Seo Han Gil, Kim Jeong-Gil, Nam Hyung Seok, Lee Woo Hyung, Han Tai Ryoon, Oh Byung-Mo
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
Dysphagia. 2017 Jun;32(3):393-400. doi: 10.1007/s00455-016-9767-x. Epub 2016 Dec 24.
The purpose of this study was to compare the swallowing function and kinematics in stroke patients with and without tracheostomies. In this retrospective matched case-control study, we compared stroke patients with (TRACH group, n = 24) and without (NO-TRACH group, n = 24) tracheostomies. Patients were matched for age, sex, and stroke-type. Swallowing function was evaluated using the videofluoroscopic dysphagia scale (VDS) and functional oral intake scale (FOIS) obtained from videofluoroscopic swallow study (VFSS) images. Swallowing kinematics were evaluated using a two-dimensional kinematic analysis of the VFSS images. Mean duration of tracheostomy was 132.38 ± 150.46 days in the TRACH group. There was no significant difference in the total VDS score between the TRACH (35.17 ± 15.30) and NO-TRACH groups (29.25 ± 16.66, p = 0.247). FOIS was significantly lower in the TRACH group (2.33 ± 1.40) than in the NO-TRACH group (4.33 ± 1.79, p = 0.001). The TRACH group had a significantly lower maximum vertical displacement (15.23 ± 7.39 mm, p = 0.011) and velocity (54.99 ± 29.59 mm/s, p = 0.011), and two-dimensional velocity (61.07 ± 24.89 mm/s, p = 0.013) of the larynx than the NO-TRACH group (20.18 ± 5.70 mm, 82.23 ± 37.30 mm/s, and 84.40 ± 36.05 mm/s, respectively). Maximum horizontal velocity of the hyoid bone in the TRACH group (36.77 ± 16.97 mm/s) was also significantly lower than that in the NO-TRACH group (47.49 ± 15.73 mm/s, p = 0.032). This study demonstrated that stroke patients with tracheostomies had inferior swallowing function and kinematics than those without tracheostomies. A prospective longitudinal study is needed to elucidate the effect of a tracheostomy on swallowing recovery in stroke patients.
本研究的目的是比较有和没有气管造口术的中风患者的吞咽功能和运动学。在这项回顾性配对病例对照研究中，我们比较了有气管造口术的中风患者（气管造口组，n = 24）和没有气管造口术的中风患者（非气管造口组，n = 24）。患者在年龄、性别和中风类型方面进行了匹配。吞咽功能通过电视透视吞咽障碍量表（VDS）和从电视透视吞咽研究（VFSS）图像中获得的功能性经口摄食量表（FOIS）进行评估。吞咽运动学通过对VFSS图像进行二维运动学分析来评估。气管造口组气管造口的平均持续时间为132.38±150.46天。气管造口组（35.17±15.30）和非气管造口组（29.25±16.66，p = 0.247）的VDS总分无显著差异。气管造口组的FOIS（2.33±1.40）显著低于非气管造口组（4.33±1.79，p = 0.001）。气管造口组的喉部最大垂直位移（15.23±7.39 mm，p = 0.011）、速度（54.99±29.59 mm/s，p = 0.011）和二维速度（61.07±24.89 mm/s，p = 0.013）均显著低于非气管造口组（分别为20.18±5.70 mm、82.23±37.
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