The Effects of the VFSS Timing After Nasogastric Tube Removal on Swallowing Function of the Patients With Dysphagia

다국어 초록 (Multilingual Abstract)

Objective To evaluate the effects of the videofluoroscopic swallowing study (VFSS) timing after the nasogastric tube (NGT) removal on swallowing function of the patients with dysphagia.Methods This study was conducted on 40 NGT-fed patients with dysphagia. To assess the patients’ swallowing function, VFSS was performed twice using a 5-mL 35% diluted barium solution. For the initial examination, VFSS was performed immediately after the NGT removal (VFSS 1). For the second examination, VFSS was performed five hours after the NGT removal (VFSS 2). We used the functional dysphagia scale (FDS) to assess swallowing function. In the FDS, a significant difference in the four items in the oral phase, seven items in the pharyngeal phase, and total scores were assessed (p<0.05). We also used modified penetration-aspiration scale (mPAS) to compare the two examinations (p<0.05).Results A paired t-test was performed to confirm the statistical significance of the two examinations (p<0.05). The overall swallowing function was assessed as better in VFSS 2 than in VFSS 1. In the FDS, significant differences in the residue in valleculae (p=0.002), the residue in pyriform sinuses (p=0.001), the coating of pharyngeal wall after swallow (p=0.001), and the total scores (p<0.001) were found between the two examinations. Also, in the mPAS that assessed the degree of penetration-aspiration, a significant difference was found between the two examinations (p<0.001).Conclusion The results of this study confirmed that the timing of the VFSS after the NGT removal affects the swallowing function. Thus, to accurately assess the swallowing function, VFSS must be performed in NGT-fed patients after they have rested for a certain period following the removal of their NGT.

참고문헌 (Reference)

1 백남종, "비디오 투시 연하 검사에 기초한 기능적 연하곤란 척도의 임상적 타당도" 대한재활의학회 29 (29): 43-49, 2005

2 정세희, "비디오 투시 연하 검사에 근거한 연하곤란 임상 척도의 타당도 평가" 대한재활의학회 29 (29): 343-350, 2005

3 Cook IJ, "Timing of videofluoroscopic, manometric events, and bolus transit during the oral and pharyngeal phases of swallowing" 4 : 8-15, 1989

4 Wang TG, "The effect of nasogastric tubes on swallowing function in persons with dysphagia following stroke" 87 : 1270-1273, 2006

5 김정윤, "The Diagnostic Usefulness of the Fiberoptic Endoscopic Evaluation of Swallowing" 대한재활의학회 35 (35): 14-22, 2011

6 Han TR, "Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies." 82 : 677-682, 2001

7 Palmer JB, "Physical medicine and rehabilitation" Saunders 581-597, 2011

8 Gomes CA Jr, "Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances" 3 : CD008096-, 2012

9 Finestone HM, "Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors" 76 : 310-316, 1995

10 Eyal H., "Evaluation and treatment of swallowing disorders (dysphagia): the American model as an opportunity for improving patient care and cost containment in Israel’s healthcare system" 132 : 775-778, 1997

11 Perlman AL, "Electromyographic activity from human laryngeal, pharyngeal, and submental muscles during swallowing" 86 : 1663-1669, 1999

12 Smithard DG, "Complications and outcome after acute stroke. Does dysphagia matter?" 27 : 1200-1204, 1996

13 American Speech-Language-Hearing Association, "Adult speech language pathology training manual"

14 Rosenbek JC, "A penetration-aspiration scale" 11 : 93-98, 1996