İnme ve Yutma
Özet
İnme, serebral işlevlerin fokal veya global bozukluğu olarak tanımlanan ve dünyada ikinci ölüm nedeni olan ciddi bir sağlık sorunudur. İnme sonrası gelişen en önemli nörolojik komplikasyonlardan biri, tüm nörolojik yutma bozukluklarının %75-80'ini oluşturan disfajidir. Disfaji; orofarengeal, özofageal, özofagogastrik ve paraözofageal olmak üzere dört tipe ayrılır ve aspirasyon pnömonisi, malnütrisyon ile artmış mortalite gibi ciddi sonuçlara yol açabilir. Yutma süreci istemli ve refleksif aşamalardan oluşan oral, farengeal ve özofageal fazları kapsar ve beş kraniyal sinir tarafından koordine edilir. Hastaların klinik yönetiminde Yale Yutma Protokolü, BJH-SDS ve GUSS gibi yatak başı tarama testlerinin yanı sıra Videofloroskopik (MBYÇ) ve Fleksible Endoskopik Yutma Çalışması (FEYÇ) gibi aletsel yöntemler kullanılır. Bu değerlendirmeler doğrultusunda hastaların beslenme durumları PAS ve FOAS skalalarıyla sınıflandırılır. Tedavide katı ve sıvı gıdaların kıvamı (püre, nektar, bal vb.) hastaya özel ayarlanır, gerekirse NG veya PEG ile alternatif besleme uygulanır. Ayrıca aspirasyonun gerçekleştiği evreye göre Mendelsohn, supraglottik yutma ve eforlu yutma gibi terapötik manevralar ile nöromüsküler elektrik stimülasyonu (NMES) gibi güncel tedavi yaklaşımlarından yararlanılır.
Stroke is defined as a focal or global impairment of cerebral functions and stands as the second leading cause of death globally. One of the most critical neurological complications developing after stroke is dysphagia, which accounts for 75-80% of all neurogenic swallowing disorders. Dysphagia is classified into four types—oropharyngeal, esophageal, esophagogastric, and paraesophageal—and can lead to severe consequences such as aspiration pneumonia, malnutrition, and increased mortality. The swallowing process, coordinated by five cranial nerves, comprises oral, pharyngeal, and esophageal phases involving voluntary and reflexive stages. In clinical management, bedside screening tests like the Yale Swallow Protocol, BJH-SDS, and GUSS are utilized alongside instrumental methods including Videofluoroscopic Swallowing Study (VFSS) and Flexible Endoscopic Evaluation of Swallowing (FEES). Based on these evaluations, patients' nutritional status is classified using the PAS and FOIS scales. In treatment, the consistency of solid and liquid foods (puree, nectar, honey, etc.) is individually adjusted, and alternative nutrition via NG or PEG is applied if necessary. Furthermore, depending on the stage where aspiration occurs, therapeutic maneuvers like the Mendelsohn, supraglottic, and effortful swallow are preferred, supplemented by neuromuscular electrical stimulation (NMES).
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