The Risk of Penetration or Aspiration during Videofluoroscopic Examination of Swallowing Varies Depending on Food Types
The Risk of Penetration or Aspiration during Videofluoroscopic Examination of Swallowing Varies Depending on Food Types
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DOI：
10.1620/tjem.220.41
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发表时间：
2010-01-01
影响因子：
2.2
通讯作者：
Uematsu, Hiroshi
中科院分区：
文献类型：
--
作者：
Ozaki, Kenichiro;Kagaya, Hitoshi;Uematsu, Hiroshi
吞咽（VF）的视频荧光镜检查是诊断和治疗吞咽困难的金标准。在VF期间，患者摄取不透射线的食物和液体，并且观察和评估吞咽生理学的口腔、咽和食管阶段。抽吸被定义为物质通过声带，喉穿透被定义为物质进入喉，但不通过声带。在这项研究中，我们比较了VF期间使用不同液体体积和食物摄入量时喉穿透或吸入的风险。在2006年1月至2008年9月期间，229例疑似吞咽困难的患者在VF期间以直立姿势进食6种液体或食物中的至少2种，而无需进行补偿操作。这6种类型分别是4 ml布丁状稠钡（PD）、4 ml（LQ4）和10 ml（LQ10）稀钡液、一口一杯的稀钡液（CUP）、8 g咸牛肉块加钡（CB）、4 g咸牛肉块加钡和5 ml稀钡液的两相混合物（MX）。配对比较显示，喉穿透风险按以下顺序增加：PD，CB，LQ4，LQ10，MX和CUP，而PD后误吸风险按以下顺序增加：CB，LQ4，LQ10，CUP和MX。因此，喉穿透或吸入的风险因食物类型而异。总之，两相食物的误吸风险最高，吞咽困难患者应谨慎使用多质地食物。
Videofluoroscopic examination of swallowing (VF) is the gold standard in diagnosis and management of dysphagia. During VF, the patient ingests radiopaque foods and liquids, and oral, pharyngeal, and esophageal stages of swallowing physiology are observed and evaluated. Aspiration is defined as passage of materials through the vocal folds, and laryngeal penetration is defined as passage of materials into the larynx, but not through the vocal folds. In this study, we compared the risk of laryngeal penetration or aspiration during VF using various liquid volumes and food consistencies. Between January 2006 and September 2008, 229 patients with suspected dysphagia each were fed at least 2 out of 6 types of liquids or foods during VF in an upright posture without compensatory maneuvers. The 6 types were pudding-thick barium of 4 ml (PD), thin liquid barium of 4 ml (LQ4) and 10 ml (LQ10), one swallow of thin liquid barium from a cup (CUP), corned beef hash (8 g) with barium (CB), and a two-phase mixture of corned beef hash (4 g) with barium and thin liquid barium of 5 ml (MX). The paired comparisons revealed that laryngeal penetration risk increased in the following order: PD, CB, LQ4, LQ10, MX and CUP, while aspiration risk after PD increased in the following order: CB, LQ4, LQ10, CUP and MX. Thus, risk of laryngeal penetration or aspiration varies, depending on food types. In conclusion, risk of aspiration is highest with the two-phase food, and multi-textured foods should be used with caution in individuals with dysphagia.