Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
Department of Computer Science and Engineering, Korea University, Seoul, 02841, Korea.
Dysphagia. 2023 Dec;38(6):1487-1496. doi: 10.1007/s00455-023-10575-0. Epub 2023 Apr 18.
The purpose of this study was to identify differences in temporal parameters correlating to the presence of aspiration and the severity of penetration-aspiration scale (PAS) in patients with dysphagia after stroke. We also investigated whether there was a significant difference in temporal parameters based on the location of the stroke lesion. A total of 91 patient videofluoroscopic swallowing study (VFSS) videos of stroke patients with dysphagia were retrospectively analyzed. Various temporal parameters including oral phase duration, pharyngeal delay time, pharyngeal response time, pharyngeal transit time, laryngeal vestibule closure reaction time, laryngeal vestibule closure duration, upper esophageal sphincter opening duration and upper esophageal sphincter reaction time were measured. Subjects were grouped by the presence of aspiration, PAS score, and location of the stroke lesion. Pharyngeal response time, laryngeal vestibule closure duration, and upper esophageal sphincter opening duration were significantly prolonged in the aspiration group. These three factors showed positive correlation with PAS. In terms of stroke lesion, oral phase duration was significantly prolonged in the supratentorial lesion group, while upper esophageal sphincter opening duration was significantly prolonged in the infratentorial lesion group. We have demonstrated that quantitative temporal analysis of VFSS can be a clinically valuable tool identifying dysphagia pattern associated with stroke lesion or aspiration risk.
本研究旨在探讨与吞咽困难后卒中患者误吸及渗透-误吸量表(PAS)严重程度相关的时间参数差异。我们还研究了基于卒中病灶位置,时间参数是否存在显著差异。本研究回顾性分析了 91 例吞咽困难卒中患者的视频荧光透视吞咽研究(VFSS)录像。测量了各种时间参数,包括口腔期持续时间、咽延迟时间、咽反应时间、咽通过时间、喉前庭关闭反应时间、喉前庭关闭持续时间、食管上括约肌开放持续时间和食管上括约肌反应时间。根据是否存在误吸、PAS 评分和卒中病灶位置对患者进行分组。在误吸组中,咽反应时间、喉前庭关闭持续时间和食管上括约肌开放持续时间明显延长。这三个因素与 PAS 呈正相关。就卒中病灶而言,在幕上病灶组中口腔期持续时间明显延长,而在幕下病灶组中食管上括约肌开放持续时间明显延长。我们的研究表明,VFSS 的定量时间分析可以作为一种有价值的临床工具,用于识别与卒中病灶或误吸风险相关的吞咽困难模式。