The Relationship Between Residue and Aspiration on the Subsequent Swallow: An Application of the Normalized Residue Ratio Scale
The Relationship Between Residue and Aspiration on the Subsequent Swallow: An Application of the Normalized Residue Ratio Scale
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DOI：
10.1007/s00455-013-9459-8
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发表时间：
2013-12-01
期刊：
影响因子：
2.6
通讯作者：
Steele, Catriona M.
中科院分区：
文献类型：
--
作者：
Molfenter, Sonja M.;Steele, Catriona M.
吞咽后残留物被广泛认为是吞咽障碍的征兆，并被认为会对后续吞咽造成误吸风险。我们进行了一项初步的回顾性研究，以调查吞咽后残留物与随后立即发生的清除吞咽（即不引入新的推注）时的渗透抽吸之间的联系。选择神经源性吞咽困难患者 156 次单次吞咽稀液体的视频荧光镜夹进行研究，因为它们显示每次吞咽多次。使用谷值 (NRRSv) 和梨状窦标准化残留比率量表对每个子吞咽 (n = 407) 的残留进行分析。研究了一次吞咽结束时残留物的存在与下一次吞咽时的穿透吸入之间的关联。一个或两个咽腔中的吞咽后残留物与随后清除吞咽相同丸剂时吞咽安全性受损显着相关。然而，当按残留位置单独分析时，只有谷残留与下一次清除吞咽时吞咽安全受损显着相关。按吞咽安全性划分的 NRRSv 评分分布表明 NRRSv 临界点为 0.09，高于该临界点时，穿透误吸的相对风险增加 2.07 倍。使用 NRRS 测量的吞咽后谷残留物与随后清除吞咽时的穿透吸入显着相关。 NRRSv 量表上具有临床意义的 0.09 分界点界定了这种风险。需要对不同推注浓度进行进一步研究。
Postswallow residue is widely considered to be a sign of swallowing impairment and is assumed to pose risk for aspiration on subsequent swallows. We undertook a preliminary retrospective study to investigate the link between postswallow residue and penetration-aspiration on the immediately occurring subsequent clearing swallow (i.e., without introduction of a new bolus). Videofluoroscopy clips for 156 thin-liquid single bolus swallows by patients with neurogenic dysphagia were selected for study because they displayed multiple swallows per bolus. Residue for each subswallow (n = 407) was analyzed using the Normalized Residue Ratio Scale for the valleculae (NRRSv) and piriform sinuses. The association between residue presence at the end of a swallow and penetration-aspiration on the next swallow was examined. Postswallow residue in one or both pharyngeal spaces was significantly associated with impaired swallowing safety on the subsequent clearing swallow for the same bolus. However, when analyzed separately by residue location, only vallecular residue was significantly associated with impaired swallowing safety on the next clearing swallow. The distribution of NRRSv scores by swallowing safety demonstrated an NRRSv cut-point of 0.09, above which there was a 2.07 times greater relative risk of penetration-aspiration. Postswallow vallecular residue, measured using the NRRS, is significantly associated with penetration-aspiration on subsequent clearing swallows. A clinically meaningful cut-point of 0.09 on the NRRSv scale demarcates this risk. Further research with different bolus consistencies is needed.