鼻胃管对咽部吞咽的影响：一项针对神经源性吞咽困难的前瞻性配对FEES研究

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中文摘要

背景： 鼻胃管（NGT）喂养广泛用于神经源性吞咽困难的短期肠内营养，但其对咽部吞咽生理的影响尚不完全清楚。
目的： 使用柔性内镜吞咽评估（FEES）评估NGT存在对咽部残留和气道保护的影响。
方法： 在这项前瞻性前后对照研究中，53例留置NGT（≥15天）的神经源性吞咽困难患者在管在位时及拔管后30分钟内，于IDDSI 1、3和5级稠度下接受FEES。残留采用Yale咽部残留严重程度评定量表分级，气道侵入采用渗透-误吸量表（PAS）评估；比较采用Wilcoxon符号秩检验和McNemar精确检验。
结果： 拔除NGT后，所有稠度下的会厌谷和梨状窦残留均显著减少（p < 0.001；r = 0.600-0.748），PAS改善（p < 0.001；r = 0.468，95% CI 0.226-0.655）；气道侵入发生率从37.7%降至15.1%。20例患者中12例（60%）侵入消失；无新发侵入（p = 0.0005）。年龄与结局无显著关联。
结论： 拔除NGT后残留和气道安全性改善，与NGT对吞咽的不良影响相符，但固定顺序设计无法确定因果关系。
意义： 在可行的情况下，可考虑早期重新评估和及时拔除NGT。

英文摘要

BACKGROUND: NGT feeding is widely used for short-term enteral nutrition in neurogenic dysphagia, but its effect on pharyngeal swallowing physiology is incompletely understood.
OBJECTIVE: To evaluate the effect of NGT presence on pharyngeal residue and airway protection using flexible endoscopic evaluation of swallowing (FEES).
METHODS: In this prospective before-after study, 53 patients with neurogenic dysphagia and indwelling NGT (≥15 days) underwent FEES with tube in situ and within 30 min of removal, at IDDSI 1, 3, and 5. Residue was graded using the Yale Pharyngeal Residue Severity Rating Scale and airway invasion using the Penetration-Aspiration Scale (PAS); comparisons used Wilcoxon signed-rank and McNemar exact tests.
RESULTS: NGT removal significantly reduced vallecular and pyriform sinus residue across all consistencies (p < 0.001; r = 0.600-0.748) and improved PAS (p < 0.001; r = 0.468, 95% CI 0.226-0.655); airway invasion prevalence fell from 37.7% to 15.1%. Invasion resolved in 12/20 patients (60%); none developed new invasion (p = 0.0005). Age was not significantly associated with outcomes.
CONCLUSION: Residue and airway safety improved after NGT removal, compatible with an adverse influence of NGT on swallowing, though the fixed-order design cannot establish causality.
SIGNIFICANCE: Early reassessment and timely NGT removal, when feasible, may be considered.