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目的探讨脑卒中部位对患者的摄食-吞咽功能障碍预后的影响,为临床预测摄食-吞咽功能及其恢复可能提供依据。方法对卒中单元901例患者按脑卒中部位进行分组:脑干组、双侧半球受损组、单侧半球受损组及脑干+半球受损组,在其进食前行吞咽困难的筛选,如确定存在摄食-吞咽障碍,则行吞咽功能评估,并由康复医师及言语治疗师给予相应的康复训练,出院时再次行吞咽功能评价。结果卒中单元患者急性期摄食-吞咽障碍的发生率为33.1%,其中脑干组80.0%,双侧大脑半球受损组75.6%,单侧大脑半球受损组17.7%,脑干+半球受损组87.5%。康复治疗后,卒中单元患者仍有7.8%存在摄食-吞咽障碍,基本都发生在脑干组、双侧半球受损组及脑干+半球受损组。结论脑卒中急性期患者常并发摄食-吞咽障碍,经过治疗和康复训练,大部分患者可安全进食,但卒中部位位于双侧半球、脑干或脑干+半球的患者摄食-吞咽功能恢复欠佳,与单侧半球组相比,预后较差。
Objective To investigate the influence of stroke site on the prognosis of patients with food intake and swallowing dysfunction and provide the basis for clinical prediction of food intake and swallowing function and their recovery. Methods A total of 901 stroke patients were divided into three groups: stroke group, brain stem group, bilateral hemisphere damaged group, unilateral hemisphere damaged group and brainstem + hemisphere damaged group, screening dysphagia before eating, Swallowing assessment is performed if food intake-swallowing disorders are identified, and appropriate rehabilitation training is given by rehabilitation physicians and speech therapists. Swallowing assessment is performed again at discharge. Results The incidence of acute phagocytic dysphagia was 33.1% in stroke patients, including 80.0% in brainstem group, 75.6% in bilateral cerebral hemisphere lesion group, 17.7% in unilateral cerebral hemisphere lesion group, and impaired brain stem + hemisphere Group 87.5%. After rehabilitation, 7.8% of stroke patients still had food-swallowing disorders, which basically occurred in brain stem group, bilateral hemisphere damaged group and brainstem + hemisphere damaged group. Conclusions Patients with acute stroke often have food-swallowing disorders. Most patients can be safely fed after treatment and rehabilitation training. However, patients with stroke sites in bilateral hemispheres, brainstem or brainstem + hemisphere have poor recovery of swallowing function , Compared with unilateral hemisphere group, the prognosis is poor.