Paced glottic closure for controlling aspiration pneumonia in patients with neurologic deficits of various causes.
Paced glottic closure for controlling aspiration pneumonia in patients with neurologic deficits of various causes.
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DOI：
10.1177/000348941011900301
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发表时间：
2010-03
期刊：
影响因子：
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通讯作者：
Tyler DJ
中科院分区：
文献类型：
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作者：
Broniatowski M;Moore NZ;Grundfest-Broniatowski S;Tucker HM;Lancaster E;Krival K;Hadley AJ;Tyler DJ
确定起搏声带内收术是否可以阻止各种神经系统疾病患者的误吸。入组了5例经荧光镜检查证实有吸入和反复肺炎的患者。将2例既往报告的半球卒中患者 * 与另外3例脑干-基底节和小脑卒中（BSBGC）、脑瘫（CP）和多发性硬化（MS）患者进行比较。将改良的Finetech-Brindey刺激器皮下植入，并通过神经周围电极连接到同侧喉返神经。声带内收和声门闭合受脉冲串（42 Hz，1.2 mA，188-560 μsec）的影响，并用Enhanced Image J ®记录。由两名独立的设盲审查员评估有刺激和无刺激的荧光透视结果。在6-12个月入组期间，比较了入组前、入组后和入组期间的肺炎发生率。所有患者的声带内收均具有统计学显著性（p <0.05），并进一步通过团块停止进行验证（根据语言病理学家的不同，对于稀、稠液体和果泥，p <0.05）。在入组期间，5例患者中有4例预防了肺炎。第5例BSBGC患者无法完全封闭声门并打开足够的cryopharyngeus来处理他的分泌物。声带起搏对各种神经损伤引起的吸入性肺炎似乎是合适的，只要声门可以封闭。当颅咽肌必须独立打开时，这是不够的。
To determine whether paced vocal fold adduction can check aspiration in patients with various neurological conditions. Five patients with fluoroscopically documented aspiration and repeated pneumonias were enrolled. Two previously reported patients with hemispheric stroke* were compared to three additional subjects with brainstem-basal ganglia and cerebellar stroke (BSBGC), cerebral palsy (CP) and multiple sclerosis (MS). A modified Finetech-Brindey stimulator was implanted subcutaneously and linked to the ipsilateral recurrent laryngeal nerve via perineural electrodes. Vocal fold adduction and glottic closure were effected with pulse trains (42 Hz, 1.2 mA, 188–560 μsec) and recorded with Enhanced Image J ®. Fluoroscopy results with and without stimulation were assessed by two independent blinded reviewers. Pneumonia rates were compared before, after and during the 6–12 months enrollment periods. There was statistically significant vocal fold adduction (p < .05) for all patients, further verified with bolus arrest (p < .05 for thin, thick liquids and puree depending on the speech-language pathologist). Pneumonia was prevented in four of the five patients during enrollment. The fifth patient with BSBGC was unable to completely seal the glottis and open the cricopharyngeus enough to handle his secretions. Vocal fold pacing for aspiration pneumonia from a variety of neurological insults appears appropriate as long as the glottis can be sealed. It is not sufficient when the cricopharyngeus must be independently opened.