Пищеводная дисфагия у пациентов с тяжелыми повреждениями головного мозга

Постановка проблемы. Одним из наиболее опасных осложнений поражения головного мозга является дисфагия. Недооценка этого симптома может приводить к таким жизнеугрожающим последствиям, как аспирация, истощение и дегидратация пациента. Цель работы - демонстрация комплексной проблемы дисфагии у пациентов с тяжелым повреждением головного мозга. Результаты. Проведенный обзор отражает необходимость исследований в изучении пищеводной дисфагии у пациентов с повреждением головного мозга. Выявлены перспективные вопросы для исследования в данном направлении -например, изучение эффективности логопедических мероприятий в лечении пищеводной дисфагии. Практическая значимость. Исследование пищеводной дисфагии у пациентов с тяжелыми повреждениями головного мозга может ускорить реабилитацию этой группы пациентов и повысить ее эффективность.

Statement of the problem. Dysphagia is one of the most dangerous complications of brain damage. Impaired swallowing and underestimation of this symptom can lead to life-threatening consequences such as aspiration, exhaustion and dehydration of the patient. Therefore, it is necessary to timely and correct diagnosis of swallowing disorders at the earliest stages of recovery of the patient after brain damage. Dysphagia in patients after brain damage is estimated more as oropharyngeal, this issue is devoted to a lot of scientific research. On the study of esophageal dysphagia in neurological patients works with evidence base is extremely small, and in severe brain damage they do not exist at all. There are only a few descriptions of cases of joint observations of patients by a neurologist and a gastroenterologist, but more often they are aimed at the diagnosis and treatment of the symptom of "lump in the throat". However, the study revealed the importance of high-resolution manometry in patients with Parkinsonism, as well as the positive effect on dysphagia in such patients by transcranial magnetic stimulation. Aim of the work - to study esophageal dysphagia in patients with brain damage is due to the high disability of patients after brain damage, low quality of life of such patients. Results. The problem is also related to the stereotype in the medical community of the study of only the oropharyngeal phase. Although the violation of mouth and pharyngeal phase of swallowing involves an infringement of the esophageal phase. Therefore, the problem of esophageal dysphagia becomes acute when restoring the oropharyngeal phase, or in the absence of its damage. A number of studies show the high role of autonomic dysfunction in patients with esophageal diseases, including esophageal dysphagia. However, the study of the role of autonomic dysfunction and its role in esophageal dysphagia in this group of patients has not previously been engaged. An algorithm of diagnosing the esophageal phase of swallowing has not been developed and high-resolution manometry has not previously been performed on patients with brain damage. There is no algorithm for feeding such patients depending on the nature of the revealed motor disorders in the pharynx and esophagus. The role of the influence of pharmacological (including psychopharmacological) drugs, psychotherapy on the course of esophageal dysphagia in this group of patients has not been studied. The role of speech therapy in the treatment of esophageal dysphagia also has not been studied. Practical significance. Therefore, we can say about the undeserved underestimation and prospects of studying the esophageal phase of swallowing in patients with brain damage. Research in this area will help to accelerate the rehabilitation of this group of patients and improve its effectiveness.