Influence of Nasogastric Tubes on Swallowing in Stroke Patients: Measuring Hyoid Bone Movement With Ultrasonography
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Objective To investigate the influence of a nasogastric tube (NGT) on swallowing simulated saliva in stroke patients. Methods Three groups of participants were enrolled into the study: group A (20 stroke patients with a NGT), a control group B (25 stroke patients without a NGT), and group C (25 healthy adults with no brain lesions or dysphagia). Participants swallowed 1 mL of water to simulate saliva. Patients in group A were tested twice: once with a NGT (group A1) and once after the NGT was removed (group A2). The distance of hyoid bone movement was measured by subtracting the shortest distance between the mandible and hyoid bone (S) from the distance at resting state (R) measured with ultrasonography. The degree of the movement was calculated by (R–S)/R. The trajectory area of hyoid bone movement (Area) and the interval between the beginning of hyoid bone movement and the moment of the shortest hyoid−mandible approximation (Interval) was calculated by a computer program. Results From group A: R–S and (R–S)/R of group A2 at 1.14±0.36 cm and 0.30±0.09 cm and were significantly greater than those of group A1 at 0.81±0.36 cm and 0.22±0.08 cm (p=0.009 and p=0.005). After removing the NGT as seen in group A2, R–S and (R–S)/R were improved to the level of those of group B at 1.20±0.32 cm and 0.30±0.09 cm (p=0.909 and p=0.997). The Area of group A2 was larger and the Interval of group A2 was shorter than those of group A1 though a comparison of these factors between A2 and A1 did not show a statistically significant difference. Conclusion A NGT interferes with the movement of the hyoid bone when swallowing 1 mL of water in stroke patients though the movement is restored to normal after removing the NGT.
Abstract
Objective To investigate the influence of a nasogastric tube (NGT) on swallowing simulated saliva in stroke patients. Methods Three groups of participants were enrolled into the study: group A (20 stroke patients with a NGT), a control group B (25 stroke patients without a NGT), and group C (25 healthy adults with no brain lesions or dysphagia). Participants swallowed 1 mL of water to simulate saliva. Patients in group A were tested twice: once with a NGT (group A1) and once after the NGT was removed (group A2). The distance of hyoid bone movement was measured by subtracting the shortest distance between the mandible and hyoid bone (S) from the distance at resting state (R) measured with ultrasonography. The degree of the movement was calculated by (R–S)/R. The trajectory area of hyoid bone movement (Area) and the interval between the beginning of hyoid bone movement and the moment of the shortest hyoid−mandible approximation (Interval) was calculated by a computer program. Results From group A: R–S and (R–S)/R of group A2 at 1.14±0.36 cm and 0.30±0.09 cm and were significantly greater than those of group A1 at 0.81±0.36 cm and 0.22±0.08 cm (p=0.009 and p=0.005). After removing the NGT as seen in group A2, R–S and (R–S)/R were improved to the level of those of group B at 1.20±0.32 cm and 0.30±0.09 cm (p=0.909 and p=0.997). The Area of group A2 was larger and the Interval of group A2 was shorter than those of group A1 though a comparison of these factors between A2 and A1 did not show a statistically significant difference. Conclusion A NGT interferes with the movement of the hyoid bone when swallowing 1 mL of water in stroke patients though the movement is restored to normal after removing the NGT.
