Improvement On The Method Of Detecting The Aspiration Of Radionuclide Imaging And The Study On The Method Of Bedside Screening Aspiration By Using Edible Pigment

?Rationale and objectives?Aspiration refers to solid food,fluid,oropharyngeal secretions,or stomach contents through the glottis into the lower respiratory tract.After aspiration can appear cough,wheezes,and even suffocation crisis life,can also have no discomfort.According to whether or not to have a cough after aspiration,it can be divided into explicit aspiration and silent aspiration.At present,the aspiration of the bedside assessment and inspection instrument check,because the bedside assessment of silent aspiration missed diagnosis,clinically silent aspiration is recognized as the "gold standard" barium swallow videofluoroscopy(VFSS),endoscopy swallowing assessment(FEES)and radionuclide imaging.The sensitivity of the first two methods was consistent with the assessment of swallowing initiation delay,penetration,aspiration,and residue after swallowing.Langmore found that the concordance rate is90% between the FEES and VESS in 1991,but Abtin Tabaee retrospective analysis the data of 54 patients with VFSS and FESS during the same period of 2 weeks,and the agreement was only 52%.It is suggested that the diagnostic significance of the two methods for aspiration is controversial,and it is necessary to find a more ideal method in the detection of aspiration.In 2012,our research group has established "^99Tc^msulfur colloid salivagram method and using this method on acute exacerbations of chronic obstructive pulmonary aspiration screening,after 3 years of 53 cases were survival analysis found that screening patients with aspiration,aspiration in patients with the risk of death was 2 times that of the non aspiration patients,though there is no relevant assessment of the accuracy of radionuclide aspiration reports,but the Baikie were compared with barium swallow X-ray imaging detection sensitivity and salivary aspiration salivagram was higher in 63 of 14 months-16 years old children with cerebral palsy,and that the continuous titration and aspiration of the reliability of image scanning detection is higher.Anterograde aspiration is also associated with nasopharyngeal secretions,in addition to oropharyngeal secretions and food intake.The past has been reported during the detection of patients with disturbance of consciousness and normal people sleep at night of nasopharyngeal secretion aspiration using radionuclide examination method,and in the presence of rhinitis or sinusitis nasal secretion for patients with silent aspiration may occur at any point in time and at different positions.In 2013,we set up a new method to detect the nasopharyngeal secretions with radionuclide imaging.We use this method to detect 32 cases of pneumonia inpatients,19 of them have a stuffy nose or runny nose,16 people tested positive for aspiration,without nasal symptoms of pneumonia patients only 3 cases of aspiration were detected.Further examination of the radionuclide aspiration reliability.At present,we are the first group to carry out the study of radionuclide aspiration.In order to popularize this method in clinic,we need to improve this method.The contents include examination time span?posture and repetitiveness.At the same time,in order to reduce the workload and the burden of patients,we propose to establish a simple and highly specific method of aspiration screening.In addition,retrospective analysis of survival was performed in patients who underwent radionuclide testing to investigate the effect of aspiration on long-term survival in patients with COPD.Therefore,the study included two parts:Section 1:The effect of observation time and postural changes on the results of radionuclide aspiration test and the repetitiveness of the results.Section 2 : The study on the method of bedside screening by using edible pigment.Section 1:The effect of observation time and postural changes on the results of radionuclide aspiration test and the repetitiveness of the results.?Objective?To improve the method of detecting the aspiration of radionuclide imaging and the contents include examination time span?posture and repetitiveness.?Method?Continuously selection 166 inpatients with AECOPD from department of respiration ward in the First Affiliated Hospital of Guangzhou Medical University during the period between August 2014 and December 2016 and all recruited patients are evaluated aspiration with99Tcm-sulfur colloid imaging.