吞咽功能障碍的超声评估及研究进展

Ultrasonic Evaluation and Research Progress of Swallowing Dysfunction

摘要: 吞咽功能一直是人们热议的话题，而吞咽功能障碍在脑卒中患者中发生率高达37%~78%，可导致误吸、肺炎甚至死亡。传统评估工具VFSS和FEES存在辐射、侵入性等局限，超声因无创、无辐射、可重复等优势成为研究热点。超声通过评估舌肌横截面积与回声强度反映肌肉数量与质量，通过测量颏舌骨肌等舌骨上肌群的厚度、位移及收缩率评估吞咽功能，其中颏舌骨肌收缩 < 22%、舌骨上移 < 3.3 mm提示吞咽困难高风险。超声测量具有良好的信度，并可指导持舌吞咽、吸气肌训练等康复训练。超声技术虽无法完整观察吞咽全过程，但在吞咽功能筛查、肌少性吞咽困难识别及康复效果评估方面展现出良好应用前景。未来需建立标准化的超声评估参数体系，开展大样本临床研究，推动超声在吞咽功能障碍临床诊疗中的规范化应用。

Abstract: Swallowing function has been a hot topic, and the incidence of swallowing dysfunction in stroke patients is as high as 37%~78%, which can lead to aspiration, pneumonia and even death. Traditional assessment tools VFSS and fees have limitations such as radiation and invasiveness. Ultrasound has become a research hotspot due to its advantages of noninvasive, non-radiation and repeatability. Ultrasound reflects the quantity and quality of muscles by evaluating the cross-sectional area and echo intensity of tongue muscle. Swallowing function is evaluated by measuring the thickness, displacement and contraction rate of suprahyoid muscles such as Geniohyoid muscle. The contraction of Geniohyoid muscle < 22% and the upward displacement of hyoid bone < 3.3 mm suggest a high risk of dysphagia. Ultrasound measurement has good reliability, and can guide tongue swallowing, inspiratory muscle training and other rehabilitation training. Although ultrasound technology cannot completely observe the whole process of swallowing, it shows good application prospects in swallowing function screening, sarcopenic dysphagia recognition and rehabilitation effect evaluation. In the future, it is necessary to establish a standardized ultrasound evaluation parameter system, carry out large sample clinical research, and promote the standardized application of ultrasound in the clinical diagnosis and treatment of swallowing dysfunction.