螢光吞嚥攝影檢查臨床實務紀要

Clinical Emphasis of the Videofluoroscopic Swallowing Study

曾琬婷(Wan-Ting Tseng)

《台灣聽力語言學會雜誌》 43期 (2020/12) Pp. 11-25

https://doi.org/10.6143/JSLHAT.202012_(43).0002

摘要

螢光吞嚥攝影檢查由於能讓評估者直接看見整個動態的吞嚥功能，被視為是最適合用來評估吞嚥能力的工具之一。國內有越來越多的醫院開始設置此項檢查，但具體執行內容，例如：鋇劑濃度的調配、液體稠度的調整、不同顯影劑之差異、放射取樣設定等卻尚無指引。本文提出各重要議題並引入文獻，就檢查操作及臨床決策給予具體之建議：一、過高的鋇劑濃度會導致對吞嚥效率的誤判。二、液體稠度的調整需要標準化，並使用xanthan gum-based增稠劑為佳。三、碘和鋇兩種不同顯影劑各有適用情況，若有手術接合或明顯有吸入可能者，較適用碘作為顯影劑。四、最佳化放射儀器設定，過低的影格率吸入影像會被遺漏。影格率每秒30次為佳，但初生兒可能可以接受每秒15次。五、選擇最具功能性、最關鍵的影像指標。Analysis of Swallowing Physiology: Events, Kinematics and Timing in Clinical Practice（ASPEKT-C）包含吞嚥安全性及效率，值得推薦；其中咽部殘留量比率（pharyngeal residue ratio, (C2-C4)^2%）大於1%則下一口吸入或嗆入的風險提升，可視為危險值界線。以上每一項皆會影響治療師對個案吞嚥實際功能的判斷和病理生理的分析。後續之臨床決策更應綜合螢光吞嚥攝影檢查和所有床邊評估資訊作全面性考量而成，尤其不可小覷呼吸與吞嚥協調性，以及照顧者餵食技巧對吸入的影響。

關鍵字

螢光吞嚥攝影檢查 ； 鋇劑濃度 ； 液體稠度 ； 殘留量 ； 吞嚥障礙

並列摘要

The videofluoroscopic swallowing study (VFSS) is regarded as one of the most suitable tools for swallowing evaluation because it allows direct inspection of the entire swallowing dynamic process. However as more and more hospitals in Taiwan built up this modality, there has been no guideline that clearly defines modulation of barium concentration, adjustment of liquid consistency, comparison of different contrast agents, and setting of radiation sampling rate. In this article we propose various important issues and give specific clinical suggestions based on literature review and our own clinical experience: (1) Barium solution of too high concentration can lead to misjudgment of swallowing efficiency. (2) The adjustment of liquid consistency needs to be standardized, and xanthan gum-based thickener is more suitable. (3) The two different imaging agents of iodine and barium have their own application conditions. In postoperative cases or cases with higher risk of aspiration iodine is the imaging agent of choice. (4) To avoid missed detection of aspiration, frame rate of 30 times per second is recommended, while 15 times per second may be sufficient in pediatric cases. (5) Choose the most functional and critical image index. The Analysis of Swallowing Physiology: Events, Kinematics and Timing in Clinical Practice (ASPEKT-C) method provides information about the safety and efficiency of swallowing and is worth recommendation. Pharyngeal residue ratio (C2-C4)^2% greater than 1% can be regarded as a meaningful cut-point. Each of the above items affects the judgment of swallowing function and pathophysiological analysis. Subsequent clinical decision-making should be based on a comprehensive VFSS and bedside evaluation. In particular, the coordination between breathing and swallowing, and the effect of the caregiver's feeding skills should not be underestimated.

並列關鍵字

Videofluoroscopic swallowing study ； Barium concentration ； Liquid consistency ； Residual ； Dysphagia

參考文獻

Bahia, M. M., & Lowell, S. Y. (2020). A systematic review of the physiological effects of the effortful swallow maneuver in adults with normal and disordered swallowing. American Journal of Speech Language Pathology, 29, 1-19. doi:10.1044/2020_AJSLP-19-00132

Barbon, C. E. A., Chepeha, D. B., Hope, A. J., Peladeau-Pigeon, M., Waito, A. A., & Steele, C. M. (2020). Mechanisms of impaired swallowing on thin liquids following radiation treatment for oropharyngeal cancer. Journal of Speech Language & Hearing Research, 63, 2970-2879. doi:10.1044/2020_JSLHR-19-00220

Bonilha, H. S., Blair, J., Carnes, B., Huda, W., Humphries, K., McGrattan, K., ... Martin-Harris, B. (2013). Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations. Dysphagia, 28, 528-538. doi:10.1007/s00455-013-9463-z

Bopeththa, B. V. K. M., Hewavithana, P. B., Hewapathirana, H. L. I., & Ralapanawa, U. (2019). Myasthenic crisis following iodinated contrast material (iohexol) aspiration: A case report. Journal of Medical Case Reports, 13, 166. doi:10.1186/s13256-019-2114-8

Cabib, C., Ortega, O., Kumru, H., Palomeras, E., Vilardell, N., AlvarezBerdugo, D., ... Clave, P. (2016). Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: From compensation to the recovery of swallowing function. Annals of the New York Academy of Sciences, 1380, 121-138. doi:10.1111/nyas.13135