PDF(Pubmed)
Abstract：
OBJECTIVE: Swallowing dysfunction and the risk of aspiration pneumonia are frequent clinical problems in the treatment of head and neck squamous cell carcinomas (HNSCCs). Breathing-swallowing coordination is an important factor in evaluating the risk of aspiration pneumonia. To investigate breathing-swallowing discoordination after chemoradiotherapy (CRT), we monitored respiration and swallowing activity before and after CRT in patients with HNSCCs.
METHODS: Non-invasive swallowing monitoring was prospectively performed in 25 patients with HNSCCs treated with CRT and grade 1 or lower radiation-induced dermatitis. Videoendoscopy, videofluoroscopy, Food Intake LEVEL Scale, and patient-reported swallowing difficulties were assessed.
RESULTS: Of the 25 patients selected for this study, four dropped out due to radiation-induced dermatitis. The remaining 21 patients were analyzed using a monitoring system before and after CRT. For each of the 21 patients, 405 swallows were analyzed. Swallowing latency and pause duration after the CRT were significantly extended compared to those before the CRT. In the analysis of each swallowing pattern, swallowing immediately followed by inspiration (SW-I pattern), reflecting breathing-swallowing discoordination, was observed more frequently after CRT (p = 0.0001). In 11 patients, the SW-I pattern was observed more frequently compared to that before the CRT (p = 0.00139). One patient developed aspiration pneumonia at 12 and 23 months after the CRT.
CONCLUSIONS: The results of this preliminary study indicate that breathing-swallowing discoordination tends to increase after CRT and could be involved in aspiration pneumonia. This non-invasive method may be useful for screening swallowing dysfunction and its potential risks.
METHODS: Non-invasive swallowing monitoring was prospectively performed in 25 patients with HNSCCs treated with CRT and grade 1 or lower radiation-induced dermatitis. Videoendoscopy, videofluoroscopy, Food Intake LEVEL Scale, and patient-reported swallowing difficulties were assessed.
RESULTS: Of the 25 patients selected for this study, four dropped out due to radiation-induced dermatitis. The remaining 21 patients were analyzed using a monitoring system before and after CRT. For each of the 21 patients, 405 swallows were analyzed. Swallowing latency and pause duration after the CRT were significantly extended compared to those before the CRT. In the analysis of each swallowing pattern, swallowing immediately followed by inspiration (SW-I pattern), reflecting breathing-swallowing discoordination, was observed more frequently after CRT (p = 0.0001). In 11 patients, the SW-I pattern was observed more frequently compared to that before the CRT (p = 0.00139). One patient developed aspiration pneumonia at 12 and 23 months after the CRT.
CONCLUSIONS: The results of this preliminary study indicate that breathing-swallowing discoordination tends to increase after CRT and could be involved in aspiration pneumonia. This non-invasive method may be useful for screening swallowing dysfunction and its potential risks.
摘要：
目的：吞咽功能障碍和吸入性肺炎的风险是头颈部鳞状细胞癌（HNSCC）治疗中常见的临床问题。呼吸-吞咽协调是评估吸入性肺炎风险的重要因素。探讨放化疗（CRT）后呼吸-吞咽不协调，我们监测了HNSCCs患者CRT前后的呼吸和吞咽活动。
方法：前瞻性地对25例接受CRT治疗的HNSCC和1级或更低级别辐射诱发的皮炎患者进行非侵入性吞咽监测。视频内窥镜检查,透视透视,食物摄入水平量表，并对患者报告的吞咽困难进行了评估.
结果：在本研究中选择的25名患者中，4人因放射性皮炎而退出。其余21例患者在CRT前后使用监测系统进行分析。对于21位患者中的每一位，分析了405只燕子。与CRT之前相比，CRT后的吞咽潜伏期和停顿持续时间显着延长。在对每种吞咽模式的分析中，吞咽后立即吸气（SW-I模式），反映呼吸-吞咽不协调，在CRT后更频繁地观察到（p=0.0001）。在11名患者中，与CRT前相比,SW-I模式的观察频率更高(p=0.00139).一名患者在CRT后12个月和23个月出现吸入性肺炎。
结论：这项初步研究的结果表明，CRT后呼吸-吞咽不协调倾向于增加，可能与吸入性肺炎有关。这种非侵入性方法可用于筛查吞咽功能障碍及其潜在风险。
方法：前瞻性地对25例接受CRT治疗的HNSCC和1级或更低级别辐射诱发的皮炎患者进行非侵入性吞咽监测。视频内窥镜检查,透视透视,食物摄入水平量表，并对患者报告的吞咽困难进行了评估.
结果：在本研究中选择的25名患者中，4人因放射性皮炎而退出。其余21例患者在CRT前后使用监测系统进行分析。对于21位患者中的每一位，分析了405只燕子。与CRT之前相比，CRT后的吞咽潜伏期和停顿持续时间显着延长。在对每种吞咽模式的分析中，吞咽后立即吸气（SW-I模式），反映呼吸-吞咽不协调，在CRT后更频繁地观察到（p=0.0001）。在11名患者中，与CRT前相比,SW-I模式的观察频率更高(p=0.00139).一名患者在CRT后12个月和23个月出现吸入性肺炎。
结论：这项初步研究的结果表明，CRT后呼吸-吞咽不协调倾向于增加，可能与吸入性肺炎有关。这种非侵入性方法可用于筛查吞咽功能障碍及其潜在风险。
