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[吞咽困难的评估。将电视荧光吞咽造影检查纳入其研究一年后的结果]

[Evaluation of dysphagia. Results after one year of incorporating videofluoroscopy into its study].

作者信息

García Romero Ruth, Ros Arnal Ignacio, Romea Montañés María José, López Calahorra José Antonio, Gutiérrez Alonso Cristina, Izquierdo Hernández Beatriz, Martín de Vicente Carlos

机构信息

Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Infantil Miguel Servet, Zaragoza, España.

Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Infantil Miguel Servet, Zaragoza, España.

出版信息

An Pediatr (Engl Ed). 2018 Aug;89(2):92-97. doi: 10.1016/j.anpedi.2017.07.009. Epub 2017 Nov 10.

Abstract

INTRODUCTION

Dysphagia is very common in children with neurological disabilities. These patients usually suffer from respiratory and nutritional problems. The videofluoroscopic swallowing study (VFSS) is the most recommended test to evaluate dysphagia, as it shows the real situation during swallowing.

OBJECTIVES

To analyse the results obtained in our centre after one year of the implementation of VFSS, the clinical improvement after confirmation, and the prescription of an individualised treatment for the patients affected.

MATERIAL AND METHODS

VFSS performed in the previous were collected. The following variables were analysed: age, pathology, degree of neurological damage, oral and pharyngeal and/or oesophageal dysphagia and its severity, aspirations, prescribed treatment, and nutritional and respiratory improvement after diagnosis. A statistical analysis was performed using SPSS v21.

RESULTS

A total of 61 VFSS were performed. Dysphagia was detected in more than 70%, being moderate-severe in 58%. Aspirations and/or penetrations were recorded in 59%, of which 50% were silent. Adapted diet was prescribed to 56%, and gastrostomy was performed on 13 (21%) patients. A statistical association was found between neurological disease and severity of dysphagia. The degree of motor impairment is related to the presence of aspirations. After VFSS evaluation and treatment adjustment, nutritional improvement was found in Z-score of weight (+0.3SD) and BMI (+0.4SD). There was respiratory improvement in 71% of patients with dysphagia being controlled in the Chest Diseases Department.

CONCLUSIONS

After implementation of VFSS, a high percentage of patients were diagnosed and benefited from a correct diagnosis and treatment. VFSS is a fundamental diagnostic test that should be included in paediatric centres as a diagnostic method for children with suspected dysphagia.

摘要

引言

吞咽困难在患有神经功能障碍的儿童中非常常见。这些患者通常会出现呼吸和营养问题。电视荧光吞咽造影检查(VFSS)是评估吞咽困难最推荐的检查方法,因为它能显示吞咽过程中的真实情况。

目的

分析在我们中心实施VFSS一年后所获得的结果、确诊后的临床改善情况以及为受影响患者制定个体化治疗方案。

材料与方法

收集此前进行的VFSS检查结果。分析以下变量:年龄、病情、神经损伤程度、口腔及咽部和/或食管吞咽困难及其严重程度、误吸情况、所开治疗方案以及诊断后的营养和呼吸改善情况。使用SPSS v21进行统计分析。

结果

共进行了61次VFSS检查。超过70%的患者检测出吞咽困难,其中58%为中重度。记录到误吸和/或食物进入气道的情况占59%,其中50%为隐性误吸。56%的患者采用了调整后的饮食方案,13名(21%)患者进行了胃造口术。发现神经疾病与吞咽困难的严重程度之间存在统计学关联。运动障碍程度与误吸的发生有关。经过VFSS评估和治疗调整后,体重Z评分(+0.3标准差)和体重指数(BMI,+0.4标准差)显示营养状况有所改善。71%吞咽困难得到控制的患者在胸部疾病科实现了呼吸改善。

结论

实施VFSS后,很大比例的患者得到诊断,并从正确的诊断和治疗中受益。VFSS是一项基本的诊断检查,应纳入儿科中心,作为疑似吞咽困难儿童的诊断方法。

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