nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2015-4-50-56nnp-559Research ArticleREVIEWSОБЗОРЫDysphagia after strokeНарушения глотания после инсультаГромоваД. О.GromovaD. O.

Кафедра нервных болезней и нейрохирургии, 119021, Москва, ул. Россолимо, 11

Department of Nervous System Diseases and Neurosurgery,

11, Rossolimo St., Moscow 119021

ЗахаровВ. В.ZakharovV. V.

Кафедра нервных болезней и нейрохирургии, 119021, Москва, ул. Россолимо, 11

Department of Nervous System Diseases and Neurosurgery,

11, Rossolimo St., Moscow 119021

zakharovenator@gmail.comГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation201515012016745056Copyright © Gromova D.O., Zakharov V.V., 20162016Громова Д.О., Захаров В.В.Gromova D.O., Zakharov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/559

The incidence of dysphagia after stroke accounts for 20 to 64%, which makes swallowing disorder one of the most common sequels of acute cerebrovascular accident. Dysphagia may cause life-threatening complications, such as aspiration pneumonia, cachexia, and dehydration. The paper gives international algorithms for the clinical and instrumental evaluation of swallowing function and the diagnosis of aspiration. It sets forth basic principles for managing patients with dysphagia, as well as dietary recommendations for these patients. The authors show the advantages of fast-dissolving oral medicines used in the therapy of patients with dysphagia after stroke. The currently available experience of drug and non-drug treatments for dysphagia in patients after stroke is analyzed.

Распространенность расстройства глотания (дисфагии) после инсульта составляет от 20 до 64%, что делает его одним из наиболее частых постинсультных нарушений. Расстройство глотание угрожает развитием таких жизненно опасных осложнений, как аспирационная пневмония, истощение и дегидратация. В статье приведены международные алгоритмы клинической и инструментальной оценки функции глотания и диагностики аспирации. Изложены основные принципы ведения пациентов с нарушениями глотания, а также рекомендации по организации их питания. Показаны преимущества использования быстрорастворимых пероральных лекарственных форм при медикаментозной терапии у пациентов с дисфагией после инсульта. Проанализирован имеющийся к настоящему времени международный опыт лекарственного и нелекарственного лечения дисфагии у пациентов после инсульта.

