Traumatic cervical spinal cord injury: a prospective clinical study of laryngeal penetration and aspiration
Traumatic cervical spinal cord injury: a prospective clinical study of laryngeal penetration and aspiration
复制标题
创伤性颈脊髓损伤：喉部穿透和误吸的前瞻性临床研究
作者：
T. Ihalainen;Irina Rinta;T. Luoto;E. Koskinen;Anna‐Maija Korpijaakko‐Huuhka;Antti Ronkainen
研究设计：前瞻性队列研究。目的：吞咽困难是创伤性颈脊髓损伤（TCSCI）患者相对常见的继发并发症。本研究的目的是确定急性 TCSCI 患者误吸和刺穿的发生率。地点：芬兰坦佩雷坦佩雷大学医院。方法：对 46 名 TCSCI 患者进行电视荧光吞咽研究 (VFSS) 进行评估。罗森贝克的穿透-吸入量表（PAS）用于对穿透或吸入程度进行分类。对每位患者的病历进行系统回顾。结果：46例患者中，85%为男性。受伤时的平均年龄为 62.1 岁。大多数患者有不完全损伤（78%），其中大多数是由于跌倒造成的（78%）。在 VFSS 中，19 名 (41%) 患者发生刺穿，15 名 (33%) 患者发生误吸。只有 12 名 (26%) 患者的 PAS 评分为 1，表明吞咽的物质没有进入气道。在误吸的患者中，73%有无声误吸。结论：根据VFSS，在这组TCSCI患者中，穿透或误吸的发生率较高。因此，急性TCSCI患者在开始经口喂养前应常规评估吞咽功能。强烈建议使用 VFSS，特别是为了排除无声吸入的可能性并获得有关安全营养一致性的信息。
Study design:Prospective cohort study.Objectives:Dysphagia is a relatively common secondary complication in patients with traumatic cervical spinal cord injuries (TCSCI). The purpose of this study was to determine the incidence of aspiration and penetration in patients with acute TCSCI.Setting:Tampere University Hospital, Tampere, Finland.Methods:A total of 46 patients with TCSCI were evaluated with a videofluoroscopic swallowing study (VFSS). Rosenbek’s penetration-aspiration scale (PAS) was used to classify the degree of penetration or aspiration. The medical records of each patient were systematically reviewed.Results:Of the 46 patients, 85% were male. The mean age at the time of the injury was 62.1 years. Most patients had an incomplete injury (78%), and most of them due to a fall (78%). In the VFSS 19 (41%) patients penetrated and 15 (33%) aspirated. Only 12 (26%) of the patients had a PAS score of 1 indicating that swallowed material did not enter the airway. Of the patients who aspirated, 73% had silent aspiration.Conclusion:The incidence of penetration or aspiration according to VFSS is high in this cohort of patients with TCSCI. Therefore, the swallowing function of patients with acute TCSCI should be routinely evaluated before initiating oral feeding. VFSS is highly recommended, particularly to rule out the possibility of silent aspiration and to achieve information on safe nutrition consistency.