Namasivayam-MacDonald Ashwini M, Riquelme Luis F
Department of Communication Sciences and Disorders, College of Education and Health Sciences, Adelphi University, Garden City, New York, NY 11530, USA.
Department of Speech-Language Pathology, School of Health Sciences and Practice, New York Medical College, Valhalla, New York, NY 10595, USA.
Geriatrics (Basel). 2019 Jan 16;4(1):13. doi: 10.3390/geriatrics4010013.
Previous research has begun to elucidate the physiological impairments associated with dysphagia in patients with dementia, but in order to select the most appropriate targets of intervention we need to better understand consequences of dysphagia. The purpose of this study was to quantify penetration, aspiration, and residue in people with dementia, and confirm if residue was associated with airway invasion on subsequent swallows. Videofluoroscopy clips of sips of thin and extremely thick liquid barium from 58 patients with dementia were retrospectively analyzed. Ratings of swallowing safety, using the Penetration⁻Aspiration Scale (PAS), and efficiency, using Normalized Residue Ratio Scale in the valleculae (NRRSv) and pyriform sinuses (NRRSp), were made on all swallows. Over 70% of both thin and extremely thick liquid swallows were found to be safe (PAS < 3). Results also revealed that residue was generally more common in the valleculae. However, the proportion of thin liquid swallows with significant NRRSp that were unsafe on the subsequent swallow was significantly greater than the proportion of swallows with significant NRRSp that were safe on the subsequent swallow. As such, there was a 2.83 times greater relative risk of penetration⁻aspiration in the presence of thin liquid pyriform sinus residue. Future research should determine the impaired physiology causing aspiration and residue in this population.
以往的研究已开始阐明痴呆患者吞咽困难相关的生理损伤，但为了选择最合适的干预目标，我们需要更好地了解吞咽困难的后果。本研究的目的是量化痴呆患者的食物渗入、误吸和残留情况，并确认残留是否与后续吞咽时的气道侵犯有关。对58例痴呆患者饮用稀薄和极浓稠液体钡剂的视频荧光造影片段进行了回顾性分析。对所有吞咽动作进行了吞咽安全性评分（使用渗入-误吸量表，即PAS）以及效率评分（使用会厌谷标准化残留率量表，即NRRSv，和梨状窦标准化残留率量表，即NRRSp）。结果发现，超过70%的稀薄和极浓稠液体吞咽动作是安全的（PAS<3）。结果还显示，残留通常在会厌谷更为常见。然而，梨状窦NRRSp显著的稀薄液体吞咽动作中，后续吞咽不安全的比例显著高于后续吞咽安全的比例。因此，存在稀薄液体梨状窦残留时，发生渗入-误吸的相对风险要高2.83倍。未来的研究应确定导致该人群误吸和残留的生理功能受损情况。
