碘海醇与硫酸钡两种造影剂在脑卒中后吞咽障碍患者吞咽造影检查中的应用

Application of iohexol and barium sulfate as contrast agents in swallowing angiography of patients with dysphagia after stroke

目的探讨碘海醇与硫酸钡两种造影剂在脑卒中后吞咽障碍患者电视荧光放射吞咽功能检查(VFSS)中的应用效果。方法选择2018年9月—2019年6月徐州医科大学附属医院康复科行VFSS的脑卒中后吞咽障碍患者71例为研究对象。依据随机数字表法将其分为硫酸钡组(36例)、碘海醇组(35例)。硫酸钡组采用硫酸钡为造影剂,碘海醇组采用碘海醇为造影剂。比较两组造影过程中渗漏-误吸程度以及两组吸入性肺炎的发生情况,并分析两种造影剂对吞咽功能障碍的治疗效果。结果两组患者第2次造影后Rosenbek渗漏-误吸量表(PAS)评分明显低于第1次造影后PAS评分,差异有统计学意义(P<0.05);两组患者PAS评分比较,差异无统计学意义(P>0.05)。硫酸钡组吸入性肺炎发生率高于碘海醇组,差异有统计学意义(P<0.05)。两组吞咽能力治疗效果比较,差异无统计学意义(P>0.05)。结论在VFSS检查中使用碘海醇作为造影剂不会降低吞咽造影检查的敏感性,且吸入性肺炎发生率低,不影响临床治疗。

Objective To investigate the application effect of iohexol and barium sulfate as contrast agents in video fluoroscopic swallowing study(VFSS)of patients with dysphagia after stroke.Methods From September 2018 to June 2019,71 patients with dysphagia after stroke who underwent VFSS in Department of Rehabilitation,Affiliated Hospital of Xuzhou Medical University were selected as study subjects.They were divided into barium sulfate group(36 cases)and iohexol group(35 cases)according to the random number table method.Barium sulfate group used barium sulfate as contrast agent,iohexol group used iohexol as contrast agent.The degree of leakage-aspiration during angiography and the incidence of aspiration pneumonia in two groups were compared,and the effects of two contrast agents on the treatment of swallowing dysfunction were analyzed.Results The penetration-aspiration scale(PAS)score after the second angiography in two groups was significantly lower than that after the first angiography,and the difference was statistically significant(P<0.05);but there was no significant difference in PAS score between two groups(P>0.05).The incidence of aspiration pneumonia in barium sulfate group was higher than that in iohexol group,and the difference was statistically significant(P<0.05).There was no significant difference in the treatment effect of swallowing ability between two groups(P>0.05).Conclusion The use of iohexol as contrast agent in VFSS does not reduce the sensitivity of swallowing angiography,and the incidence of aspiration pneumonia is low and does not affect clinical treatment.