验联合应用时的敏感度在89%～98%之间，阴性预测值在94%～99%之间；几种方法作为序列试验应用时的特异度在97%～99%之间，阳性预测值在82%～90%之间。结论：根据不同方法的预测特点，可得到针对不同患者的、有效的床旁评估方法。床旁吞咽评估简单、有效、便捷，是临床工作中适宜的评估方法。
目的:观察中频电刺激治疗急性缺血性脑卒中后吞咽困难的临床疗效。方法:选取急性缺血性脑卒中并发生吞咽困难的患者80例,随机分为治疗组和对照组,两组临床用药完全一致,对照组和治疗组分别辅以冰刺激和中频电刺激进行康复治疗,疗程为1月。观察患者吞咽困难的恢复情况.结果:治疗组治愈率为35％,总有效率为90％,与对照组比较差异具显著性。结论:中频电刺激是治疗脑卒中后吞咽困难的一种有效、简便、安全的方法,可推荐临床使用。
ObjectiveTo systematically evaluate the effectiveness of acupuncture combined with rehabilitation training compared with simple rehabilitation training or acupuncture treatment of dysphagia after stroke, and make clear whether the effect of acupuncture combined with rehabilitation training is better than simple rehabilitation training or acupuncture treatment.MethodsSix databases including China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP, PubMed, Cochrance Library, and Embase were searched by computer for the randomized controlled trials on acupuncture combined with rehabilitation training treatment of post-stroke dysphagia, which were published from January 1st, 2010 to December 31st, 2018. After literature including, excluding, and screening, RevMan 5.3 software was used to conduct a meta-analysis.ResultsA total of 22 studies were included, including 1 987 patients. All the included studies took simple rehabilitation training or rehabilitation training combined with sham acupuncture as the control. Meta-analysis of efficiency and outcome measures for relevant studies showed that: compared with simple rehabilitation training, the effectiveness of acupuncture combined with rehabilitation training on post-stroke dysphagia was higher [17 studies included; odds ratio=3.66, 95% confidence interval (CI) (2.66, 5.05), P<0.000 01], the video fluoroscopy swallowing study score of acupuncture combined with rehabilitation training after treatment was higher [8 studies included; mean difference (MD)=2.31, 95%CI (1.75, 2.87), P<0.000 01], and the StandardizedSwallowing Assessment score of acupuncture combined with rehabilitation training after treatment was lower [6 studies included; MD=−3.20, 95%CI (−3.78, −2.61), P<0.000 01]; at the same time the Watian Drinking Water Test score of acupuncture combined with rehabilitation training after treatment was lower [6 studies included; MD=−0.65, 95%CI (−0.91, −0.39), P<0.000 01].ConclusionsAcupuncture combined with rehabilitation training is effective in dysphagia after stroke, and the combined effect is better than simple rehabilitation training. However, due to the limitations of quality of included literature and sample size, the above results and conclusions still require high quality and large sample studies to testify.
Objective To explore the clinical effect of occipital-cervical fusion and its impact on cervical curvature, and preliminarily study the causes of postoperative dysphagia. Methods The data of 24 patients who underwent occipito-cervical fusion in the Fourth People’s Hospital of Zigong between January 2014 and December 2018 were retrospectively analyzed, including 13 males and 11 females, aged 33-82 years, with an average age of (58.3±13.3) years. Among them, there were 14 cases of atlas fractures, 6 cases of atlantoaxial fractures, 1 case of intraspinal canal space-occupying lesion, 2 cases of chronic atlantoaxial dislocation with spinal cord compression, and 1 case of instability caused by inflammatory diseases. Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) score were used to evaluate neurological function and pain of patients preoperatively and postoperatively. Occipito-cervical angle (O-C2) and lower cervical angle (C2-C7) were measured to evaluate the preoperative and postoperative angle changes in patients. The causes of postoperative dysphagia were analyzed. Results All the 24 patients were followed up for 8-50 months (26.3 months on average). The mean JOA score increased from 11.6±1.5 before surgery to 15.4±1.2 at the last follow-up, and the mean VAS score decreased from 6.4±1.1 before surgery to 2.0±0.6 at the last follow-up; the differences between the two time points were statistically significant (P<0.001). The bone graft fusion rate was 95.8% (23/24). The mean O-C2 angle decreased from (16.5±7.6)° before surgery to (14.7±4.5)° at the last follow-up, with no statistical significance (P=0.395). The mean angle of C2-C7 increased from (9.4±5.5)° before surgery to (16.3±3.5)° at the last follow-up, and the difference was statistically significant (P<0.001). Two patients developed postoperative dysphagia, possibly due to fusion in a flexion position. Conclusion Occipito-cervical fusion has reliable efficacy in treating occipito-cervical instability, with a high fusion rate and a low incidence of complications, but it will change the physiological curvature of upper and lower cervical vertebra, and fusion in a flexion position may cause postoperative dysphagia.
