由单侧大脑半球卒中后吞咽障碍谈假性球麻痹
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摘要
脑卒中后吞咽障碍严重影响患者生活质量。假性球麻痹吞咽障碍由双侧皮质延髓束损伤引起,但临床中很多单侧大脑半球卒中患者伴发吞咽障碍。本文通过复习相关流行病学文献,阐明单侧大脑半球卒中患者吞咽障碍的发病机制和康复机制,强烈建议完善教科书中"假性球麻痹"概念,以避免给临床和教学带来更多误导和困扰。
Post-stroke dysphagia is a main barrier for stroke patients. Dysphagia in the pseudobulbar palsy patients is caused by the damage of bilateral corticobulbar tracts, but many patients with unilateral cerebral hemisphere stroke also suffer from dysphagia. This article reviewed the relevant epidemiological literatures, explained the nosogenesis and rehabilitation mechanism of dysphagia after unilateral cerebral hemisphere stroke, and strongly suggested the supplementation and perfection of the concept "pseudobulbar palsy", in order to avoid further misleading and confusion in the clinic and medical education.
Post-stroke dysphagia is a main barrier for stroke patients. Dysphagia in the pseudobulbar palsy patients is caused by the damage of bilateral corticobulbar tracts, but many patients with unilateral cerebral hemisphere stroke also suffer from dysphagia. This article reviewed the relevant epidemiological literatures, explained the nosogenesis and rehabilitation mechanism of dysphagia after unilateral cerebral hemisphere stroke, and strongly suggested the supplementation and perfection of the concept "pseudobulbar palsy", in order to avoid further misleading and confusion in the clinic and medical education.
引文
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[2]万学红,卢雪峰.诊断学[M]. 8版.北京:人民卫生出版社,2013:27-29.
[3]窦祖林.吞咽障碍评估与治疗[M].北京:人民卫生出版社, 2009:17-79.
[4]贾建平,陈生弟.神经病学[M].北京:人民卫生出版社,2013:46.
[5]Handy S, Rothwell JC, Aziz Q, et al. Organization and reorganization of human swallowing motor cortex:implications for recovery after stroke[J]. Clin Sci (Lond),2000, 99(2):151-157.
[6]Bastian HC. A treatise on aphasia and other speech deficits[M]. London:Lewis, 1898.
[7]邓红琼,李宁.脑卒中后吞咽障碍的发生机制研究进展[J].中华老年心脑血管病杂志, 2014, 16(9):1000-1001.
[8]王文忠. 225例急性脑卒中吞咽功能评估[J].中国医药导刊, 2014, 16(9):1199-1200.
[9]周立辉,施荣芳,吴毅杰.脑梗死部位与吞咽障碍的相关性研究[J].影像研究与医学应用, 2017, 5(1):31-33.
[10]张国栋,肖飞,吕昕.急性缺血性脑卒中后吞咽功能障碍发生率及危险因素的分析[J].中西医结合心脑血管病杂志, 2016, 14(8):910-912.
[11]秦海强,张婧.单侧大脑半球损伤导致吞咽困难一例[J].中国卒中杂志, 2007, 2:236-238.
[12]O’Neil PA. Swallowing and prevention of complications[J].Br Med Bull, 2000, 56(2):457-465.
[13]HamdyS,AzizQ,RothwellJC,etal.Thecortical topography of human swallowing musculature in health and disease[J]. Nat Med, 1996, 2:1217-1224.
[14]Hamdy S, Aziz Q, Rothwell JC, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex[J]. Gastroenterology, 1998,115:1104-1112.
[15]Teismann IK, Dziewas R, Steinstraeter O, et al. Timedependent hemispheric shift of the cortical control of volitional swallowing[J]. Hum Brain Mapp, 2009, 30(1):92-100.
[16]李爱国,周国强,张志,等.脑卒中急性期吞咽障碍的临床影像评价[J].中国康复, 2010, 25(3):176-178.
[17]张婧,周筠,赵性泉,等.人类吞咽皮质的功能定位[J].国际脑血管病杂志, 2006, 14:774-776.
[18]周立富,王淑娟,元小冬,等.正常人吞咽活动激活脑皮质中枢的功能磁共振定量分析[J].中华物理医学与康复杂志, 2015, 37(4):262-265.
[19]Takeuchi N, Izumi S. Maladaptive plasticity for motor recovery after stroke:mechanisms and approaches[J]. Neural Plast, 2012, 2012:359728.
[20]魏新华,戴建平,沈慧聪,等.脑卒中后吞咽障碍康复机制的功能性磁共振成像研究[J].中华物理医学与康复杂志, 2009, 31(12):812-816.
[21]Li S, Luo C, Yu B, et al. Functional magnetic resonance imaging study on dysphagia after unilateral hemispheric stroke:apreliminarystudy[J].JNeurolNeurosurg Psychiatry, 2009, 80:1320-1329.
[22]王刚,黄葵.脑卒中吞咽障碍康复治疗进展[J].中国康复理论与实践, 2016, 22(2):160-163.
