Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.
Neurogastroenterol Motil. 2019 Nov;31(11):e13695. doi: 10.1111/nmo.13695. Epub 2019 Aug 11.
Increasing viscosity with thickening agents is a valid therapeutic strategy for oropharyngeal dysphagia (OD). To assess the therapeutic effect of a xanthan gum-based thickener (Nutilis Clear ) at six viscosities compared with thin liquid in poststroke OD (PSOD) patients.
A total of 120 patients with PSOD were studied in this controlled, multiple-dose, fixed-order, and single-blind study using videofluoroscopy (VFSS). A series of boluses of 10 mL thin liquid and 2000, 1400, 800, 450, 250, and 150 mPa s viscosities were given in duplicate, interrupted in case of aspiration. We assessed the safety and efficacy of swallow and the kinematics of the swallow response.
A total of 41.2% patients had safe swallow at thin liquid which significantly increased for all viscosities from 71.9% at 150 mPa s to 95.6% at 1400 mPa s (P < .001). PAS score (3.7 ± 2.3) at thin liquid was also reduced by increasing bolus viscosity (P < .001). The prevalence of patients with aspiration at thin liquid was 17.5% and decreased at all viscosities (P < .01), except at 150 mPa s. Increasing viscosity shortened time to laryngeal vestibule closure (LVC) at all viscosities (P < .01) and reduced bolus velocity at ≥450 mPa s (P < .05). The prevalence of patients with pharyngeal residue at each viscosity 37.7%-44.7% was similar to that at thin liquid (41.2%).
The prevalence of unsafe swallow with thin liquids is very high in PSOD. Increasing shear bolus viscosity with this xanthan gum-based thickener significantly increased the safety of swallow in patients with PSOD in a viscosity-dependent manner without increasing the prevalence of pharyngeal residue.
增加稠度剂的粘性是治疗口咽吞咽困难（OD）的有效治疗策略。评估与稀薄液体相比，六种粘度的黄原胶基增稠剂（Nutilis Clear）在卒中后 OD（PSOD）患者中的治疗效果。
本研究为对照、多剂量、固定顺序和单盲研究，使用视频透视吞咽检查（VFSS）对 120 例 PSOD 患者进行研究。给予 10 毫升稀薄液体和 2000、1400、800、450、250 和 150 mPa·s 粘度的双份系列 bolus，在发生吸入时中断。我们评估吞咽的安全性和有效性以及吞咽反应的运动学。
在稀薄液体时，41.2%的患者吞咽安全，所有粘度均显著增加，从 150 mPa·s 时的 71.9%增加到 1400 mPa·s 时的 95.6%（P <.001）。随着 bolus 粘度的增加，PAS 评分（3.7±2.3）也降低（P <.001）。在稀薄液体时，有 17.5%的患者发生吸入，在所有粘度下均降低（P <.01），但在 150 mPa·s 时除外。随着粘度的增加，所有粘度的声门关闭时间（LVC）均缩短（P <.01），且在≥450 mPa·s 时 bolus 速度降低（P <.05）。每个粘度下的咽后残留患者的比例为 37.7%-44.7%，与稀薄液体相似（41.2%）。
PSOD 患者使用稀薄液体进行不安全吞咽的比例非常高。用这种黄原胶基增稠剂增加剪切 bolus 粘度可显著增加 PSOD 患者吞咽的安全性，且不会增加咽后残留的发生率。
