Kim Yong Kyun, Lee Sang-Heon, Lee Jang-Won
Department of Physical Medicine and Rehabilitation, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea.
Ann Rehabil Med. 2017 Jun;41(3):426-433. doi: 10.5535/arm.2017.41.3.426. Epub 2017 Jun 29.
To investigate the impact of tracheostomy tube capping on swallowing physiology in stroke patients with dysphagia via videofluoroscopic swallowing study (VFSS).
This study was conducted as a prospective study that involved 30 stroke patients. Then, 4 mL semisolid swallowing was conducted with capping of the tracheostomy tube or without capping of the tracheostomy tube. The following five parameters were measured: laryngeal elevation, pharyngeal transit time, post-swallow pharyngeal remnant, upper esophageal sphincter width (UES), and penetration-aspiration scale (PAS) score.
On assessment of the differences in swallowing parameters during swallowing between 'with capping' and 'without capping' statuses, statistically significant differences were found in the post-swallow pharyngeal remnant (without capping, 48.19%±28.70%; with capping, 25.09%±19.23%; p<0.001), normalized residue ratio scale for the valleculae (without capping, 0.17±0.12; with capping, 0.09±0.12; p=0.013), normalized residue ratio scale for the piriform sinus (without capping, 0.16±0.12; with capping, 0.10±0.07; p=0.015), and UES width (without capping, 3.32±1.61 mm; with capping, 4.61±1.95 mm; p=0.003). However, there were no statistically significant differences in laryngeal elevation (x-axis without capping, 2.48±1.45 mm; with capping, 3.26±2.37 mm; y-axis without capping, 11.11±5.24 mm; with capping, 12.64±6.16 mm), pharyngeal transit time (without capping, 9.19± 10.14 s; with capping, 9.09±10.21 s), and PAS score (without capping, 4.94±2.83; with capping, 4.18±2.24).
Tracheostomy tube capping is a useful way to reduce post-swallow remnants and it can be considered an alternative method for alleviating dysphagia in stroke patients who can tolerate tracheostomy tube capping when post-swallow remnants are observed.
通过电视荧光吞咽造影检查（VFSS），研究气管切开套管封堵对吞咽困难的中风患者吞咽生理的影响。
本研究为前瞻性研究，纳入30例中风患者。然后，在气管切开套管封堵或未封堵的情况下进行4 mL半固体吞咽测试。测量以下五个参数：喉提升、咽传输时间、吞咽后咽部残留、食管上括约肌宽度（UES）和渗透-误吸量表（PAS）评分。
在评估“封堵”和“未封堵”状态下吞咽过程中吞咽参数的差异时，发现吞咽后咽部残留（未封堵，48.19%±28.70%；封堵，25.09%±19.23%；p<0.001）、会厌谷标准化残留率量表（未封堵，0.17±0.12；封堵，0.09±0.12；p=0.013）、梨状窦标准化残留率量表（未封堵，0.16±0.12；封堵，0.10±0.07；p=0.015）和UES宽度（未封堵，3.32±1.61 mm；封堵，4.61±1.95 mm；p=0.003）存在统计学显著差异。然而，喉提升（x轴：未封堵，2.48±1.45 mm；封堵，3.26±2.37 mm；y轴：未封堵，11.11±5.24 mm；封堵，12.64±6.16 mm）、咽传输时间（未封堵，9.19±10.14 s；封堵，9.09±10.21 s）和PAS评分（未封堵，4.94±2.83；封堵，4.18±2.24）无统计学显著差异。
气管切开套管封堵是减少吞咽后残留的有效方法，当观察到吞咽后残留时，对于能够耐受气管切开套管封堵的中风患者，可将其视为缓解吞咽困难的替代方法。
