방사선학회 회장단 및 분과위원장

Size: px

Start display at page:

Download "방사선학회 회장단 및 분과위원장"

수향 윤
5 years ago
Views:

1 Myoyoung Jung, Namgil Choi, Jaebok Han, Jongnam Song, Weonjin Kim Dept. of Radiology, Dongshin University, Dept. of Occupational Therapy, Dongshin University 정묘영, 최남길, 한재복, 송종남, 김원진 동신대학교방사선학과, 동신대학교작업치료학과 Acute phase patients who are unconscious and are suffering from cerebral infarction, cranial nerve disorders, or cerebral apoplexy are susceptible to aspiration pneumonia due to dysphagia. In these cases, a nasogastric tube is inserted to supply nutrients. Although bedside screening tests are administered during recovery after rehabilitation, clinical examinations may not be able to ascertain asymptomatic aspiration. Therefore, a video fluoroscopy swallowing study (VFSS) was performed in 10 patients with dysphagia after rehabilitation therapy; these patients had nasogastric tubes inserted, and a rehabilitation specialist assessed the degree of swallowing based on the patients diet and posture. If aspiration or swallowing difficulties were observed, dysphagia rehabilitation therapy was administered. The patients were reassessed approximately 3050 days after administration of therapy, based on the patients condition. If aspiration is not observed, the nasogastric tube was removed. A functional dysphagia scale was used to analyze the VFSS images, and the scores were statistically calculated. The mean score of patients with nasogastric tubes was ± 9.431, thereby indicating aspiration risk, whereas the group without nasogastric tubes showed a mean score of ± 1.932, which indicated low risk of aspiration. These results demonstrated that a significantly low score was associated with nasogastric tube removal. Mann-Whitney s test was performed to assess the significance of both the groups, and the results were statistically significant with a P value < In conclusion, VFSS can effectively assess the movements and structural abnormalities in the oral cavity, pharynx, and esophagus. It can also be used to determine the aspiration status and ascertain the appropriate diet or swallowing posture for the patient. Therefore, VFSS can potentially be used as a reliable standard test to assess swallowing in order to determine nasogastric tube removal. Key Words : VFSS, Nasogastric tube, Swallowing Corresponding Author: Weonjin Kim way2call@naver.com Tel: Add. Dept. of Occupational Therapy, Dongshin University, 185 Geonjae-Ro, Naju-si, Jeonlanamdo, Korea. Received : November 03, 2014 Revised : December 20, 2014 Accepted : January 25, 2015

2 , (nasogastric tube).. 10 VFSS,, VFSS, 49.79±9.431, 11.20± Mann-Whitney test < VFSS,,,. :,,, Ⅰ.,. () 50% 70%. (swellowing),..,,.,.,,,.,...,,,, (bedside screening test). (silent aspiration). (Video Fluoroscopy Swallowing Study : VFSS) spot (dynamic recording). (VFSS) X- (ma), (sec),,. (nasogastric tube),

,.,, (gold standard).,, VFSS. Ⅱ. H,, (nasogastric tube) 10. 39 80 62.1, 5 5. 2.

. 35% barium, yogurt+barium(3:1), liquid rice+barium(3:1), solid rice+barium(3:1) (Fig. 3).

3 ,.,, (gold standard).,, VFSS. Ⅱ. H,, (nasogastric tube) , KMC-950 (Comed Medical System, Korea) ( Fig. 1). (, : 721, : 140, ) (Fig. 2). 2.2, VFSS.. 35% barium, yogurt+barium(3:1), liquid rice+barium(3:1), solid rice+barium(3:1) (Fig. 3). VFSS neck AP, neck LAT, chest spot,. barium, yogurt, liquid rice, solid rice,. (chin tuck), (head rotation), (head tilt), neck AP, neck LAT, chest spot., (nasogastric tube), (aspiration)

3050..,,, 4,, 3,,,,, 2. 0 100 100. VFSS, 10 2 1 VFSS (Table 1).

valleculae), (residue in pyriform sinuses), (coating of pharyngeal wall after swallow), (pharyngeal transit time) Factor Coded value Score Intact 0 Lip closure Inadequate 5 10 None 10 Intact 0 Bolus

4 3050..,,, 4,, 3,,,,, VFSS, VFSS (Table 1).. (lip closure), (bolus formation), (residue in oral cavity), (oral transit time), (triggering of pharyngeal swallow), (laryngeal elevation and epiglottic closure), (nasal penetration), (reside in valleculae), (residue in pyriform sinuses), (coating of pharyngeal wall after swallow), (pharyngeal transit time) Factor Coded value Score Intact 0 Lip closure Inadequate 5 10 None 10 Intact 0 Bolus formation Inadequate 3 6 None 6 Residue in oral cavity 10% % % 6 Oral transit time 1.5 sec sec 6 6 Triggering of pharyngeal swallow Normal 0 Delayed Laryngeal elevation and Normal 0 epiglottic closure Reduced Nasal penetration 10% % 8 50% Residue in valleculae 10% % 8 50% Residue in pyriform sinuses 10% % 8 50% Coating of pharyngeal wall after No 0 swallow Yes Pharyngeal transit time 1.0 sec sec 4 4 Total 100 *100점에가까울수록연하장애심각성을나타냄 SPSS VFSS 10 VFSS,

5 24case. Mann-Whitney test Ⅲ ±9.431, ± Mann-Whitney test <0.001 (Table 2). nasogastric tube state Mean±SD value nasogastric tube insert state nasogastric tube removal state 49.79± ±1.932 <0.001 *Mean 값이 100 점에가까울수록연하장애심각성을나타냄 Ⅳ., ( ),,,..,,,.,,,...,,,,,,. VFSS 40%60%. VFSS (manometry), (ultrasound), (video endoscopy), EGG (electroglottography), FEES (fiberoptic endoscopic evaluation of swalloing disorders). VFSS,,,,.,

. VFSS. 1900. 1930,,. (cinefluorography),...,...,.,.. (full digital), PACS.

6 . VFSS ,,. (cinefluorography),...,...,.,.. (full digital), PACS.. VFSS, (motility problems), (aspiration).,,,,. VFSS. VFSS. (AP) (lateral) (lateral). (AP). (lateral) (Fig. 4).,.,,.

7 B.S.Kwon, S.J.Lee, J.K.Hyun, I.S.Jung, S.T.Park, S.Y.Chung, Quantitative Evaluation of Dysphagia Using Scintigraphy, J.of Korean Acad. of Rehab. Med., Vol.23, No.4, pp , Jeri A.Logemann, Evaluation and Treatment of Swallowing Disorders -2e-, Seoul, HAKJISA, Ⅴ. VFSS. (nasogastric tube).,. Reference T.R.Han, N.J.Paik, J.W.Park, The functional Dysphagia Scale Using Videofluoroscopic Swallowing Study in Stroke Patients, J. of Korean Acad. of Rehab. Med., Vol.23, No.6, pp , J.W.Beom, T.R.Han, Treatment of dysphagia in patients with brain disorders, J. Korean Med Assoc., Vol.56, No.1, pp.7-15, S.J.Eun, S.G.Kim, J.R.Hong, The Usefulness of Video Fluoroscopic Swallowing Study in Post-Stroke Dysphagia Patients, The Korean Society of Radiology, Vol.4, No.3, pp.19-25, S.D.Youn, Comparison Study of the Results Videofluoroscopic Swallowing Study of according to Dysphagia Patients insertion Nasogastric Tube, Daegu University, 2008.

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar