Videofluoroscopic assessment of pharyngeal stage delay reflects pathophysiology after brain infarction
Videofluoroscopic assessment of pharyngeal stage delay reflects pathophysiology after brain infarction
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DOI：
10.1002/lary.23588
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发表时间：
2012-12-01
期刊：
影响因子：
2.6
通讯作者：
Komune, Shizuo
中科院分区：
文献类型：
--
作者：
Miyaji, Hideaki;Umezaki, Toshiro;Komune, Shizuo
目的/假设：脑梗死引起的吞咽困难的病理生理学随脑内病变部位的不同而不同。球上病变的患者表现出延迟触发咽期，包括延迟喉抬高。严重咽部分期延迟的患者下呼吸道顽固性误吸的风险很高。尽管如此，很少有研究比较了病变部位与咽部分期延迟。我们定义了一个新的时间参数的咽阶段延迟评估喉提升延迟对团流入咽空间。本研究旨在阐明咽部分期延迟这一参数在临床上是否可用于评估脑梗死后脑病变的病理生理学。研究设计：病例对照研究。方法：2000年1月7日至2011年3月29日在九州大学医院进行吞咽检查的视频荧光镜评估。我们通过对吞咽功能正常的患者和脑梗死患者（分为病理生理性病变组）进行视频透视吞咽检查，使用运动分析评估咽部分期延迟。分析喉抬高延迟时间和咽部延迟时间。结果：喉上举延迟时间在各病理生理病变组之间存在显著差异。然而，各组间的咽部延迟时间保持相似。皮质延髓束和基底节区脑梗死与喉抬高延迟时间延长显著相关。结论：低粘度造影剂的喉抬高延迟时间是区分皮质延髓束和基底节病变的推荐参数。喉镜，2012
Objectives/Hypothesis: The pathophysiology of dysphagia caused by brain infarction varies with the site of the lesion in the brain. Patients with suprabulbar lesions have demonstrated delayed triggering of pharyngeal stage including delayed laryngeal elevation. Patients with severe pharyngeal stage delay have a high risk of intractable aspiration to the lower respiratory tract. Despite this, few studies have compared the pharyngeal stage delay with the lesion site. We defined a new temporal parameter of the pharyngeal stage delay to assess laryngeal elevation delay against the bolus inflow into the pharyngeal space. This study aimed to elucidate whether this parameter of pharyngeal stage delay is clinically useful to assess the pathophysiology of brain lesions after brain infarction. Study Design: Case-control study. Methods: Videofluoroscopic assessment of swallowing examinations was performed from January 7, 2000 to March 29, 2011 at Kyushu University Hospital. We evaluated the pharyngeal stage delay using motion analysis on videofluoroscopic swallowing examination in patients with normal swallowing and brain infarction patients divided into pathophysiologic lesion groups. Laryngeal elevation delay time and pharyngeal delay time were analyzed. Results: Significant differences in laryngeal elevation delay time were observed between each pathophysiologic lesion group. However, pharyngeal delay time remained similar among groups. Brain infarctions of corticobulbar tract and basal ganglion were significantly associated with laryngeal elevation delay time prolongation. Conclusions: Laryngeal elevation delay time with low-viscosity contrast medium is a recommended parameter to discriminate the corticobulbar tract and the basal ganglion lesion. Laryngoscope, 2012