下颌内收动作对预防机械性或神经源性吞咽困难成人喉部渗漏/误吸的效果：一项系统综述

文献信息

中文摘要

下颌内收动作是一种用于处理吞咽困难个体喉部误吸的代偿技术。然而，其有效性及应用的临床标准仍不明确。本系统综述旨在评估下颌内收动作对预防机械性（即结构性或解剖性改变，如肿瘤、术后改变或纤维化）或神经源性吞咽困难成人喉部渗漏/误吸的效果。遵循PRISMA指南并在PROSPERO数据库注册，对PubMed Central、SciELO、Cochrane Library、Lilacs和EBSCOHost数据库进行了无时间限制的系统检索。纳入以英语、法语、葡萄牙语和西班牙语发表的研究。两名独立研究者筛选文献、提取数据，并使用Rayyan®软件进行分析。方法学质量采用Joanna Briggs研究所批判性评价工具和牛津循证医学中心证据等级进行评估。共纳入16项研究（13项分析性横断面研究、2项随机对照试验和1项队列研究），偏倚风险从低到高不等。10项研究报告该动作具有积极效果，成功率范围为19.6%至81%。识别出若干可能影响其有效性的因素，包括吞咽启动时间、生物力学参数、食团特征和患者相关变量。关于下颌内收动作可能在何种临床条件下有效，尚无共识。现有证据不一，且总体为低至极低确定性。某些变量可能影响其有效性；然而，这些发现应被视为产生假设而非确定性结论。在获得更强证据之前，临床医生在推荐下颌内收动作时应谨慎，并确保患者接受个体化评估以确定其是否可能获益。

英文摘要

The chin-down maneuver is a compensatory technique used to address laryngeal aspiration in individuals with dysphagia. However, its effectiveness and the clinical criteria for its application remain unclear. This systematic review aimed to evaluate the effects of the chin-down maneuver on preventing laryngeal penetration/aspiration in adults with mechanical (i.e., structural or anatomical alterations such as tumors, postsurgical changes, or fibrosis) or neurogenic dysphagia. Following the PRISMA guidelines and registration in the PROSPERO database, a systematic search was conducted in the PubMed Central, SciELO, Cochrane Library, Lilacs, and EBSCOHost databases, with no temporal restrictions. Studies published in English, French, Portuguese, and Spanish were included. Two independent researchers screened the literature, extracted the data, and conducted the analysis using Rayyan® software. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools and the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Sixteen studies were included (13 analytical cross-sectional studies, two randomized controlled trials, and one cohort study), with the risk of bias ranging from low to high. Ten studies reported positive effects of the maneuver, with success rates ranging from 19.6% to 81%. Several factors were identified as potentially influencing its effectiveness, including the time of swallow initiation, biomechanical parameters, bolus characteristics, and patient-related variables. There is no consensus regarding the clinical conditions under which the chin-down maneuver may be effective. The available evidence is mixed and generally of low to very low certainty. Some variables may influence its effectiveness; however, these findings should be regarded as hypothesis-generating rather than definitive. Until stronger evidence becomes available, clinicians should exercise caution when recommending the chin-down maneuver and ensure that patients undergo individualized assessment to determine whether they are likely to benefit.