Bülow M, Olsson R, Ekberg O
Department of Diagnostic Radiology, Malmö University Hospital, Lund University, Malmö, Sweden.
Acta Radiol. 2005 Apr;46(2):126-31. doi: 10.1080/02841850510015965.
To study survival in two groups of dysphagic patients--one group unable to elicit the pharyngeal stage of swallow (APS) and another group with pharyngeal swallow (WPS)--and to compare recommendations regarding nutrition and therapeutic strategies based on the therapeutic swallowing study.
In this retrospective study, the records of dysphagic patients who have undergone a therapeutic videoradiographic swallowing study (TVSS) were reviewed. Forty patients without pharyngeal swallow were matched for age and gender with 40 patients with pharyngeal swallow; altogether 80 patients were included in the study. Survival was registered at 3, 12, and 72 months after the TVSS.
In this study, the APS group had a significantly shorter survival time (P=0.0030) compared to the WPS group when followed-up at 12 months. In the APS group, most patients (37.5% (15/40)) died within the 3 months after TVSS. At 72 months, 62.5% (25/ 40) of the patients in the APS group had died. In the WPS group, 5% (2/40) had died within 3 months and 47.4% (19/40) after 12 months. At 72 months, 52.5% (21/40) of the patients in the WPS group had died. Regarding nutritional and therapeutic recommendations based on TVSS, 34/40 in the APS group were recommended no oral intake. Eighteen naso-gastric tubes were placed directly after TVSS. The therapeutic strategies recommended were head-positioning, thermal tactile stimulation, and tongue exercises (in 8 patients). In the WPS group, all patients were recommended oral intake. Diet modification was recommended in 29 patients. The therapeutic strategies recommended were head-positioning, thermal tactile stimulation, tongue exercises, supraglottic swallow, and effortful swallow (in 24 patients).
Patients unable to elicit the pharyngeal stage of swallow had a shorter survival time than patients with pharyngeal swallow, probably due to a more severe underlying disease. Tube feeding was more frequent in the APS group. Fewer therapeutic strategies were recommended compared to the WPS group. In the WPS group, diet modification was frequent. Several patients had different therapeutic strategies. At the end of the study, 8/40 patients (20%) in the APS group had recovered and regained the ability to elicit the pharyngeal stage of swallow. All eight had achieved active swallowing rehabilitation.
研究两组吞咽困难患者的生存率，一组无法引发吞咽的咽部阶段（APS），另一组有咽部吞咽（WPS），并根据治疗性吞咽研究比较关于营养和治疗策略的建议。
在这项回顾性研究中，回顾了接受治疗性视频放射吞咽研究（TVSS）的吞咽困难患者的记录。40例无咽部吞咽的患者与40例有咽部吞咽的患者按年龄和性别匹配；共80例患者纳入研究。在TVSS后3个月、12个月和72个月记录生存率。
在本研究中，在12个月随访时，APS组的生存时间明显短于WPS组（P = 0.0030）。在APS组中，大多数患者（37.5%（15/40））在TVSS后3个月内死亡。在72个月时，APS组62.5%（25/40）的患者死亡。在WPS组中，5%（2/40）在3个月内死亡，12个月后47.4%（19/40）死亡。在72个月时，WPS组52.5%（21/40）的患者死亡。关于基于TVSS的营养和治疗建议，APS组40例中有34例被建议禁止经口摄入。TVSS后直接放置了18根鼻胃管。推荐的治疗策略为头部定位、温热触觉刺激和舌部运动（8例患者）。在WPS组中，所有患者均被建议经口摄入。29例患者被建议调整饮食。推荐的治疗策略为头部定位、温热触觉刺激、舌部运动、声门上吞咽和用力吞咽（24例患者）。
无法引发吞咽咽部阶段的患者比有咽部吞咽的患者生存时间短，可能是由于潜在疾病更严重。APS组管饲更频繁。与WPS组相比，推荐的治疗策略更少。在WPS组中，饮食调整很常见。一些患者有不同的治疗策略。在研究结束时，APS组40例患者中有8例（20%）康复并恢复了引发吞咽咽部阶段的能力。所有8例均实现了积极的吞咽康复。
