Tempo de trânsito oral e estado nutricional na criança e adolescente com acometimento neurológico e indicação de gastrostomia.
Carregando...
Arquivos
Data
2018-04-16
Autores
Afonso, Débora [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A disfagia orofaríngea na criança e adolescente com acometimento neurológico (CAAN) é um sintoma frequente que pode ocasionar desnutrição e complicações pulmonares. Objetivo: Esse estudo teve por objetivo comparar o tempo de trânsito oral total (TTOT) em CAAN com e sem indicação de gastrostomia e correlacionar com o estado nutricional. Método: Foram analisados 64 exames de videofluoroscopia de deglutição do período de 2012 a 2017 de CAAN com disfagia orofaríngea. Destes, foram incluídos os 29 exames com 30 frames e qualidade de imagem adequada, independente do gênero ou faixa etária, com Sistema de Classificação da Função Motora Grossa (GMFCS) que variou de I a IV em 13 indivíduos e os demais com GMFCS desconhecido. Foram constituídos dois grupos. O grupo 1 (G1) foi composto de CAAN com indicação de gastrostomia por equipe interdisciplinar e o grupo 2 (G2) chamado de grupo controle foi composto de CAAN que não receberam a indicação de gastrostomia pela mesma equipe. Realizada análise quantitativa do TTOT com software específico nas consistências pastosa e líquida, no volume de 5 ml na colher e fluxo contínuo habitual de líquido na mamadeira. Realizado teste de confiabilidade entre julgadores por meio do Coeficiente de Correlação Intraclasse. Foi avaliado o estado nutricional por meio da classificação de z-score. Para análise estatística foi utilizado o teste de MannWhitney e o Teste de Spearman. Resultado: Constatou-se TTOT mais longo com diferença estatística significante no G1 (p=0,029), nas consistências pastosa (4.124,54ms) e líquida (5.348,50ms) quando ofertado na colher, do que no G2 (p=0,058), respectivamente, (1.998,30ms) e (640,42ms). Não houve correlação entre TTOT e z-score nos grupos, sendo os valores de correlação para o G1 -0,254 (p=0,451) na consistência pastosa, -0,211 (p=0,789) na consistência líquida na colher e 0,144 (p=0,758) na consistência líquida na mamadeira. Já para o G2 foram encontrados os valores de correlação -0,248 (p=0,520) na consistência pastosa, 0,527 (p=0,361) na consistência líquida na colher e -0,064 (p=0,881) na consistência líquida na mamadeira. Conclusão: O tempo de trânsito oral total na consistência pastosa em crianças e adolescentes com acometimento neurológico com indicação de gastrostomia foi mais longo do que em crianças e adolescentes com acometimento neurológico que não tinham indicação de gastrostomia. Não houve correlação entre o TTOT e o estado nutricional em ambos os grupos.
Introduction: Oropharyngeal dysphagia in children and teenager with neurological impairment (CTNI) is a frequent symptom that can lead to malnutrition and pulmonary complications. Purpose: This study aimed to compare total oral transit time (TOTT) in CTNI with and without indication of gastrostomy and to correlate with nutritional status. Method: We analyzed 64 swallowing videofluoroscopy exams of the CTNI with oropharyngeal dysphagia from 2012 to 2017. Of these, 29 were included with 30 frames, regardless of gender or age group, with GMFCS, which ranged from I to IV in 13 individuals and the others with unknown GMFCS. Two groups were composed. Group 1 (G1) was included of CTNI with indication of gastrostomy by interdisciplinary team and control group 2 (G2) was included of CTNI who did not receive an indication of gastrostomy by the same team. The TOTT was analyzed by of specific software using paste and liquid consistency, in the 5 ml volume in the spoon and habitual continuos flow of liquid in the bottle. A reliability test was performed among the judges using the Intraclass Correlation Coefficient. Nutritional status was assessed by z-score classification. For statistical analysis were used the Mann Whitney test and the Spearman test. Results: A longer TOTT was observed with a significant statistical difference in G1 (p = 0.029), paste consistency (4.124.54ms) and liquid (5.348,50ms) when offered in the spoon, than in G2 (p = 0.058), respectively, (1.998.30ms) and (640.42ms). There was no correlation between TTOT and z-score in the groups, and the correlation values for G1 -0.254 (p = 0.451) in the paste consistency, -0.211 (p = 0.789) in the liquid consistency in the spoon and 0.144 (p = 0.758) in the liquid consistency in the bottle. For G2, correlation values were found -0.248 (p = 0.520) in the paste consistency, 0.527 (p = 0.361) in the liquid consistency in the spoon and -0.064 (p = 0.881) in the liquid consistency in the bottle. Conclusion: The total oral transit time in paste consistency in children and teenager with neurological impairment with indication of gastrostomy was longer than in children and teenager with neurological impairment who had no indication of gastrostomy. There was no correlation between TOTT and nutritional status in both groups.
Introduction: Oropharyngeal dysphagia in children and teenager with neurological impairment (CTNI) is a frequent symptom that can lead to malnutrition and pulmonary complications. Purpose: This study aimed to compare total oral transit time (TOTT) in CTNI with and without indication of gastrostomy and to correlate with nutritional status. Method: We analyzed 64 swallowing videofluoroscopy exams of the CTNI with oropharyngeal dysphagia from 2012 to 2017. Of these, 29 were included with 30 frames, regardless of gender or age group, with GMFCS, which ranged from I to IV in 13 individuals and the others with unknown GMFCS. Two groups were composed. Group 1 (G1) was included of CTNI with indication of gastrostomy by interdisciplinary team and control group 2 (G2) was included of CTNI who did not receive an indication of gastrostomy by the same team. The TOTT was analyzed by of specific software using paste and liquid consistency, in the 5 ml volume in the spoon and habitual continuos flow of liquid in the bottle. A reliability test was performed among the judges using the Intraclass Correlation Coefficient. Nutritional status was assessed by z-score classification. For statistical analysis were used the Mann Whitney test and the Spearman test. Results: A longer TOTT was observed with a significant statistical difference in G1 (p = 0.029), paste consistency (4.124.54ms) and liquid (5.348,50ms) when offered in the spoon, than in G2 (p = 0.058), respectively, (1.998.30ms) and (640.42ms). There was no correlation between TTOT and z-score in the groups, and the correlation values for G1 -0.254 (p = 0.451) in the paste consistency, -0.211 (p = 0.789) in the liquid consistency in the spoon and 0.144 (p = 0.758) in the liquid consistency in the bottle. For G2, correlation values were found -0.248 (p = 0.520) in the paste consistency, 0.527 (p = 0.361) in the liquid consistency in the spoon and -0.064 (p = 0.881) in the liquid consistency in the bottle. Conclusion: The total oral transit time in paste consistency in children and teenager with neurological impairment with indication of gastrostomy was longer than in children and teenager with neurological impairment who had no indication of gastrostomy. There was no correlation between TOTT and nutritional status in both groups.
Descrição
Palavras-chave
Paralisia cerebral, Síndrome genética, Transtornos de deglutição, Criança, Análise quantitativa, Tempo, Cerebral palsy, Deglutition disorders, Children, Fluoroscopy, Quantitative analysis, Time