Gastroenterology Unit, Child, Youth & Women's Health Service, North Adelaide, South Australia, Australia.
Am J Gastroenterol. 2011 Oct;106(10):1796-802. doi: 10.1038/ajg.2011.143. Epub 2011 May 10.
This validation study evaluates a new manometry impedance-based approach for the objective assessment of pharyngeal function relevant to postswallow bolus residue.
We studied 23 adult and pediatric dysphagic patients who were all referred for a videofluoroscopy, and compared these patients with 10 adult controls. The pharyngeal phase of swallowing of semisolid boluses was recorded with manometry and impedance. Fluoroscopic evidence of postswallow bolus residue was scored. Pharyngeal pressure impedance profiles were analyzed. Computational algorithms measured peak pressure (Peak P), pressure at nadir impedance (PNadImp), time from nadir impedance to PeakP (PNadImp-PeakP), the duration of impedance drop in the distal pharynx (flow interval), upper esophaghageal sphincter (UES) relaxation interval (UES-RI), nadir UES pressure (NadUESP), UES intrabolus pressure (UES-IBP), and UES resistance. A swallow risk index (SRI) was derived by the formula: SRI=(FI × PNadImp)/(PeakP × (TNadImp-PeakP+1)) × 100.
In all, 76 patient swallows (35 with residue) and 39 control swallows (12 with residue) were analyzed. Different functional variables were found to be altered in relation to residue. In both controls and patients, flow interval was longer in relation to residue. In controls, but not patients, residue was associated with an increased PNadImp (suggestive of increased pharyngeal IBP). Controls with residue had increased UES-IBP, NadUESP, and UES resistance compared with patients with residue. Residue in patients was related to a prolonged UES-RI. The SRI was elevated in relation to residue in both controls and patients and an average SRI of 9 was optimally predictive of residue (sensitivity 75% and specificity 80%).
We present novel findings in control subjects and dysphagic patients showing that combined manometry and impedance recordings can be objectively analyzed to derive pressure-flow variables that are altered in relation to the bolus residual and can be combined to predict ineffective pharyngeal swallowing.
本验证研究评估了一种新的基于测压和阻抗的方法，用于客观评估与吞咽后食团残留相关的咽功能。
我们研究了 23 名成人和儿科吞咽困难患者，他们均被转介行视频透视检查，并将这些患者与 10 名成人对照进行比较。使用测压和阻抗记录半固体食团的咽期吞咽情况。根据透视结果对吞咽后食团残留进行评分。分析咽压-阻抗图谱。计算算法测量峰值压力（Peak P）、阻抗最低点压力（PNadImp）、从阻抗最低点到 PeakP 的时间（PNadImp-PeakP）、远端咽段阻抗下降的持续时间（流量间隔）、食管上括约肌（UES）松弛间隔（UES-RI）、UES 最低点压力（NadUESP）、UES 内压（UES-IBP）和 UES 阻力。通过公式计算吞咽风险指数（SRI）：SRI=（FI×PNadImp）/（PeakP×（TNadImp-PeakP+1））×100。
共分析了 76 例患者吞咽（35 例有残留）和 39 例对照吞咽（12 例有残留）。发现不同的功能变量与残留有关。在对照和患者中，残留与流量间隔延长有关。在对照中，但在患者中，残留与 PNadImp 增加有关（提示咽内压升高）。与患者残留相比，有残留的对照UES-IBP、NadUESP 和 UES 阻力增加。患者残留与 UES-RI 延长有关。在对照和患者中，SRI 与残留相关，平均 SRI 为 9 时，对残留的预测最佳（敏感性 75%，特异性 80%）。
我们在对照和吞咽困难患者中提出了新的发现，表明结合测压和阻抗记录可以对压力-流量变量进行客观分析，这些变量与食团残留有关，并可以结合起来预测无效的咽吞咽。
