Temporal Characteristics of Penetration and Aspiration in Patients with Severe Dysphagia Associated with Lateral Medullary Syndrome
Temporal Characteristics of Penetration and Aspiration in Patients with Severe Dysphagia Associated with Lateral Medullary Syndrome
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DOI：
10.1007/s00455-023-10607-9
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发表时间：
2023-08-16
期刊：
影响因子：
2.6
通讯作者：
Dou，Zu-Lin
中科院分区：
文献类型：
--
作者：
Dai，Meng;Qiao，Jiao;Dou，Zu-Lin
评估延髓外侧综合征（LMS）后严重吞咽困难的穿透和吸入（PA）的严重程度和时间及其与时间特征的相关性。我们对48名LMS和严重吞咽困难患者以及26名性别和年龄匹配的健康受试者进行了视频透视吞咽研究（VFSS）。比较了两组之间的以下时间测量：咽喉闭合持续时间（VCD）;舌骨运动持续时间（HMD）;喉前庭闭合持续时间（LCD）;上食管括约肌（UES）开放持续时间（UOD）;阶段转换持续时间（STD）和喉前庭闭合与UES开放之间的间隔（LC-UESop）。分析时间测量值与渗透-抽吸量表（PAS）评分之间的相关性。比较了亚组之间的时间测量差异（安全吞咽和吞咽期间和吞咽后发生PA事件的吞咽）。LMS患者48%的吞咽（4%发生在吞咽前，35%发生在吞咽期间，61%发生在吞咽后）中观察到PAS评分≥ 3。与健康受试者相比，患者的STD和LC-UESop显着延长（p< 0.05）。HMD、LCD和UOD与PA严重程度呈显著负相关。短UOD是最强的预测因子，受试者工作特征曲线下面积为0.66。吞咽后PA病例的UOD也明显缩短（p< 0.01）。涉及严重吞咽困难的LMS患者表现出PA的高频率（主要在吞咽期间和之后）。PA事件与较短的UOD、HMD和LCD相关。值得注意的是，缩短的UOD似乎与PA密切相关。
To assess the severity and timing of penetration and aspiration (PA) of severe dysphagia after lateral medullary syndrome (LMS) and its association with temporal characteristics. We performed videofluoroscopic swallowing studies (VFSS) in 48 patients with LMS and severe dysphagia and 26 sex- and age-matched healthy subjects. The following temporal measures were compared between groups: velopharyngeal closure duration (VCD); hyoid bone movement duration (HMD); laryngeal vestibular closure duration (LCD); upper esophageal sphincter (UES) opening duration (UOD); stage transition duration (STD) and the interval between laryngeal vestibular closure and UES opening (LC-UESop). The association between temporal measures and Penetration–Aspiration Scale (PAS) scores was analyzed. Differences in timing measures were compared between subgroups (safe swallows, and swallows with PA events during and after the swallow). PAS scores ≥ 3 were seen in 48% of swallows (4% occuring before, 35% occurred during and 61% after the swallow) from the LMS patients. Significantly longer STD and LC-UESop were found in the patients compared to the healthy subjects (p< 0.05). Significant negative correlations with PA severity were found for HMD, LCD, and UOD. Short UOD was the strongest predictor with an area under the receiver-operating-characteristic curve of 0.66. UOD was also significantly shorter in cases of PA after the swallow (p< 0.01). Patients with LMS involving severe dysphagia exhibit a high frequency of PA (mostly during and after swallowing). PA events were associated with shorter UOD, HMD, and LCD. Notably, shortened UOD appears to be strongly associated with PA.