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급성 허혈성 뇌졸중에 수반된 연하장애에 관한 임상적 고찰
Clinical Review about Dysphagia associated with Acute Ischemic Stroke

한명아   (원광대학교 전주한방병원 내과UU0001021  ); 김동웅   (원광대학교 전주한방병원 내과UU0001021  );
  • 초록

    Objectives : Dysphagia is common and severe problems of acute stroke determining the prognosis of stroke only second to mental change, and results in secondary fatal complications such as aspiration pneumonia, malnutrition, dehydration, etc. Therefore, we were to investigate the clinical characteristics of dysphagia accompanied by acute ischemic stroke. Methods : We selected subjects through clinical notes retrospectively, whose main problems included dysphagia resulted from acute stroke within 72 hours from onset who were admitted to the Internal Medicine Department of Wonkwang Oriental Medicine Hospital from Jan. 2000 to Apr. 2001. We assessed the severity of dysphagia from admission to discharge using a staging method : stage 0 is normal without dysphagia, stage 1 is nearly normal except for intermittent dysphagia, stage 2 is compensated abnormal swallowing requiring adjusted diets or delayed feeding time, stage 3 is uncompensated abnormal swallowing resulted in weight loss down to 10% of initial and daily aspiration, coughing, and vomiting, stage 4 is uncompensated abnormal swallowing resulting in weight loss beyond 10% and recommended for non-oral feeding, and stage 5 is 100% non-oral feeding by L-tube, or gastrostomy or NPO state. Results : Dysphagia was improved statistically significantly from the mean stage of $3.6{\pm}0.29$ on admission to $1.88{\pm}0.32$ on discharge (P $7.1{\pm}1.48$ days were required for improving more than one stage level. As patients were older and the stage of dysphagia was worse on admission, severity of dysphagia was more difficult to improve (correlation coefficiency was 0.55 and 0.77 respectively, P $3.36{\pm}0.37$ . However, any specific values such as lesion size, lesion site, sex, age, past history and NIH Stroke Scale on admission did not affect it (P>0.05). Conclusion : Clinical course of dysphagia was determined about I week from the onset. Aspiration pneumonia was mainly complicated during oral feeding periods. If there were no improvement of dysphagia over 2-3 weeks, then non-oral feeding such as Levin tube or gastrostomy must be considered.


  • 주제어

    Dysphagia .   Aspiration Pneumonia .   Acute Ischemic Stroke.  

  • 참고문헌 (37)

