A Method to Objectively Assess Swallow Function in Adults With Suspected Aspiration
A Method to Objectively Assess Swallow Function in Adults With Suspected Aspiration
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DOI：
10.1053/j.gastro.2011.02.051
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发表时间：
2011-05-01
期刊：
影响因子：
29.4
通讯作者：
Rommel, Nathalie
中科院分区：
文献类型：
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作者：
Omari, Taher I.;Dejaeger, Eddy;Rommel, Nathalie
背景与目的：咽测压和阻抗提供吞咽功能的信息。我们开发了一种新的分析方法来评估吸入风险。方法：我们研究了20例（30-95岁）疑似误吸的患者，这些患者被转诊接受视频透视检查，沿着的还有对照组（年龄24-47岁）。用压力计和阻抗法记录液体团吞咽的咽部相。分析了第一次吞咽推注和随后的清除吞咽的数据。我们对吸入的荧光透视证据进行评分，并研究了一系列计算得出的功能变量。其中，4个突出为具有高诊断价值：峰值压力（PeakP）、最低阻抗处的压力（PNadImp）、从最低阻抗到峰值压力的时间（TNadImp-PeakP）和远端咽中阻抗下降的间隔（流动间隔）。结果：在54次液体、首次吞咽和40次清除吞咽中，35例（13例患者）观察到误吸。与对照组相比，患者吞咽的特征在于较低的PeakP、较高的PNadImp、较长的流动间隔和较短的TNadImp-PeakP。吞咽风险指数（SRI），旨在识别与误吸相关的功能障碍，是从变量的迭代评估开发的。平均第一次吞咽SRI与平均误吸评分相关（斯皮尔曼等级相关，r = 0.846，P <0.00001）。当用作临界值时，平均SRI为15，预测了该队列X线透视期间的抽吸（kappa = 1.0）。结论：压力-流量变量来自对组合测压/阻抗测量的自动分析，提供了有价值的诊断信息。当结合到SRI中时，这些测量值是抽吸的稳健预测器。
BACKGROUND & AIMS: Pharyngeal manometry and impedance provide information on swallow function. We developed a new analysis approach for assessment of aspiration risk. METHODS: We studied 20 patients (30-95 years old) with suspected aspiration who were referred for videofluoroscopy, along with controls (ages 24-47 years). The pharyngeal phase of liquid bolus swallowing was recorded with manometry and impedance. Data from the first swallow of a bolus and subsequent clearing swallows were analyzed. We scored fluoroscopic evidence of aspiration and investigated a range of computationally derived functional variables. Of these, 4 stood out as having high diagnostic value: peak pressure (PeakP), pressure at nadir impedance (PNadImp), time from nadir impedance to peak pressure (TNadImp-PeakP), and the interval of impedance drop in the distal pharynx (flow interval). RESULTS: During 54 liquid, first swallows and 40 clearing swallows, aspiration was observed in 35 (13 patients). Compared to those of controls, patient swallows were characterized by a lower PeakP, higher PNadImp, longer flow interval, and shorter TNadImp-PeakP. A Swallow Risk Index (SRI), designed to identify dysfunctions associated with aspiration, was developed from iterative evaluations of variables. The average first swallow SRI correlated with the average aspiration score (r = 0.846, P < .00001 for Spearman Rank Correlation). An average SRI of 15, when used as a cutoff, predicted aspiration during fluoroscopy for this cohort (kappa = 1.0). CONCLUSIONS: Pressure-flow variables derived from automated analysis of combined manometric/impedance measurements provide valuable diagnostic information. When combined into an SRI, these measurements are a robust predictor of aspiration.