(To mimic increasing nasopharyngeal secretion by dripping saline into nasal pharynx.A dose of 111.0 MBq99Tcm-sulfur colloid was diluted in 24 m L of saline,and then the mixture was dripped into nasal pharynx of volunteer by 24ml/h.Dynamic imaging from the mouth to the stomach was acquired by SPECT/CT).Step one is supine position with pillow for 6cm altitude,and step two is sitting position immobile or Bicycle seat,the testing time is30 min respectively.Firstly,a patient with supine position accept dynamic scanning for30 min,if the result is aspiration positive and we would stop the test,as a result we would continue 5min static scanning.Secondly we devided the patients with aspiration negative in the first test into three groups(A.continue supine position for 30min;B.seat immobile for 30min;C.Bicycle seat for 30min),and at the end of intranasal instillation all subjects are performed 5min static scanning.The patient who would be in hospital next time shoule be examined in the same way.?Results?66 patients with AECOPD are aspiration positive in the first step.The others have been devided into 3 groups by table of random number.A group,B group,C group were 33,35,and 32;The number of aspiration positive was 0,9,11.There was significant difference between the 3 groups(x~2=13.097,p=0.001),and also A group between B group,A group between C group(x~2=9.78,13.655;p=0.002,0.000).But there was no significant difference between B group and C group(x~2=0.599,p=0.439).12 patients underwent a repeat test,7 cases were positive and 4cases were negative in the two inspection,only 1 patient didn't aspirate in the first test but aspirated in the second time;Mc Nemar(M)consistency test Kappa value was0.82(U=5.05,p<0.001).?Conclusion?It is not possible to increase the detection rate of aspiration by extending the time of supine position by 99Tcm-sulfur colloid imaging.However,the incidence of aspiration can be increased by changing to sitting position whether or not active limbs.Radionuclide imaging detection of aspiration is recommended to lie supine pillow 30min and delayed 5min image acquisition,for the negative results suggest changing the position to continue to check to reduce missed diagnosis.Radionuclide has a strong repeatability for the detection of aspiration,and should be clinically applicated as a screening method for evaluating aspiration.Section 2: The study on the method of bedside screening aspiration by using edible pigment?Objective?To explore the method of bedside screening aspiration by using edible pigment.?Method?Patients suspected dysphagia admitted to the First Affiliated Hospital of Guangzhou Medical University during the period between August 2016 and March2017 accepted to evaluate aspiration with radionuclide salivary scintigraphy.Of course we mixed edible pigment with nuclide liquid.We colected their clinical data synchronously and screened simply with Kubota water swallow test(KWST).Sputum color was observed before the examination.After the end of salivary scintigraphy test,the patient was instructed to clean the oropharyngeal and esophageal residues.Then cough expectoration would performed after half an hour,and sputum color was observed within 2 hours.The sputum color before and after the examination would be compared to determine aspiration or not aspiration.Feasibility ? sensibility and specificity were analysed in order to establish a simple bedside aspiration test.?Results?1.General information33 patients participated in our study,the male and female were 28 and 5,respectively;range from 50-90 years old,mean(68.1±11.4)years.2.The KWST results17 subjects were in Grade 1,11 in Grade 2,1 in Grade 3,4 in Grade 4.3.The results of radionuclide and edible pigment aspiration test :4 cases are positive in Radionuclide imaging,and 6 subjects showed positive sputum color.There are 3 people are positive in all two methods of aspiration assessment.4.Correlation analysis between KWST and Radionuclide aspiration test In the KWST,Grade 1 is normal,Grade 2 is characterized as suspicious aspiration and Grade 3 or above was identified as abnormal.17 participants pass and16 failed the KWST.Sensibility for predicing aspioration status during Radionuclide imaging=50%,specifity = 51.7%,and consistency=0.008(U=0.045,p>0.05).5.Correlation analysis between edible pigment test and Radionuclide aspiration test For edible pigment,Sensibility for predicing aspioration status during Radionuclide imaging=75%,specifity = 89.7%,Positive likelihood ratio= 7.25,Negative likelihood ratio=0.279,consistency=0.532(U=3.28,p<0.025),moderately consistent.?Conclusion?1.KWST is unsuitable for aspiration census because of its low sensibility and specifity.2.The method of edible pigment as a measure of bedside aspiration assessment is feasible.But the sensibility is lower.3.we propose to combine it with the 3 oz water test.If the sputum mixed with edible pigment,we diagnosed positive for aspiration;If the 3 oz water test is aspiration positive and food pigment is negative,we should suggest further radionuclide imaging to make a definite diagnosis.