Ⅰ. 緖論
(Dysphagia) ,
1. Perlman
(afferent control of swallowing) (efferent control of swallowing)
2.
30-40%
25-50%
.
3.
(Levin-tube) , ,
,
4.
平胃散과 保和丸으로 호전된 연하장애 환자 2례
김동우, 오중한, 김봉석, 임희용, 최빈혜, 허진일, 변준석, 김대준
대구한의대학교 부속 구미한방병원
Two Patients with Dysphagia after Stroke who were Treated with Pyungwesan and Bowhawhan
Kim Dong woo, Oh Jung-hwan, Kim Bong-seok, Lim Hee-yong, Choi Bin-hye, Heo Jin-il, Byeon Jun-seok, Kim Dae-jun
Gumi Oriental Hospital of Daegu Hanny University
Dysphagia is an important complication for the rehabilitative treatment and life quality of stroke patients.
This report is about two patients with dysphagia after stroke who were treated with Pyungwesan and Bowhawhan. The severity of the patient’s dysphagia was evaluated with stage of dysphagia according to severity.
After treatment, dysphagia were remarkably improved(from stage 5 to 2, 5 to 1). This result shows that Pyungwesan and Bowhawhan could be effective against dysphagia after stroke.
Key Key Key
Key Words:Words:Words: Dysphagia, Pyungwesan, BowhawhanWords:
, ,
, ,
6.
.
Ⅱ. 硏究方法
1. 치료경과의 평가
1) Intake
. 2)
45° 10ml 10ml
.
2
7
Salassa
JR.9 7 8
(Table 1 ).
Ⅲ. 證例
〈증례1〉
1. : (M/63)
2. :
Rt. side hemiplegia (Gr /Gr ) Aphasia
Dysphagia 3.
Cb-infarction
4. : 2004 5 4
5. : 2004 7 5 - 2005 4 20
6. :
7. :
8. : 63
rt. side hemiplegia, ahasia, dysphagia . MRI
Lt. MCA Infarction 2004 7 5
2004
7 5 .
Swallowing Compensation Feeding Methods Weight Loss Aspiration Pneumania
Stage 0 Normal Oral
Stage 1Normal but intermittent
chocking Oral
Stage 2
Abnormal adjusted diets content or delayed diets time
Compensated Oral
Stage 3
Abnormal daily coughing, aspiration,
vomiting
Not Compensated Oral +less than 10% ±
Stage 4 Abnormal Not compensated Oral but, Non-oral
feeding recommended +more than 10%
Not compensated
Non-oral : N.P.O. or Gastrostomy or Levin
tube
± ±
9.
: O/S
. : 2-3 /
. :
2-3
.
: , , ,
.
: , .
:
. : 1 /4-5
.
: .
: : :
: , ,
,
. 10. (Table 2)
11.
1)
: Table 3 1
2 300cc 100cc 3 30
(Table 3 ).
:
( 0.30×30mm
stainless steel)
1 1 20 .
3
1 1 .
2) (Fig. 1, Table 6 )
2004/07/05-07/13( 1 - 9 ) (stage 5)
Stage 5 , ,
, , , ,
8
10mg .
2004/07/14-08/13( 10 - 40 ) (stage 5) , ,
30% , ,
Brain MRI(2004/05/06) Lt MCA Infarction Chest PA
EKG
Lungs are clear.
LVH
Lab Findings
CBC : WBC 12400 Hb 11.6g% Platelet 398ul U/A : Occult Blood 2+ RBC 3-4 WBC 6-8
L.F.T : Protein Total 5.7gm% TG 188mg% K 3.1 ol/l
Date Herb Medication
2004/07/05-2004/08/13
5 : 8g, 6g, 4g, 3g, 2g, 2g
( , .)
2004/08/14-2004/09/13
5 : 6g, ( ), ( ), , , 4g, 2g, 2g
( , .)
. Stage 5 .
2004/08/14-08/22( 41 - 49 ) (stage 4)
5 1-2
2-3
200-400 mg
, , ,
, ,
70% . Stage 4
.
2004/08/23-08/30( 50 - 57 ) (stage 2)
5 1-2
8 23
Intake 50%
70%
90%
.
Stage 2 .
2004/08/31-09/13( 58 - 71 ) (stage 1)
Stage 1 .
〈증례2〉
1. : ( /51)
2. :
Rt. side hemiplegia (Gr /Gr ) Aphasia
Dysphagia 3.
Cb-infarction
4. : 2003 10 5
5. : 2004 3 26 - 2004 6 5
6.