ObjectiveTo compare the predictive abilities of O-C2 angle (O-C2a), O-EA angle (O-EAa), and Oc-Ax angle (Oc-Axa) for development of dysphagia in patients after occipitocervical fusion (OCF).MethodsBetween April 2010 and May 2019, 114 patients who underwent OCF and met the selection criteria were selected as the research objects. Among them, 54 were males and 60 were females; they were 14-76 years old, with an average of 50.6 years old. The follow-up time was 13-122 months (median, 60.5 months). The O-C2a, O-EAa, Oc-Axa, and the narrowest oropharyngeal airway space (nPAS) were measured by the lateral X-ray films before operation and at last follow-up, and the differences before and after operation (dO-C2a, dO-EAa, dOc-Axa, and dnPAS) were calculated. Patients were divided into two groups according to whether they had developed postoperative dysphagia. The general data including age, gender, fixed segment, proportion of patients with rheumatoid arthritis (RA), atlantoaxial subluxation (AS), and combined with anterior release surgery (ARS), and imaging indicators were compared between the two groups. The correlations between dO-C2a, dO-EAa, and dOc-Axa and dnPAS in 114 patients were analyzed to further compare the predictive value of three imaging indicators for occurrence of dysphagia after OCF.ResultsDysphagia occurred after OCF in 31 cases with the incidence of 27.2%. There was significant difference in gender between the dysphagia group and the non-dysphagia group (χ2=7.940, P=0.005). There was no significant difference between the two groups in age, fixed segment, the proportion of patients with RA, the proportion of patients with AS, and the proportion of patients combined with ARS (P>0.05). There was no significant difference in O-C2a and Oc-Axa of 114 patients before operation and at last follow-up (P>0.05). The differences in O-EAa and nPAS were significant (P<0.05). There was no significant difference in preoperative O-EAa, Oc-Axa, and nPAS between the dysphagia group and the non-dysphagia group (P>0.05); the difference in the O-C2a was significant (t=2.470, P=0.016). At last follow-up, the differences in the above imaging indicators were significant (P<0.05). There were significant differences in the dO-C2a, dO-EAa, dOc-Axa, and dnPAS between the two groups (P<0.05). Correlation analysis showed that the dO-C2a, dO-EAa, dOc-Axa were all positively correlated with dnPAS (P<0.05). The dO-C2a≤−5°, postoperative O-EAa≤100°, postoperative Oc-Axa≤65° were all related to postoperative dysphagia (P<0.05), and the highest risk factor suffering postoperative dysphagia was dO-C2a ≤−5° with a significant OR of 14.4.ConclusionThe dO-C2a, postoperative O-EAa, and postoperative Oc-Axa can be used as the predictive indexes of dysphagia after OCF, among which dO-C2a has the highest predictive value.
With the aging of the population, the incidence of stroke is increasing year by year. More than 50% of stroke patients have post-stroke dysphagia, which not only increases the risk of complications such as aspiration pneumonia, malnutrition and dehydration, but also is associated with poor prognosis and increasing mortality. Due to its high morbidity and high risk of complications, the European Stroke Organization and the European Society for Dysphagia have launched the guideline for the diagnosis and treatment of post-stroke dysphagia (2021 Edition). This guideline mainly raises questions about the screening, assessment, and treatment of post-stroke dysphagia, and answers them based on evidence-based medical evidences. This article mainly interprets this in order to better guide clinical practice.
ObjectiveTo introduce a new occipitocervical angle parameter, occipito-odontoid angle (O-Da), for predicting dysphagia after occipitocervical fusion (OCF) in patients with C2, 3 Klippel-Feil syndrome (KFS) and analyze its effectiveness. Methods A total of 119 patients met selective criteria between April 2010 and November 2019 were retrospectively included as the study subjects. There were 56 males and 63 females. The age ranged from 14 to 76 years, with a median age of 51 years. There were 44 cases of basilar invagination and 75 cases of atlantoaxial subluxation. Forty patients were combined with C2, 3 KFS. Seven patients underwent anterior decompression combined with posterior OCF and 112 patients underwent posterior OCF. The fixed segments were O-C2 in 36 cases, O-C3 in 51 cases, O-C4 in 25 cases, and O-C5 in 7 cases. All patients were followed up 21-136 months, with a median time of 79 months. The lateral cervical X-ray films before operation and at last follow-up were used to measure the occipital to C2 angle (O-C2a), the occipital and external acoustic meatus to axis angle (O-EAa), the occipital protuberance to axial angle (Oc-Axa), the O-Da, and the narrowest oropharyngeal airway space (nPAS). The differences of the above parameters between the last follow-up and the preoperative values were calculated (represented as dO-C2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS). Patients were divided into two groups according to whether they suffered dysphagia after operation, and the differences in clinical data and radiographic parameters were compared between the two groups. The correlation between occipitocervical angle parameters and nPAS in 40 patients with C2, 3 KFS was analyzed respectively. In addition, sensitivity and specificity analyses were used to assess the effectiveness of dO-Da≤−5° for the prediction of postoperative dysphagia. ResultsThirty-one patients (26.1%) suffered dysphagia after OCF (dysphagia group), including 10 patients with C2, 3 KFS; no dysphagia occurred in 88 patients (non-dysphagia group). There was no significant difference in age, follow-up time, fixed segment, proportion of patients with rheumatoid arthritis, proportion of patients with atlantoaxial subluxation, and proportion of patients with C2, 3 KFS between the two groups (P>0.05). The proportion of female patients was significantly higher in dysphagia group than in non-dysphagia group (χ2=7.600, P=0.006). The difference in preoperative O-C2a between the two groups was significant (t=2.528, P=0.014). No significant differences were observed in preoperative O-EAa, Oc-Axa, O-Da, and nPAS (P>0.05). There was no significant difference in dO-C2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS between the two groups (P>0.05). The dO-C2a, dO-EAa, dOc-Axa, and dO-Da were positively correlated with dnPAS in 40 patients with C2, 3 KFS (r=0.604, P<0.001; r=0.649, P<0.001; r=0.615, P<0.001; r=0.672, P<0.001). Taking dO-Da≤−5° as the standard, the sensitivity and specificity of dO-Da to predict postoperative dysphagia in patients with C2, 3 KFS were 80.0% (8/10) and 93.3% (28/30), respectively. ConclusionThe dO-Da is a reliable indicator for predicting dysphagia after OCF in patients with C2, 3 KFS.