哪些透视参数易受钡剂产品和浓度差异的影响？
Which Videofluoroscopy Parameters Are Susceptible to the Influence of Differences in Barium Product and Concentration?
机构信息
Swallowing Rehabilitation Research Laboratory, KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Ontario, Canada.
Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada.
出版信息
Am J Speech Lang Pathol. 2022 Sep 7;31(5):2145-2158. doi: 10.1044/2022_AJSLP-22-00017. Epub 2022 Aug 31.
PURPOSE
Prior studies suggest there may be differences in videofluoroscopic measures of swallowing across different barium concentrations. Whether different barium products of identical concentration result in similar swallowing physiology remains unknown. This is important, as barium intended for videofluoroscopy (i.e., Bracco Varibar) is not available globally. Our aim was to identify differences in healthy swallowing across five different barium stimuli.
METHOD
Twenty healthy adults (10 women), aged 22-54 years, underwent videofluoroscopy including comfortable sips of thin liquid barium: two sips of 20% weight-to-volume (w/v) barium prepared with E-Z-HD powder, and two sips each of 20%w/v and 40%w/v barium prepared with Liquid Polibar Plus and E-Z-Paque powder. Recordings were analyzed according to the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method. Measures of timing, kinematics and residue were obtained. Chi-square, Friedman's, and Wilcoxon signed-ranks test were used to identify differences across stimuli.
RESULTS
Significant differences were seen across barium stimuli for upper esophageal sphincter (UES) opening duration, UES diameter, pharyngeal area at maximum constriction, and residue. In all cases, smaller values were seen with the 20%w/v E-Z-HD stimulus; however, this stimulus had questionable opacity for visualization. Patterns of residue severity were not explained by barium concentration.
CONCLUSIONS
This study confirms that some measures of swallowing are influenced by barium product and/or concentration. Measures are not necessarily similar across different barium products at the same concentration. This study illustrates the importance of using standard and appropriate stimuli in videofluoroscopy, and for clinicians to report not only the product but also the concentration of stimuli used.
SUPPLEMENTAL MATERIAL
目的
先前的研究表明，不同钡浓度下的吞咽视频荧光透视测量可能存在差异。相同浓度的不同钡产品是否会导致相似的吞咽生理仍不清楚。这很重要，因为用于视频荧光透视的钡（即 Bracco Varibar）并非全球都有。我们的目的是确定五种不同钡刺激物对健康吞咽的影响。
方法
20 名健康成年人（10 名女性），年龄 22-54 岁，进行视频荧光透视检查，包括舒适地小口喝下稀薄的钡液：两小口 20%重量-体积（w/v）钡，用 E-Z-HD 粉末配制，以及两口 20%w/v 和 40%w/v 钡，分别用 Liquid Polibar Plus 和 E-Z-Paque 粉末配制。根据吞咽生理分析：事件、运动学和时间方法进行分析。获得了时间、运动学和残留物的测量值。使用卡方检验、Friedman 检验和 Wilcoxon 符号秩检验来识别不同刺激物之间的差异。
结果
在食管上括约肌（UES）开放持续时间、UES 直径、最大收缩时的咽腔面积和残留物方面，不同钡刺激物之间存在显著差异。在所有情况下，使用 20%w/v E-Z-HD 刺激物时，这些值较小；然而，这种刺激物的不透明度对于可视化来说存在疑问。残留物严重程度的模式不能用钡浓度来解释。
结论
本研究证实，一些吞咽测量结果受到钡产品和/或浓度的影响。在相同浓度下，不同钡产品的测量结果不一定相似。本研究说明了在视频荧光透视中使用标准和适当刺激物的重要性，并且临床医生不仅要报告使用的产品，还要报告刺激物的浓度。
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