McGrattan Katlyn Elizabeth, McGhee Heather, DeToma Allan, Hill Elizabeth G, Zyblewski Sinai C, Lefton-Greif Maureen, Halstead Lucinda, Bradley Scott M, Martin-Harris Bonnie
Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina.
Congenit Heart Dis. 2017 May;12(3):382-388. doi: 10.1111/chd.12456. Epub 2017 Feb 28.
Deficits in swallowing physiology are a leading morbidity for infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliation. Despite the high prevalence of this condition, the underlying deficits that cause this post-operative impairment remain poorly understood.
Identify the physiologic correlates of dysphagia in infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliative surgery.
Postoperative fiberoptic laryngoscopies and videofluoroscopic swallow studies (VFSS) were conducted sequentially on infants with functional single ventricles following stage 1 palliative surgery. Infants were dichotomized as having normal or impaired laryngeal function based on laryngoscopy findings. VFSS were evaluated frame-by-frame using a scale that quantifies performance within 11 components of swallowing physiology. Physiologic attributes within each component were categorized as high functioning or low functioning based on their ability to support milk ingestion without bolus airway entry.
Thirty-six infants (25 male) were included in the investigation. Twenty-four underwent the Norwood procedure and twelve underwent the Hybrid procedure. Low function physiologic patterns were observed within multiple swallowing components during the ingestion of thin barium as characterized by ≥4 sucks per swallow (36%), initiation of pharyngeal swallow below the level of the valleculae (83%), and incomplete late laryngeal vestibular closure (56%) at the height of the swallow. Swallowing deficits contributed to aspiration in 50% of infants. Although nectar thick liquids reduced the rate of aspiration (P = .006), aspiration rates remained high (27%). No differences in rates of penetration or aspiration were observed between infants with normal and impaired laryngeal function.
Deficits in swallowing physiology contribute to penetration and aspiration following stage 1 palliation among infants with normal and impaired laryngeal function. Although thickened liquids may improve airway protection for select infants, they may inhibit their ability to extract the bolus and meet nutritional needs.
吞咽生理功能缺陷是功能性单心室和一期姑息治疗后存在体循环流出道梗阻的婴儿的主要发病原因。尽管这种情况很常见，但导致术后功能障碍的潜在缺陷仍知之甚少。
确定功能性单心室和一期姑息性手术后存在体循环流出道梗阻的婴儿吞咽困难的生理相关因素。
对功能性单心室婴儿在一期姑息性手术后依次进行术后纤维喉镜检查和视频荧光吞咽造影检查（VFSS）。根据喉镜检查结果，将婴儿分为喉功能正常或受损两类。使用一个量表对VFSS进行逐帧评估，该量表可量化吞咽生理11个组成部分的表现。根据各组成部分在支持摄入乳汁而不使食团进入气道方面的能力，将其生理属性分为功能良好或功能低下。
36名婴儿（25名男性）纳入研究。24名接受了诺伍德手术，12名接受了杂交手术。在摄入稀钡剂期间，多个吞咽组成部分观察到功能低下的生理模式，其特征为每次吞咽≥4次吸吮（36%）、咽吞咽起始于会厌谷水平以下（83%）以及吞咽高峰时喉前庭晚期闭合不完全（56%）。50%的婴儿因吞咽缺陷导致误吸。尽管饮用蜂蜜样黏稠液体可降低误吸率（P = .006），但误吸率仍很高（27%）。喉功能正常和受损的婴儿在渗透或误吸发生率上未观察到差异。
吞咽生理功能缺陷导致一期姑息治疗后喉功能正常和受损的婴儿出现食物渗透和误吸。尽管黏稠液体可能改善部分婴儿的气道保护，但可能会抑制他们摄取食团和满足营养需求的能力。
