Study On The Characteristics Of Swallowing Angiography And Its Correlation With Aspiration In Patients With Stroke Recovery

Purpose:Digital swallowing angiography(the video fluoroscopic study of swallowing,VFSS)was used to study the abnormal imaging signs of dysphagia in patients with convalescent stroke,and the correlation between the signs and brain stem injury in patients with stroke.The correlation between abnormal signs of swallowing angiography and aspiration in patients with dysphagia after stroke was analyzed,which pointed out the direction clinical practice.Methods:A total of 162 patients with ischemic/hemorrhagic stroke and dysphagia confirmed by cranial MRI and CT examination in the Rehabilitation Department of Chenzhou first people’s Hospital from January2019 to December 2020 were selected as subjects(97 of them are ischemic stroke,The other 65 patients were hemorrhagic stroke).Digital swallowing angiography was performed during stroke recovery.Three different types of contrast agents of different viscosity were prepared by rehabilitation physicians and speech therapists using iodine-containing contrast agents(pan-glucamine)and thickeners,They are liquid,thin paste and thick paste.Patients swallowing in the order of liquid-thin paste-thick paste,The whole swallowing process was recorded under a digital gastroenterography machine,and the recorded images were repeatedly observed by a number of radiologists,together with rehabilitation doctors and therapists,and the results were evaluated to record the push function of tongue activity,swallowing initiation,pharyngeal contractile activity,regurgitation and laryngeal vestibular closure,cyclopharyngeal muscle opening and aspiration.According to the location of stroke injury,the patients were divided into stroke brainstem involvement group(n=67)and stroke brainstem non-involvement group(n=95).The Rosenbek osmotic/aspiration scale was used to evaluate the degree of dysphagia and determine whether there was aspiration.If there is a cough within one min after the occurrence of false aspiration,it can be judged as dominant false aspiration,and no choking cough indicates that it is occult false aspiration.The incidence of abnormal swallowing function in brainstem injury group and non-brainstem injury group was examined by chi-square test;Analysis of risk factors associated with aspiration in patients with dysphagia after stroke by LOGISTIC regression.All the data were input into the SPSS22.0 software for processing and analysis,P<0.05 that the difference was statistically significant.Results:1.The results of brainstem injury group(67 cases)were: abnormal movement of tongue 41 cases(61.19%),abnormal swallowing initiation 58 cases(86.57%),abnormal contraction force of laryngeal cavity 46cases(68.66%),laryngeal vestibular closure abnormality 47 cases(70.15%),epiglottis dyskinesia 52 cases(77.61%),abnormal opening of crico-pharyngeal muscle 53 cases(79.10%),47 cases of aspiration during inspection(70.15%),dominant false aspiration 43 cases(64.18%),6 cases of occult false aspiration(8.96%),There were 3 cases both have dominant and recessive aspiration(4.48%).2.The results of non-brainstem injury group(95cases)were:abnormal movement of tongue 74 cases(77.89%),abnormal swallowing initiation 72 cases(75.79%),abnormal contraction force of laryngeal cavity 35 cases(36.84%),laryngeal vestibular closure abnormality42 cases(44.21%),epiglottis dyskinesia 59 cases(62.11%),abnormal opening of crico-pharyngeal muscle 10 cases(10.53%),38 cases of aspiration during inspection(40.00%),dominant false aspiration 36 cases(37.89%),3 cases of occult false aspiration(3.16%).3.Comparison of the results of contrast examination on abnormal signs of dysphagia between stroke brainstem affected group and stroke brainstem unaffected group:abnormal movement of tongue(x~2=5.321,P<0.05),abnormal swallowing initiation(x~2=2.879,P>0.05),abnormal contraction force of laryngeal cavity(x~2=15.907,P<0.05),laryngeal vestibular closure abnormality(x~2=10.678),P<0.05),epiglottis dyskinesia(x~2=4.380),P<0.05),abnormal opening of crico-pharyngeal muscle(x~2=77.752,P<0.05),aspiration(x~2=14.320,P<0.05),among them,dominant false aspiration(x~2=0.072,P>0.05),occult false aspiration(x~2=2.517,P>0.05).4.The LOGISTIC regression analysis of signs of dysphagia in patients with dysphagia and dysphagia imaging showed that there were statistically significant images of dysphagia in 95%confidence intervals:abnormal movement of tongue(OR=3.032),abnormal swallowing initiation(OR=3.703),laryngeal vestibular closure abnormality(OR=12.604),and abnormal opening of crico-pharyngeal muscle(OR=2.886).Conclusion:1.Whether the injury caused by stroke involves the brainstem and the imaging manifestations of swallowing angiography are different:the abnormal swallowing function of stroke patients with non-brain stem injury mainly occurs in oral stage,while the main dysphagia in stroke patients with brain stem injury occurs in pharyngeal stage.2.The imaging signs related to the occurrence of aspiration in patients with dysphagia after stroke were abnormal tongue movement and transport,abnormal swallowing initiation,laryngeal vestibular closure abnormality and abnormal opening of crico-pharyngeal muscle.among them,the abnormal closure of laryngeal vestibule is the most closely related to the occurrence of aspiration.