10 ( )
2004 1
7. :
8. : 51 Rt. side
hemiplegia, aphasia, dysphagia
Brain MRI Lt. MCA Infarction
Levin tube 2003 10 5
2004 2 28
aphasia, dysphagia 2004 3
26 .
9.
:
. : 3 / (via Levin tube)
. :
3
.
: 1 /1-2 30
, , .
: ,
: .
: 1 /2-3 .
: 6-7 / , .
: :
: ,
.
10. (Table 4) 11.
1)
: 5 1 2
300cc 100cc 3 30
(Table 5 ).
:
( 0.30×30mm
stainless steel)
1 1 20 .
3
1 1 .
2) (Fig. 2, Table 6 )
2004/03/26-04/06( 1 - 12 ) (stage 5)
5 2-3
Stage 5 , , ,
, , , ..
50-100mg
.
2004/04/07-04/18( 13 - 24 ) (stage 4)
1-2
3-4 300mg 100-200mg
Brain MRI(2003/10/21) Lt MCA Infarction Chest PA Lungs are clear.
EKG LVH
Lab Findings
CBC : WBC 14400 Hb 10.6g% Platelet 434ul U/A : WNL
L.F.T : ALP 130 kalU/l Glucose 122mg%
Date Herb Medication
2004/03/26-2004/04/18
5 : 8g, 6g, 4g, 3g, 2g, 2g
( , )
2004/04/19-2004/05/17
5 : 6g, ( ), ( ), , , 4g, 2g, 2g
( , )
0 500 1000 1500 2000 2500 3000
7/7-7/12 7/13-7/30 7/31-8/13 08월 14일 08월 16일 08월 18일 08월 20일 08월 22일 08월 23일 08월 24일 08월 25일 08월 26일 08월 27일 08월 28일 08월 29일 08월 30일 08월 31일 09월 01일 09월 02일 09월 03일 09월 04일 09월 05일 09월 06일 09월 07일 09월 08일 09월 09일 09월 10일 09월 11일 09월 12일 09월 13일
경구투여 총섭취량
, , , ,
50% .
Stage 4 .
2004/04/19-2004/05/11( 25 - 47 ) (stage 3)
5 2-3
100-200mg
, , , , ,
70% coughing,
aspiration Stage 3 .
2004/05/12-2004/05/17( 48 - 53 ) (stage 2)
Stage 2 .
Ⅳ. 考察
30-40%
, 25-50% 3
0 500 1000 1500 2000 2500 3000 3500
3/26-4/6 4/7-4/12 04월 13일 04월 14일 04월 15일 04월 16일 04월 17일 04월 18일 04월 19일 04월 20일 04월 21일 04월 22일 04월 23일 04월 24일 04월 25일 04월 26일 04월 27일 04월 28일 04월 29일 04월 30일 05월 01일 05월 02일 05월 03일 05월 04일 05월 05일 05월 06일 05월 07일 05월 08일 05월 09일 05월 10일 05월 11일 05월 12일 05월 13일 05월 14일 05월 15일 05월 16일 05월 17일
경구투여 총섭취량
10cc 50-100
mg 8/23
Intake 2/3
.
50mg
.
: 2-3 / ( )
: 3 / ( )
: 3 / ( )
: 3 / ( )
:
: .
:
. :
: Stage 5 : Stage 1
: Stage 5 : Stage 2 : 1 /4-5 Hard form
: 1 /3-4 Normal form
: 1 /2-3 Hard form : 1 /1-2 Normal form : State of Foley catheter, urine color is normal
: 4-5 / ,
: 6-7 / , Urine color is normal : 6-7 / ,
, ,
10.
13
69%
58.8%
5 55%
50%
6 .
,
, , ,
, ,
, , ,
, , ,
6.
, , , , , ,
.
5
.
(vidoifluoroscopic swallowing study) ,
4
.
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3. .
. . 1993;14(4):p.568.4.
. . . 2002;23
(5):p.190-194.
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1283,949,1127-1134.
6. . . : ; 1997, p.492-
498.
7. , , , , .
(CV23)
1 . . 2003,
p.74-75.
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9. , .
. .
2001;22(3):p.43-44.
10. , .
. . 1993;14(4):p.563- 565.
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8:p.195-202.
12. .
. : ;
2000.
13. .
. . 1993;14(4):p.568.
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15. , , , .
, . . 1999;22(1):p.190-101.
16. , , , .
. : ; 2003, p.751-756.
17. , .
. The journal of wonkwang Oriental Medicine 1997;7(1):p.128.