инсультдисфагияаспирацияstrokedysphagiaaspirationReferencesПарфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskii insul't [Ischemic stroke]. Moscow: MIA; 2012. 288 p.]Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskii insul't [Ischemic stroke]. Moscow: MIA; 2012. 288 p.]Дамулин ИВ, Парфенов ВА, Скоромец АА, Яхно НН. Нарушения кровообращения в головном и спинном мозге. Болезни нервной системы. Руководство для врачей. Москва: Медицина; 2005. Т.1. С. 232-303. [Damulin IV, Parfenov VA, Skoromets AA, Yakhno NN. Narusheniya krovoobrashcheniya v golovnom i spinnom mozge. Bolezni nervnoi sistemy. Rukovodstvo dlya vrachei [Circulatory disorders in the brain and spinal cord. Diseases of the nervous system. A guide for physicians]. Moscow: Meditsina; 2005. Vol.1. P. 232-303.]Дамулин ИВ, Парфенов ВА, Скоромец АА, Яхно НН. Нарушения кровообращения в головном и спинном мозге. Болезни нервной системы. Руководство для врачей. Москва: Медицина; 2005. Т.1. С. 232-303. [Damulin IV, Parfenov VA, Skoromets AA, Yakhno NN. Narusheniya krovoobrashcheniya v golovnom i spinnom mozge. Bolezni nervnoi sistemy. Rukovodstvo dlya vrachei [Circulatory disorders in the brain and spinal cord. Diseases of the nervous system. A guide for physicians]. Moscow: Meditsina; 2005. Vol.1. P. 232-303.]Скворцова ВИ, Губский ЛВ, Стаховская ЛВ и др. Ишемический инсульт. В кн.: Неврология, национальное руководство. Гусев ЕИ, Коновалова АИ, Скворцова ВИ, редакторы. Москва: ГЕОТАР-МЕДИА; 2009. С. 592-615. [Skvortsova VI, Gubskii LV, Stakhovskaya LV, et al. Ischemic stroke. In: Gusev EI, Konovalova AI, Skvortsova VI, editors. Nevrologiya, natsional'noe rukovodstvo [Neurology. A national guide]. Moscow: GEOTAR-MEDIA; 2009. P. 592-615.]Скворцова ВИ, Губский ЛВ, Стаховская ЛВ и др. Ишемический инсульт. В кн.: Неврология, национальное руководство. Гусев ЕИ, Коновалова АИ, Скворцова ВИ, редакторы. Москва: ГЕОТАР-МЕДИА; 2009. С. 592-615. [Skvortsova VI, Gubskii LV, Stakhovskaya LV, et al. Ischemic stroke. In: Gusev EI, Konovalova AI, Skvortsova VI, editors. Nevrologiya, natsional'noe rukovodstvo [Neurology. A national guide]. Moscow: GEOTAR-MEDIA; 2009. P. 592-615.]Кадыков АС, Шахпаронова НВ. Лечение и реабилитация больных в восстановительном резидуальном периодах инсульта. Москва; 2014. 93 с. [Kadykov AS, Shakhparonova NV. Lechenie i reabilitatsiya bol'nykh v vosstanovitel'nom rezidual'nom periodakh insul'ta [The treatment and rehabilitation of patients in recovery residual period of stroke]. Moscow; 2014. 93 s.]Кадыков АС, Шахпаронова НВ. Лечение и реабилитация больных в восстановительном резидуальном периодах инсульта. Москва; 2014. 93 с. [Kadykov AS, Shakhparonova NV. Lechenie i reabilitatsiya bol'nykh v vosstanovitel'nom rezidual'nom periodakh insul'ta [The treatment and rehabilitation of patients in recovery residual period of stroke]. Moscow; 2014. 93 s.]Кадыков АС, Черникова ЛА, Шахпаронова НВ. Реабилитация неврологических больных. Москва: МЕДпресс-информ; 2008. 288 с. [Kadykov AS, Chernikova LA, Shakhparonova NV. Reabilitatsiya nevrologicheskikh bol'nykh [Rehabilitation of neurological patients]. Moscow: MEDpress-inform; 2008. 288 p.]Кадыков АС, Черникова ЛА, Шахпаронова НВ. Реабилитация неврологических больных. Москва: МЕДпресс-информ; 2008. 288 с. [Kadykov AS, Chernikova LA, Shakhparonova NV. Reabilitatsiya nevrologicheskikh bol'nykh [Rehabilitation of neurological patients]. Moscow: MEDpress-inform; 2008. 