뇌졸중 환자의 비디오 연하 검사시 관찰되는 고점도 식이에서의 기도 흡인과 인두 잔여물의 비전형적 양상

Abstract

Background : In stroke patients with dysphagia, food thickening is widely used for dysphagia treatment. However increase of subglottic aspiration or amounts of pharyngeal residue at higher viscosity foods such as pudding and semiblended diet (SBD) - that is atypical pattern - was infrequently found on VFSS. The purpose of the study is to identify factors associated with atypical patterns of aspiration and pharyngeal residue in high viscosity food. Methods : We analyzed clinical features and VFSS findings of one hundred sixty four stroke patients. We classified them into atypical pattern groups (group A: increase of aspiration and pharyngeal residue, group B:reduce of aspiration and increase of pharyngeal residue) and typical pattern group. Statistical analyses were done for comparison of clinical features, results of clinical evaluation of swallowing function, and VFSS findings among 3 groups. Results : There were no significant differences in all data between A group and B group. In atypical group in comparison with typical group, there were significant differences in sex (odds ratio(OR):1.30), duration of dysphagia (OR:2.33), feeding type (OR:3.82), lesion of underlying disease (OR:3.08), water swallow test (OR:4.13). In VFSS findings, significance differences were found in factors such as poor bolus formation (OR:5.13), presence of tongue residue (OR:2.54), reduced piglottic closure (OR:3.63), the presence of vallecular residue (OR:19.36), the presence of pyriform sinus (OR:7.95) and presence of pharyngeal wall coating (OR:5.71). Conclusions : Atypical patterns on VFSS were found in 30% of stroke patients. The clinical factors associated with atypical pattern were male, tube feeding, chronic stage, brainstem lesion and positive water swallow test. The VFSS findings associated with atypical pattern were residue in pharyngeal and oral phase, pharyngeal wall coating, reduced epiglottic closure and poor bolus formation. When providing diets in such patients, prescription of high viscosity food is not always helpful.