Bedside Thyroid Palpation Technique as Indicator for Penetration/Aspiration Risk in Stroke Patients

以床邊甲狀軟骨觸診預測中風病人吸入／嗆入風險

齊永均(Yung-Chun Chi) ； 蔡牧宏(Mu-Hung Tsai) ； 林琮凱(Jerry Tsung-Kai Lin) ； 游宜蓁(Yi-Chen Yu) ； 張時中(Shih-Chung Chang)

《台灣復健醫學雜誌》 47卷2期 (2019/12) Pp. 109-115

https://doi.org/10.6315/TJPMR.201912_47(2).0004

摘要

Background: Bedside thyroid cartilage palpation technique is a quick and non-invasive swallowing screening test. However, the correlation between thyroid cartilage movement and penetration/aspiration risks in stroke patients has not been conclusive to date. Therefore, we compared the result of videofluoroscopic swallowing study (VFSS) and bedside thyroid cartilage palpation to determine the penetration/ aspiration risks in stroke patients. Material and methods: Our study included 53 patients admitted to a medical center for rehabilitation within 6-months of stroke onset. We recorded penetration-aspiration scale by VFSS and compared it with a bedside thyroid cartilage palpation technique. Results: Our results show significant higher rates of penetration/aspiration in patients with thyroid elevation ≤1.5 finger widths during palpation compared to ＞1.5 finger widths (p=0.0223). For the prediction of penetration/aspiration on VFSS, palpation ≤1.5 finger width has a sensitivity of 77.42% (95% CI: 58.90% to 90.41%) and specificity 54.55% (95% CI: 32.21% to 75.61%). Conclusion: Our results indicate that a ≤ 1.5 finger width elevation of thyroid cartilage during palpation technique is a sensitive, quick and non-invasive swallowing screening test to evaluate possible risks of penetration/aspiration in stroke patients or used as a follow up examination after VFSS.

關鍵字

dysphagia ； penetration ； aspiration ； thyroid cartilage ； palpation

並列摘要

背景：床邊甲狀軟骨觸診是一個迅速且非侵入式的吞嚥篩檢測試，然而截至目前為止甲狀軟骨的移動與中風病人吸入／嗆入的風險仍未有結論。因此我們藉著比較床邊甲狀軟骨觸診與螢光吞嚥攝影檢查結果，來找出甲狀軟骨移動與中風病人吸入／嗆入風險的關係。方法：我們的研究收錄53位中風六個月內住在醫學中心的病人，並記錄吞嚥時觸診的甲狀軟骨移動距離與吞嚥攝影的吸入／嗆入分數（PAS score）做比較。結果：我們的結果顯示吞嚥時甲狀軟骨觸診上升距離≤1.5指幅（約2公分）的病人吸入／嗆入的風險比上升＞1.5指幅的病人高，且有統計學上顯著差異（p=0.0223）。而用≤1.5指幅甲狀軟骨上升來預測病人吸入／嗆入風險與吞嚥攝影做對照，敏感性及特異性分別可達77.42%（95% CI: 58.90% to 90.41%）、54.55%（95% CI: 32.21% to 75.61%）。結論：我們的結果顯示以吞嚥時觸診甲狀軟骨上抬距離≤ 1.5的指幅來預測中風病人吸入／嗆入風險是一個敏感性高、迅速且非侵入性的篩檢方法，並作為螢光吞嚥攝影檢查後吸入／嗆入高風險患者的追蹤評估方式。

並列關鍵字

吞嚥障礙（dysphagia） ； 嗆入（penetration） ； 吸入（aspiration） ； 甲狀軟骨（thyroid cartilage） ； 觸診（palpation）

參考文獻

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