High-resolution impedance manometry facilitates assessment of pharyngeal residue and oropharyngeal dysphagic mechanisms
High-resolution impedance manometry facilitates assessment of pharyngeal residue and oropharyngeal dysphagic mechanisms
复制标题
DOI：
10.1111/dote.12101
复制
发表时间：
2014-04-01
影响因子：
2.6
通讯作者：
Kim, J-O
中科院分区：
文献类型：
--
作者：
Lee, T. H.;Lee, J. S.;Kim, J-O
高分辨率阻抗测压（HRIM）用于评估口咽吞咽困难（OPD）的实用性已被研究。这些方法由于方法复杂而受到限制。需要一种将HRIM转化为用于评估OPD的简单而有用的诊断工具的方法。由独立的盲法检查者在26名连续的健康志愿者（12名男性;中位年龄，56.5岁）和10名OPD患者（5名男性;中位年龄，59.5岁）中进行视频荧光透视吞咽研究（VFSS）和HRIM。使用标准HRIM方案测量上食管括约肌（UES）松弛参数。使用HRIM改良方案评估咽食管（PE）段的蠕动和推注传输，其中将导管拉回10 cm。采用阻抗轮廓模式（线性vs.停滞）方法评价PE推注传输。仅在咽部收缩持续时间方面，观察到健康志愿者和OPD患者的测压测量值之间存在显著差异（0.49 ± 0.19 vs. 0.76 ± 0.33s，P=0.04）。VFSS和阻抗分析检测咽部残留物的百分比一致性和Kappa值分别为100%和1.00。HRIM允许对2例患者中导致VFSS上咽部残留物的异常咽部成分进行全面评估; 1例患者中舌根减少与咽部收缩减弱，另1例患者中UES松弛减少与喉部抬高减少。我们的研究结果表明，HRIM使用简单的方法（即，导管的拉回）通过阻抗轮廓模式（线性对停滞）的简单分析检测咽部残留物。此外，HRIM有助于全面评估OPD机制，并识别VFSS上肉眼尚不可见的细微异常。
The utility of high-resolution impedance manometry (HRIM) for evaluating oropharyngeal dysphagia (OPD) has been investigated. These approaches are limited because of the sophisticated methodology. A method of transforming HRIM into a simple and useful diagnostic tool for evaluating OPD is needed. A videofluoroscopic swallowing study (VFSS) and HRIM were performed by independent blinded examiners in 26 consecutive healthy volunteers (12 men; median age, 56.5 years) and 10 OPD patients (five men; median age, 59.5 years). Upper esophageal sphincter (UES) relaxation parameters were measured using a standard HRIM protocol. Peristalsis and bolus transit of the pharyngoesophageal (PE) segment were assessed using an HRIM-modified protocol in which the catheter was pulled back 10cm. PE bolus transits were evaluated with an impedance contour pattern (linear vs. stasis) method. A significant difference was observed between the manometric measures of healthy volunteers and OPD patients for only the duration of pharyngeal contraction (0.490.19 vs. 0.76 +/- 0.33s, P=0.04). The percentage agreement and kappa value for detecting pharyngeal residue between the VFSS and the impedance analysis were 100% and 1.00, respectively. HRIM allowed for comprehensive assessment of abnormal pharyngeal components that caused pharyngeal residue on VFSS in two patients; reduced base of the tongue versus weak pharyngeal contraction in one, and reduced relaxation of the UES versus reduced laryngeal elevation in the remaining patient. Our findings demonstrated that HRIM using a simple methodology (i.e., pull-back of the catheter) detected pharyngeal residue through a simple analysis of the impedance contour pattern (linear vs. stasis). Furthermore, HRIM facilitated a comprehensive assessment of OPD mechanisms and recognition of subtle abnormalities not yet visible to the naked eye on VFSS.