[23]Hamdy S, Aziz Q, Rothwell JC, et al. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke[J]. Lancet,1997, 350:686-692.
[24]陈诗玲,倪光夏.针刺治疗神经性吞咽困难选穴规律文献研究[J].中医杂志, 2015, 56(15):1335-1338.
[25]楚佳梅.项针对假性延髓麻痹病人TCD的影响[J].针灸临床杂志, 2005, 21(8):4.
[26]汪军.针刺配合吞咽治疗仪对脑卒中后吞咽障碍的影响[J].上海针灸杂志, 2012, 31(4):225-227.
[27]魏鹏绪,鲍瑞雪,张通,等.刺激下肢穴位对吞咽中枢—岛叶皮质的激活效应:功能性磁共振成像的研究[J].中华物理医学与康复杂志, 2011, 33(12):898-901.
[2]万学红,卢雪峰.诊断学[M]. 8版.北京:人民卫生出版社,2013:27-29.
[3]窦祖林.吞咽障碍评估与治疗[M].北京:人民卫生出版社, 2009:17-79.
[4]贾建平,陈生弟.神经病学[M].北京:人民卫生出版社,2013:46.
[5]Handy S, Rothwell JC, Aziz Q, et al. Organization and reorganization of human swallowing motor cortex:implications for recovery after stroke[J]. Clin Sci (Lond),2000, 99(2):151-157.
[6]Bastian HC. A treatise on aphasia and other speech deficits[M]. London:Lewis, 1898.
[7]邓红琼,李宁.脑卒中后吞咽障碍的发生机制研究进展[J].中华老年心脑血管病杂志, 2014, 16(9):1000-1001.
[8]王文忠. 225例急性脑卒中吞咽功能评估[J].中国医药导刊, 2014, 16(9):1199-1200.
[9]周立辉,施荣芳,吴毅杰.脑梗死部位与吞咽障碍的相关性研究[J].影像研究与医学应用, 2017, 5(1):31-33.
[10]张国栋,肖飞,吕昕.急性缺血性脑卒中后吞咽功能障碍发生率及危险因素的分析[J].中西医结合心脑血管病杂志, 2016, 14(8):910-912.
[11]秦海强,张婧.单侧大脑半球损伤导致吞咽困难一例[J].中国卒中杂志, 2007, 2:236-238.
[12]O’Neil PA. Swallowing and prevention of complications[J].Br Med Bull, 2000, 56(2):457-465.
[13]HamdyS,AzizQ,RothwellJC,etal.Thecortical topography of human swallowing musculature in health and disease[J]. Nat Med, 1996, 2:1217-1224.
[14]Hamdy S, Aziz Q, Rothwell JC, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex[J]. Gastroenterology, 1998,115:1104-1112.
[15]Teismann IK, Dziewas R, Steinstraeter O, et al. Timedependent hemispheric shift of the cortical control of volitional swallowing[J]. Hum Brain Mapp, 2009, 30(1):92-100.
[16]李爱国,周国强,张志,等.脑卒中急性期吞咽障碍的临床影像评价[J].中国康复, 2010, 25(3):176-178.
[17]张婧,周筠,赵性泉,等.人类吞咽皮质的功能定位[J].国际脑血管病杂志, 2006, 14:774-776.
[18]周立富,王淑娟,元小冬,等.正常人吞咽活动激活脑皮质中枢的功能磁共振定量分析[J].中华物理医学与康复杂志, 2015, 37(4):262-265.
[19]Takeuchi N, Izumi S. Maladaptive plasticity for motor recovery after stroke:mechanisms and approaches[J]. Neural Plast, 2012, 2012:359728.
[20]魏新华,戴建平,沈慧聪,等.脑卒中后吞咽障碍康复机制的功能性磁共振成像研究[J].中华物理医学与康复杂志, 2009, 31(12):812-816.
[21]Li S, Luo C, Yu B, et al. Functional magnetic resonance imaging study on dysphagia after unilateral hemispheric stroke:apreliminarystudy[J].JNeurolNeurosurg Psychiatry, 2009, 80:1320-1329.
[22]王刚,黄葵.脑卒中吞咽障碍康复治疗进展[J].中国康复理论与实践, 2016, 22(2):160-163.
[23]Hamdy S, Aziz Q, Rothwell JC, et al. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke[J]. Lancet,1997, 350:686-692.
[24]陈诗玲,倪光夏.针刺治疗神经性吞咽困难选穴规律文献研究[J].中医杂志, 2015, 56(15):1335-1338.
[25]楚佳梅.项针对假性延髓麻痹病人TCD的影响[J].针灸临床杂志, 2005, 21(8):4.
[26]汪军.针刺配合吞咽治疗仪对脑卒中后吞咽障碍的影响[J].上海针灸杂志, 2012, 31(4):225-227.
[27]魏鹏绪,鲍瑞雪,张通,等.刺激下肢穴位对吞咽中枢—岛叶皮质的激活效应:功能性磁共振成像的研究[J].中华物理医学与康复杂志, 2011, 33(12):898-901.