288 p.]Teasell R., Foley N., Martino R., et al. Dysphagia and Aspiration Following Sroke. Evidence-Based Review of Stroke Rehabilitation, chaper 15, September 2013, p. 1-74.Teasell R., Foley N., Martino R., et al. Dysphagia and Aspiration Following Sroke. Evidence-Based Review of Stroke Rehabilitation, chaper 15, September 2013, p. 1-74.Altman KW. Oropharyngeal dysphagia pathophysiology, complications and science-based interventions. Nestle Nutr Inst Workshop Ser. 2012;72:119-26. doi: 10.1159/000340000. Epub 2012 Sep 24..Altman KW. Oropharyngeal dysphagia pathophysiology, complications and science-based interventions. Nestle Nutr Inst Workshop Ser. 2012;72:119-26. doi: 10.1159/000340000. Epub 2012 Sep 24..Falsetti P, Acciai C, Palilla R, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009 SepOct;18(5):329-35. doi: 10.1016/j.jstrokecerebrovasdis.2009.01.009.Falsetti P, Acciai C, Palilla R, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009 SepOct;18(5):329-35. doi: 10.1016/j.jstrokecerebrovasdis.2009.01.009.Flowers HL, Silver FL, Fang J, et al. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after firstever acute ischemic stroke. J Commun Disord. 2013 May-Jun;46(3):238-48. doi: 10.1016/j.jcomdis.2013.04.001. Epub 2013 Apr 12.Flowers HL, Silver FL, Fang J, et al. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after firstever acute ischemic stroke. J Commun Disord. 2013 May-Jun;46(3):238-48. doi: 10.1016/j.jcomdis.2013.04.001. Epub 2013 Apr 12.Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005 Dec;36(12):2756-63. Epub 2005 Nov 3.Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005 Dec;36(12):2756-63. Epub 2005 Nov 3.Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999 Apr;30(4):744-8.Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999 Apr;30(4):744-8.Gosney M, Martin MV, Wright AE. The role of selective decontamination of the digestive tract in acute stroke. Age Ageing. 2006 Jan;35(1):42-7.Gosney M, Martin MV, Wright AE. The role of selective decontamination of the digestive tract in acute stroke. Age Ageing. 2006 Jan;35(1):42-7.Remesso GC, Fukujima MM, Chiappetta AL, et al. Swallowing disorders after ischemic stroke. Arq Neuropsiquiatr. 2011 Oct;69(5):785-9.Remesso GC, Fukujima MM, Chiappetta AL, et al. Swallowing disorders after ischemic stroke. Arq Neuropsiquiatr. 2011 Oct;69(5):785-9.Baroni AF, Fabio SR, Dantas RO. Risk factors for swallowing dysfunction in stroke patients. Arq Gastroenterol. 2012 Apr-Jun;49(2):118-24.Baroni AF, Fabio SR, Dantas RO. Risk factors for swallowing dysfunction in stroke patients. Arq Gastroenterol. 2012 Apr-Jun;49(2):118-24.Terre R, Mearin F. Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration. Neurogastroenterol Motil. 2006 Mar;18(3):200-5.Terre R, Mearin F. Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration. Neurogastroenterol Motil. 2006 Mar;18(3):200-5.Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001 Apr;81(2):929-69.Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001 Apr;81(2):929-69.Daniels SK, Brailey K, Priestly DH, et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil. 1998 Jan;79(1):14-9.Daniels SK, Brailey K, Priestly DH, et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil. 1998 Jan;79(1):14-9.Falsetti P, Acciai C, Palilla R, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009 SepOct;18(5):329-35. doi: 10.1016/j.jstrokecerebrovasdis.2009.01.009.Falsetti P, Acciai C, Palilla R, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009 SepOct;18(5):329-35. doi: 10.1016/j.jstrokecerebrovasdis.2009.01.009.Nakajoh K, Nakagawa T, Sekizawa K, et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med. 2000 Jan;247(1):39-42.Nakajoh K, Nakagawa T, Sekizawa K, et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med. 2000 Jan;247(1):39-42.Chong MS, Lieu PK, Sitoh YY, et al. Bedside clinical methods useful as screening test for aspiration in elderly patients with recent and previous strokes. Ann Acad Med Singapore. 2003 Nov;32(6):790-4.Chong MS, Lieu PK, Sitoh YY, et al. Bedside clinical methods useful as screening test for aspiration in elderly patients with recent and previous strokes. Ann Acad Med Singapore. 2003 Nov;32(6):790-4.DePippo KL, Holas MA, Reding MJ. The Burke dysphagia screening test: validation of its use in patients with stroke. Arch Phys Med Rehabil. 