Silver K H, Van Nostrand D, Kuhlemeier K V, Siebens A A
Division of Rehabilitation Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Arch Phys Med Rehabil. 1991 Oct;72(11):902-10. doi: 10.1016/0003-9993(91)90009-8.
Eleven patients with previously documented aspiration underwent a radioisotopic swallowing study to detect and quantify airway penetration. In those subjects able to complete a rapid-acquisition phase during swallowing, no laryngotracheal penetration was seen despite previous evidence of aspiration. However, sequential static pulmonary imaging showed significant aspiration in three individuals. Attempts were made to measure the percentage of ingested material aspirated and the clearance rate from the airways. Eight patients (73%) failed to show definite evidence of aspiration on scintigrams. It is hypothesized that the lack of scintigraphic detection in previously proven aspirators was due either to interval improvement of the dysphagia or to difficult-to-detect laryngotracheal aspiration. Isotopic imaging during swallowing appears to have little utility; however, after ingestion, the technique can demonstrate more distal penetration not detected on videofluoroscopy. More studies are suggested to better define the sensitivity and specificity of scintigraphy in aspiration detection and to determine whether these techniques have prognostic value that could alter patient management.
11名既往有明确误吸记录的患者接受了放射性同位素吞咽研究，以检测并量化气道穿透情况。在那些能够在吞咽过程中完成快速采集阶段的受试者中，尽管既往有误吸证据，但未观察到喉气管穿透。然而，连续静态肺部显像显示3例患者存在明显误吸。尝试测量误吸摄入物质的百分比以及气道清除率。8例患者（73%）在闪烁扫描图上未显示明确的误吸证据。据推测，既往已证实有误吸的患者未被闪烁扫描检测到，要么是由于吞咽困难的间歇性改善，要么是由于难以检测到的喉气管误吸。吞咽期间的同位素显像似乎作用不大；然而，摄入后，该技术可以显示在视频荧光透视检查中未检测到的更远端的穿透。建议进行更多研究，以更好地确定闪烁扫描在误吸检测中的敏感性和特异性，并确定这些技术是否具有可改变患者管理的预后价值。
