Logemann J A, Pauloski B R, Colangelo L
Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois 60208, USA.
Head Neck. 1998 Jan;20(1):52-7. doi: 10.1002/(sici)1097-0347(199801)20:1<52::aid-hed8>3.0.co;2-2.
This study examined the effects of digital occlusion of the tracheostomy tube versus no occlusion on oropharyngeal swallowing in head and neck cancer patients.
Eight treated head and neck cancer patients were studied, six of whom had undergone surgical treatment for oral or laryngeal cancer and two who had undergone high-dose chemotherapy and radiotherapy for laryngeal cancer. Videofluorographic studies of oropharyngeal swallowing were accomplished on 3-mL boluses of liquid in seven patients and 3-mL boluses of paste in three patients, first with the tracheostomy not occluded and then with it lightly digitally occluded by the patient. Videofluorographic studies of swallow were examined for observations of aspiration and residue. Biomechanical analysis of each liquid swallow was also completed.
Four of the seven patients aspirated on thin liquids with the tube unoccluded. Aspiration was eliminated with the tracheostomy digitally occluded in two of these four patients. One of the patients also aspirated on paste with the tube unoccluded, and the aspiration was eliminated with the tube occluded. A third patient who aspirated on thin liquid had no change when the tube was occluded, and one patient's swallow worsened with the tube occluded on liquid. There were significant changes in five measures of swallow biomechanics on liquids with the tube occluded: (1) duration of base of tongue contact to the posterior pharyngeal wall was reduced, (2) maximal laryngeal elevation increased, (3) and (4) laryngeal and hyoid elevation at the time of initial cricopharyngeal opening increased, and (5) onset of anterior movement of the posterior pharyngeal wall relative to the onset of cricopharyngeal opening began later.
Light digital occlusion of the tracheostomy tube appears to be a safe procedure, because most biomechanics of swallow are positively affected, perhaps because of the increased resistance provided by the closed trachea. However, not all patients received benefit from tube occlusion, indicating that each patient must be evaluated individually to determine whether or not tube occlusion improves their swallow.
本研究探讨了气管造口管数字闭塞与不闭塞对头颈癌患者口咽吞咽的影响。
对8例接受治疗的头颈癌患者进行了研究，其中6例接受了口腔或喉癌手术治疗，2例接受了喉癌高剂量化疗和放疗。对7例患者进行了3毫升液体团块的口咽吞咽视频荧光造影研究，对3例患者进行了3毫升糊状团块的研究，首先不闭塞气管造口，然后由患者轻轻用手指闭塞。对吞咽的视频荧光造影研究进行了误吸和残留观察。还完成了每次液体吞咽的生物力学分析。
7例患者中有4例在气管造口未闭塞时对稀液体有误吸。在这4例患者中，有2例通过数字闭塞气管造口消除了误吸。其中1例患者在气管造口未闭塞时对糊状物也有误吸，闭塞气管造口后误吸消除。第3例对稀液体有误吸的患者在闭塞气管造口时无变化，1例患者在液体吞咽时闭塞气管造口后吞咽情况恶化。闭塞气管造口时，液体吞咽的五项生物力学指标有显著变化：（1）舌根与咽后壁接触的持续时间缩短，（2）最大喉上抬增加，（3）和（4）环咽肌开始开放时喉和舌骨上抬增加，（5）咽后壁相对于环咽肌开放开始的向前运动开始延迟。
气管造口管的轻度数字闭塞似乎是一种安全的方法，因为大多数吞咽生物力学受到积极影响，这可能是由于封闭的气管提供了增加的阻力。然而，并非所有患者都从气管造口管闭塞中受益，这表明必须对每个患者进行单独评估，以确定气管造口管闭塞是否能改善其吞咽功能。