1994 Dec;75(12):1284-6.DePippo KL, Holas MA, Reding MJ. The Burke dysphagia screening test: validation of its use in patients with stroke. Arch Phys Med Rehabil. 1994 Dec;75(12):1284-6.Daniels SK, Anderson JA, Willson PC. Valid items for screening dysphagia risk in patients with stroke: a systematic review. Stroke. 2012 Mar;43(3):892-7. doi: 10.1161/STROKEAHA.111.640946. Epub 2012 Feb 2.Daniels SK, Anderson JA, Willson PC. Valid items for screening dysphagia risk in patients with stroke: a systematic review. Stroke. 2012 Mar;43(3):892-7. doi: 10.1161/STROKEAHA.111.640946. Epub 2012 Feb 2.Osawa A, Maeshima S, Tanahashi N. Water-swallowing test: screening for aspiration in stroke patients. Cerebrovasc Dis. 2013;35(3):276-81. doi: 10.1159/000348683. Epub 2013 Mar 26.Osawa A, Maeshima S, Tanahashi N. Water-swallowing test: screening for aspiration in stroke patients. Cerebrovasc Dis. 2013;35(3):276-81. doi: 10.1159/000348683. Epub 2013 Mar 26.Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a dysphagia screening tool in acute stroke patients. Am J Crit Care. 2010 Jul;19(4):357-64. doi: 10.4037/ajcc2009961. Epub 2009 Oct 29.Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a dysphagia screening tool in acute stroke patients. Am J Crit Care. 2010 Jul;19(4):357-64. doi: 10.4037/ajcc2009961. Epub 2009 Oct 29.Sellars C, Dunnet C, Carter R. (1998). A preliminary comparison of videofluoroscopy of swallow and pulse oximetry in the identification of aspiration in dysphagic patients. Dysphagia. 1998 Spring;13(2):82-6.Sellars C, Dunnet C, Carter R. (1998). A preliminary comparison of videofluoroscopy of swallow and pulse oximetry in the identification of aspiration in dysphagic patients. Dysphagia. 1998 Spring;13(2):82-6.Improving Recognition and Management of Dysphagia in Acute Stroke. Heart and StrokeImproving Recognition and Management of Dysphagia in Acute Stroke. Heart and StrokeFoundation of Ontario, 2002.Foundation of Ontario, 2002.Bach DB, Pouget S, Belle K, et al. An integrated team approach to the management of patients with oropharyngeal dysphagia. J Allied Health. 1989 Fall;18(5):459-68.Bach DB, Pouget S, Belle K, et al. An integrated team approach to the management of patients with oropharyngeal dysphagia. J Allied Health. 1989 Fall;18(5):459-68.Diniz PB, Vanin G, Xavier R, Parente MA. Reduced incidence of aspiration with spoonthick consistency in stroke patients. Nutr Clin Pract. 2009 Jun-Jul;24(3):414-8. doi: 10.1177/0884533608329440.Diniz PB, Vanin G, Xavier R, Parente MA. Reduced incidence of aspiration with spoonthick consistency in stroke patients. Nutr Clin Pract. 2009 Jun-Jul;24(3):414-8. doi: 10.1177/0884533608329440.Keller H, Chambers L, Niezgoda H, Duizer L. Issues associated with the use of modified texture foods. J Nutr Health Aging. 2012 Mar;16(3):195-200.Keller H, Chambers L, Niezgoda H, Duizer L. Issues associated with the use of modified texture foods. J Nutr Health Aging. 2012 Mar;16(3):195-200.Hirani H, Rathod DA, Vadalia KR. Orally disintegrated tablets: a review. Tropical J of Pharmaceutical Res. 2009;8(2):162-72.Hirani H, Rathod DA, Vadalia KR. Orally disintegrated tablets: a review. Tropical J of Pharmaceutical Res. 2009;8(2):162-72.Kiss В, Karpati E. Mechanism of action of vinpocetine. Acta Pharm Hung. 1996 Sep;66(5):213-24.Kiss В, Karpati E. Mechanism of action of vinpocetine. Acta Pharm Hung. 1996 Sep;66(5):213-24.Табеева ГР, Азимова ЮЭ. Мультимодальная стратегия нейропротекции при инсульте: результаты российской многоцентровой клинико-эпидемиологической программы «СОКОЛ» (Сравнительная Оценка эффективности Кавинтона и Общепринятых схем Лечения, перенесших острое нарушение мозгового кровообращения). Журнал неврологии и психиатрии им. С.С.Корсакова. 