참고문헌 (27)
- Daniels SK, "Clinical predictors of dysphagia and aspiration risk: outcome measures in acute stroke patients", Arch Phys Med Rehabil, 81, pp.1030~1033 (2000)[DOI]
- Finestone HM, "Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors", Arch Phys Med Rehabil, 76, pp.310~316 (1995)[DOI]
- Behrens R, "Percutaneous endoscopic gastrostomy in children and adolescents", J Pediatr Gastroenterol Nutr, 25, pp.487~491 (1997)[DOI]
- Rosenvinge SK, "Improving care for patients with dysphagia", Age Ageing, 34, pp.587~593 (2005)[DOI]
- Hayes JC, "Current feeding policies for patients with stroke", Br J Nurs, 7, pp.580~588 (1998)[DOI]
- Kim MH, "A study on the applying of training program to facilitate deglution: on spontaneous intracerebral hemorrhage patients with nasogastric tube", J Korean Acad Adult Nurs, 13, pp.136~147 (2001)
- Geeganage C, "Interventions for dysphagia and nutritional support in acute and subacute stroke", Cochrane Database Syst Rev, 10 (2012)
- Ishida R, "Hyoid motion during swallowing: factors affecting forward and upward displacement", Dysphagia, 17, pp.262~272 (2002)[DOI]
- Logemann JA, "Closure mechanisms of laryngeal vestibule during swallow", Am J Physiol, 262(2), pp.G338~G344 (1992)
- Hsiao MY, "Application of ultrasonography in assessing oropharyngeal dysphagia in stroke patients", Ultrasound Med Biol, 38, pp.1522~1528 (2012)[DOI]
- Chen YC, "Reliability of ultrasonography in evaluating hyoid bone movement", J Med Ultrasound, 25, pp.90~95 (2017)[DOI]
- Morgan A, "Acute characteristics of pediatric dysphagia subsequent to traumatic brain injury: videofluoroscopic assessment", J Head Trauma Rehabil, 17, pp.220~241 (2002)[DOI]
- 신현영, "2014년 사망원인 통계", 대한의사협회지, 59(3), pp.221~232 (2016), 대한의사협회[DOI]
- Ring H, "Functional measures of first-stroke rehabilitation inpatients: usefulness of the Functional Independence Measure total score with a clinical rationale", Arch Phys Med Rehabil, 78, pp.630~635 (1997)[DOI]
- Huggins PS, "Effects of nasogastric tubes on the young, normal swallowing mechanism", Dysphagia, 14, pp.157~161 (1999)[DOI]
- Robbins J, "Oropharyngeal swallowing in normal adults of different ages", Gastroenterology, 103, pp.823~829 (1992)[DOI]
- Robbins JA, "The impact of oral motor dysfunction on swallowing: from beginning to end", Semin Speech Lang, 13, pp.55~69 (1992)[DOI]
- Macrae PR, "Intra- and inter-rater reliability for analysis of hyoid displacement measured with sonography", J Clin Ultrasound, 40, pp.74~78 (2012)[DOI]
- Huang YL, "Ultrasonographic evaluation of hyoid-larynx approximation in dysphagic stroke patients", Ultrasound Med Biol, 35, pp.1103~1108 (2009)[DOI]
- Shawker TH, "Ultrasound analysis of tongue, hyoid, and larynx activity during swallowing", Invest Radiol, 19, pp.82~86 (1984)[DOI]
- Yabunaka K, "Sonographic assessment of hyoid bone movement during swallowing: a study of normal adults with advancing age", Radiol Phys Technol, 4, pp.73~77 (2011)[DOI]
- Fanucci A, "Physiology of oral swallowing studied by ultrasonography", Dentomaxillofac Radiol, 23, pp.221~225 (1994)[DOI]
- Kuhl V, "Sonographic analysis of laryngeal elevation during swallowing", J Neurol, 250, pp.333~337 (2003)[DOI]
- Dziewas R, "Do nasogastric tubes worsen dysphagia in patients with acute stroke?", BMC Neurol, 8, pp.28~ (2008)[DOI]
- Gomes GF, "The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia", Curr Opin Clin Nutr Metab Care, 6, pp.327~333 (2003)
- Rahnemai-Azar AA, "Percutaneous endoscopic gastrostomy: indications, technique, complications and management", World J Gastroenterol, 20, pp.7739~7751 (2014)[DOI]
- Paik NJ, "Movement of the hyoid bone and the epiglottis during swallowing in patients with dysphagia from different etiologies", J Electromyogr Kinesiol, 18, pp.329~335 (2008)[DOI]