帕金森病口咽吞咽障碍的量化评估及相关性研究

发布时间：2018-04-29 03:42

  本文选题：帕金森病 + 吞咽障碍　； 参考：《山西医科大学》2017年硕士论文

【摘要】：目的:通过改良的吞钡造影评估体系(Modified Barium Swallow Impairment Profile,MBSIm P)及Rosenbek穿透-误吸量表从吞咽有效性和安全性两方面量化评估帕金森患者口咽吞咽过程,并对其进行相关性分析。方法:1.在线学习改良的吞钡造影评估体系(Modified Barium Swallow Impairment Profile,MBSIm P),并通过MBSIm P官方在线考核,取得可在临床使用该评估体系的资质。2.临床资料搜集及吞咽检查:筛选2015年12月-2016年12月山西医科大学第一医院神经内科诊断的符合纳入排除标准的帕金森患者并搜集患者病情相关资料,在患者及家属知情同意的情况下完成造影检查。3.运用MBSIm P、Rosenbek穿透-误吸量表从吞咽有效性和安全性两方面量化评估患者口咽吞咽过程。4.数据分析:根据数据类型及分布特征对变量进行统计描述;根据吞咽安全性评估结果,将帕金森患者分为穿透误吸阳性和阴性组,采用Mann-Whitney秩和检验比较两组患者的差异;采用Cochran’s Q检验比较不同食物性状及进食方式对吞咽安全的影响;等级资料运用Spearman秩相关进行相关性研究;检验水准α=0.05,p≤0.05有统计学意义。结果:1.本研究共有40名帕金森患者符合纳入排除标准,其中男性患者21名(52.5%),女性患者19名(47.5%),40名患者(100%)均有不同程度的吞咽障碍,且主要为轻中度水平,症状可同时累及口咽期。2.40名研究对象中有20名(50%)患者存在穿透误吸症状,其中7名(17.5%)患者为误吸,13名(32.5%)患者为穿透;18名(45%)患者为隐性症状,2名(5%)患者为隐性、显性共存;HoehnYahr分级越高,穿透误吸患病率越高。3.穿透误吸阳性组和阴性组在HoehnYahr分级、UPDRS总分、UPDRSⅢ得分、病程、咽期吞咽症状均存在显著差异。4.穿透误吸阳性组进食5ml不同稠度的食物时,吞咽安全并无差异,但连续吞咽时,穿透误吸风险显著增高。5.40名患者的UPDRS总分、UPDRSⅢ得分与口腔期、咽期总分、穿透误吸得分显著相关,HoehnYahr分级只与口腔期总分、穿透误吸得分相关,病程与咽期总分、穿透误吸得分相关。结论:1.帕金森患者口咽吞咽障碍可同时累及口咽期且主要为轻中度水平。2.帕金森患者的穿透误吸主要为隐性症状,提示帕金森患者存在咽喉感觉减退现象。3.少量进食时,食物性状对吞咽安全影响较小;但连续吞咽会显著增加穿透误吸风险。4.从临床表现方面评估,帕金森患者口咽吞咽障碍与帕金森病情呈正相关;但从临床残疾角度分析,HoehnYahr分级与帕金森病口咽吞咽障碍的相关性有待进一步明确。
[Abstract]:Objective: to evaluate the oral swallowing process of Parkinson's patients quantitatively by modified Barium Swallow Impairment Profilesis-MBSIm PIm (modified barium swallowing) and Rosenbek Penetration and misprision scale (Rosenbek) in terms of effectiveness and safety of swallowing, and to analyze the correlation between them. Method 1: 1. The modified barium swallowing imaging evaluation system was improved by online learning. The qualification of modified Barium Swallow Impairment Profilesis-MBSIm Pe was obtained by MBSIm P official online examination, and the qualification of the evaluation system was obtained. 2. Clinical data collection and swallowing examination: screening PD patients diagnosed by Department of Neurology, first Hospital of Shanxi Medical University from December 2015 to December 2016, and collecting relevant data of patients' condition, Complete the examination with the informed consent of the patient and his / her family. The oral swallowing process of patients was evaluated quantitatively by using the MBSIm P Rosenbek Penetration and misprision scale in terms of both the efficacy and safety of swallowing. Data analysis: the variables were statistically described according to the data types and distribution characteristics, and according to the results of swallowing safety evaluation, Parkinson's patients were divided into positive and negative groups of penetrating aspiration. The difference between the two groups was compared by Mann-Whitney rank sum test. Cochran's Q test was used to compare the effects of different food traits and eating patterns on swallowing safety; Spearman rank correlation was used to study the correlation of grade data; the test level 伪 -0. 05 p 鈮，

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