2012;12(2):20-30. [Tabeeva GR, Azimova YuE. The multimodal strategy for the neuroprotection in stroke: results of the Russian multicenter clinical-epidemiological program Sokol. Zhurnal nevrologii i psikhiatrii im. S.S.Korsakova. 2012;12(2):20-30. (In Russ.)].Табеева ГР, Азимова ЮЭ. Мультимодальная стратегия нейропротекции при инсульте: результаты российской многоцентровой клинико-эпидемиологической программы «СОКОЛ» (Сравнительная Оценка эффективности Кавинтона и Общепринятых схем Лечения, перенесших острое нарушение мозгового кровообращения). Журнал неврологии и психиатрии им. С.С.Корсакова. 2012;12(2):20-30. [Tabeeva GR, Azimova YuE. The multimodal strategy for the neuroprotection in stroke: results of the Russian multicenter clinical-epidemiological program Sokol. Zhurnal nevrologii i psikhiatrii im. S.S.Korsakova. 2012;12(2):20-30. (In Russ.)].Foley N, Teasell R, Salter K, et al. Dysphagia treatment post stroke: a systematic review of randomised controlled trials. Age Ageing. 2008 May;37(3):258-64. doi: 10.1093/ageing/afn064.Foley N, Teasell R, Salter K, et al. Dysphagia treatment post stroke: a systematic review of randomised controlled trials. Age Ageing. 2008 May;37(3):258-64. doi: 10.1093/ageing/afn064.Gallas S, Marie JP, Leroi AM, Verin E. Sensory transcutaneous electrical stimulation improves post-stroke dysphagic patients. Dysphagia. 2010 Dec;25(4):291-7. doi: 10.1007/s00455-009-9259-3. Epub 2009 Oct 24.Gallas S, Marie JP, Leroi AM, Verin E. Sensory transcutaneous electrical stimulation improves post-stroke dysphagic patients. Dysphagia. 2010 Dec;25(4):291-7. doi: 10.1007/s00455-009-9259-3. Epub 2009 Oct 24.Khedr EM, Abo-Elfetoh N, Rothwell JC. Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation. Acta Neurol Scand. 2009 Mar;119(3):155-61. doi: 10.1111/j.1600-0404.2008.01093.x. Epub 2008 Sep 3.Khedr EM, Abo-Elfetoh N, Rothwell JC. Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation. Acta Neurol Scand. 2009 Mar;119(3):155-61. doi: 10.1111/j.1600-0404.2008.01093.x. Epub 2008 Sep 3.McCullough GH, Kamarunas E, Mann GC, et al. Effects of Mendelsohn maneuver on measures of swallowing duration post stroke. Top Stroke Rehabil. 2012 MayJun;19(3):234-43. doi: 10.1310/tsr1903-234.McCullough GH, Kamarunas E, Mann GC, et al. Effects of Mendelsohn maneuver on measures of swallowing duration post stroke. Top Stroke Rehabil. 2012 MayJun;19(3):234-43. doi: 10.1310/tsr1903-234.Terre R, Mearin F. Effectiveness of chindown posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study. Neurogastroenterol Motil. 2012 May;24(5):414-9, e206. doi: 10.1111/j.1365-2982.2011.01869.x. Epub 2012 Feb 6.Terre R, Mearin F. Effectiveness of chindown posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study. Neurogastroenterol Motil. 2012 May;24(5):414-9, e206. doi: 10.1111/j.1365-2982.2011.01869.x. Epub 2012 Feb 6.Perez I, Smithard DG, Davies H, Kalra L. Pharmacological treatment of dysphagia in stroke. Dysphagia. 1998 Winter; 13(1):12-6.Perez I, Smithard DG, Davies H, Kalra L. Pharmacological treatment of dysphagia in stroke. Dysphagia. 1998 Winter; 13(1):12-6.Arai T, Sekizawa K, Yoshimi N, et al. Cabergoline and silent aspiration in elderly patients with stroke. J Am Geriatr Soc. 2003 Dec;51(12):1815-6.Arai T, Sekizawa K, Yoshimi N, et al. Cabergoline and silent aspiration in elderly patients with stroke. J Am Geriatr Soc. 2003 Dec;51(12):1815-6.Osawa A, Maeshima S, Tanahashi N. Efficacy of Cilostazol in Preventing Aspiration Pneumonia in Acute Cerebral Infarction. J Stroke Cerebrovasc Dis. 2013 Aug;22(6): 857-61. doi: 10.1016/j.jstrokecerebrovasdis.2012.06.008. Epub 2012 Aug 9.Osawa A, Maeshima S, Tanahashi N. Efficacy of Cilostazol in Preventing Aspiration Pneumonia in Acute Cerebral Infarction. J Stroke Cerebrovasc Dis. 2013 Aug;22(6): 857-61. doi: 10.1016/j.jstrokecerebrovasdis.2012.06.008. Epub 2012 Aug 9.

The authors declare that there are no conflicts of interest present.