    1. The association of swallowing dysfunction and aspiration pneumonia , Martin, B.J.;Corlew, M.M.;Wood, H.;Olson, D.;Golopol, L.A.;Wingo, M.;Kirmani, N.;Clement, J. , Dysphagia / v.9,pp.1-6,
    2. The gag reflex and aspiration: a retrospective analysis of 120 patients assessed by videofluoroscopy , Bleach, N.R. , Clinical Otolaryngology & Allied Sciences / v.18,pp.303-307,
    3. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding , Nakajoh, K.;Nakagawa, T.;Sekizawa, K.;Matsui, T.;Arai, H.;Sasaki, H. , Journal of Internal Medicine / v.247,pp.39-42,
    4. Validation of the 50 ml drinking test for evaluation of post-stroke dysphagia , Gottlieb, D.;Kipnis, M.;Sister, E.;Vardi, Y.;Brill, S. , Disability & Rehabilitation / v.18,pp.529-532,
    5. The functional Neuroanatomy of Voluntary Swallowing , Zald, D.H.;Pardo, J.V. , Americal Neurological Association / v.46,pp.281-286,
    6. Dysphagia in stroke: a prospective study of quantitative aspects of swallowing in dysphagic patients , Nilsson, H.;Ekberg, O.;Olsson, R.;Hindfeli, B. , Dysphagia / v.13,pp.32-38,
    7. Neurogenic dysphagia: the role of the neurologist , Hughes, T.A.T.;Wiles, C.M. , Journal of Neurology, Neurosurgery & Psychiatry / v.64,pp.569-572,
    8. Spectrum of lateral medullary syndrome, Correlation between clinical findings and magnetic resonance imaging in 33 subjects , Kim. J.S.;Lee, J.H.;Suh, D.C.;Lee, M.C. , Stroke / v.25,pp.1405-1410,
    9. Functional outcome in brain stem stroke patients after rehabilitation , Chua, K.S.;Kong, K.H. , Archives of Physical Medicine & Rehabilitation / v.77,pp.194-197,
    10. Lesion localization in acute stroke patients with risk of aspiration , Daniels, S.K.;Foundas, A.L. , Journal of Neuroimaging / v.9,pp.91-98,
    11. Brainstem infarct with pharyngeal dysmotility and paralyzed vocal cord: management with a multidisciplinary approach , Saltzman, L.S.;Rosenberg, C.H.;Wolf, R.H. , Archives of Physical Medicine and Rehabilitation / v.74,pp.214-216,
    12. Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke , James, A.;Kapur, K.;Hawthorne, A.B. , Age & Ageing / v.27,pp.671-676,
    13. Outcome in patients who require a gastrostomy after stroke , Wanklyn, P.;Cox, N.;Belfield, P. , Age & Ageing / v.24,pp.510-514,
    14. 뇌졸중 환자에서 목의 자세가 연하게 미치는 영향 , 백승석;박시복;이상건;이강목;김승현 , 대한재활의학회지 / v.21,pp.8-12,
    15. 흡인성 연하 곤란의 회복 지표 , 이강우;권정이 , 대한재활의학회지 / v.21,pp.13-19,
    16. Evaluation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke parients , Goulding, R.;Bakheit, A.M. , Clincial Rehabilitation / v.14,pp.119-124,
    17. Complications and Outcome After Acute Stroke , Smithard, D.G.;O'Neill, P.A.;Park, C.;Morris, J.;Wyatt, R.;England, R.;Martin, D.F. , Does Dysohagia in stroke A Journal of Cerebral Circulation / v.27,pp.1200-1204,
    18. 연하장애를 동반한 허혈성 뇌졸중의 임상적 특성 , 김장성;홍태용 , 인제의학 / v.14,pp.561-566,
    19. The differential Diagnosis in Long-Term Care , Dysphaiga, Amella E.J. , Lippincott Williams & Wilkins / v.3,pp.135-149,
    20. Gottlieb, D.;Brill, S.;Khvoles, S.;Kipnis, S.;Manevitch, D. , Reduction in frequency of penumonia after stroke, following programmed swallowing evaluation Harefuah / v.129,pp.33-35,
    21. Dysphagina in acute stroke , British Medical Journal Clinical Research Ed. / v.295,pp.411-414,
    22. Dysphagia associated with neurological disorders , Buchholz, D.W. , Acta Oto-Rhino-:aryngologica Belgica / v.48,pp.143-155,
    23. Dysphagia following stroke: quantitative evaluation of pharyngcal transit times , Johnson, E.F.;McKenzie, S.W.;Rosenquist, C.J.;Lieverman, J.S.;Sievers, A.E. , Archives of Physical Medicine & Rehavilitation / v.73,pp.419-423,
    24. Supraglottic and pharyngeal sensory abnormalities in stroke patients with dysphagia , Aviv, J.E.;Martin, J.H.;Sacco, R.L.;Zager, D.;Diamond, B.;Keen, M.S.;Blitzer, A. , Annals of Otology, Rhinology & Laryngology / v.105,pp.92-97,
    25. Aspiration in acute stroke: a clinical study with videofluoroscopy , Kidd, D.;Lawson, J.;Nesbitt, R.;MacMahon, J. , Quarterly Journal of Medicine / v.86,pp.825-829,
    26. Incidence and patient characteristics associated with silent aspiration in the acute care setting , Smith, C.H.;Logemann, J.A.;Colangelo, L.A.;Rademaker, A.W.;Pauloski, B.R. , Dysphagia / v.14,pp.1-7,
    27. Aspiration and relative risk of medical complications following stroke , Holas, M.A.;DePippo, K.L.;Reding, M.J. , Archives of Neurology / v.51,pp.1051-1053,
    28. 죄졸증 환자에서 연하곤란의 임상적 고찰(1) , 전주언;전세일;김동아;배하석 , 대한재활 의학회지 / v.20,pp.305-311,
    29. A functional outcome swallowing scale for staging oropharyngeal dysphagia , Salassa, J.R. , Digestive Diseases / v.17,pp.230-234,
    30. Swallow management in patients on an acute stroke pathway: quality is cost effective , Odderson, I.R.;Keaton, J.C.;McKenna, B.S. , Archives of Physical Medicine & Rehabilitation / v.76,pp.1130-1133,
    31. 연하곤란성 뇌졸중에서 경비위관과 경피적 내시경적 위루설치술 의 비교 , 김철준;전민호;하상배 , 대한재활의학회지 / v.21,pp.1110-1117,
    32. 허혈성 뇌졸중에 동반된 연하장애의 단기간 임상경과 , 김장성 , 인제의학 / v.14,pp.567-570,
    33. 연하곤란의 재활치료 결과 , 김수열;최선미;김유철 , 대한재활의학회지 / v.18,pp.640-646,
    34. Dysphagia in Patients with Brainstem Stroke , Meng, N.H.;Wang, T.G.;Lien, I.N. , Incidence and Outcome / v.79,pp.170-175,
    35. Dysphagia after stroke , Campbell-Taylor , Neurology / v.45,pp.1786-1787,
    36. Aspiration penumonia in stroke , Johnson, E.R.;McKenzie, S.W.;Sievers, A. , Archives of Physical Medicine & Rehabilitation / v.74,pp.973-976,
    37. Pneumonia in atroke patients: a retrospective study , Ding, R.;Logemann, J.A. , Dysphagia / v.15,pp.51-57,

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