Tutor James D, Srinivasan Saumini, Gosa Memorie M, Spentzas Thomas, Stokes Dennis C
Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, Le Bonheur Children's Hospital and St. Jude Children's Research Hospital, Memphis, TN, United States of America.
Rehabilitation Services-Department of Speech-Language Pathology, Le Bonheur Children's Hospital, Memphis, TN, United States of America; Department of Communicative Disorders, The University of Alabama, Tuscaloosa, AL, United States of America.
PLoS One. 2015 May 15;10(5):e0123125. doi: 10.1371/journal.pone.0123125. eCollection 2015.
Swallowing dysfunction can lead to recurring aspiration and is frequently associated with chronic symptoms such as cough and wheezing in infants. Our objective was to describe the characteristics of infants with swallowing dysfunction, determine if pulmonary function abnormalities are detectable, and if they improve after therapy.
We studied 38 infants with a history of coughing and wheezing who had pulmonary function tests performed within two weeks of their diagnosis of swallowing dysfunction. The raised lung volume rapid thoracoabdominal compression technique was used. After 6 months of therapy, 17 of the infants repeated the tests.
Initially, 25 had abnormal spirometry, 18 had abnormal plethysmography, and 15 demonstrated bronchodilator responsiveness. Six months later test were repeated for seventeen patients. Ten patients had continued abnormal spirometry, two patients remained normal, three patients' abnormal spirometry had normalized, and two patients' previously normal studies became abnormal. Eight of the 17 patients had continued abnormal plethysmography, six had continued normal plethysmography, and three patients' normal plethysmography became abnormal. After 6 months of treatment, eight patients demonstrated bronchodilator responsiveness, of which five continued to demonstrate bronchodilator responsiveness and three developed responsiveness. The remainder either continued to be non- bronchodilator responsive (two) or lost responsiveness (three.) The findings of the abnormal tests in most infants tested is complicated by frequent occurrence of other co-morbidities in this population, including gastroesophageal reflux in 23 and passive smoke exposure in 13 of the infants.
The interpretation of lung function changes is complicated by the frequent association of swallowing dysfunction with gastroesophageal reflux and passive smoke exposure in this population. Six months of medical therapy for swallowing dysfunction/gastroesophageal reflux did not significantly improve pulmonary function in these infants. Long-term studies will be necessary to determine which of these changes persists into adulthood.
吞咽功能障碍可导致反复误吸，且常与婴儿的慢性症状如咳嗽和喘息相关。我们的目的是描述吞咽功能障碍婴儿的特征，确定是否可检测到肺功能异常，以及治疗后这些异常是否改善。
我们研究了38例有咳嗽和喘息病史的婴儿，这些婴儿在诊断吞咽功能障碍后两周内进行了肺功能测试。采用肺容积升高快速胸腹按压技术。治疗6个月后，17例婴儿重复进行测试。
最初，25例婴儿肺活量测定异常，18例体积描记法异常，15例显示支气管扩张剂反应性。6个月后，对17例患者重复进行测试。10例患者肺活量测定仍异常，2例正常，3例异常的肺活量测定恢复正常，2例之前正常的检查变为异常。17例患者中有8例体积描记法仍异常，6例持续正常，3例正常的体积描记法变为异常。治疗6个月后，8例患者显示支气管扩张剂反应性，其中5例继续显示支气管扩张剂反应性，3例出现反应性。其余患者要么继续无支气管扩张剂反应（2例），要么失去反应性（3例）。在该人群中，大多数接受测试的婴儿出现异常检查结果的情况因其他合并症的频繁发生而变得复杂，包括23例婴儿有胃食管反流，13例有被动吸烟暴露。
在该人群中，吞咽功能障碍常与胃食管反流和被动吸烟暴露相关，这使得对肺功能变化的解释变得复杂。针对吞咽功能障碍/胃食管反流进行6个月的药物治疗并未显著改善这些婴儿的肺功能。需要进行长期研究以确定这些变化中哪些会持续到成年期。
