摘要
目的探讨吞咽障碍的评估方法。方法回顾性分析2010年6月至2012年7月间诊治的37例吞咽障碍患者的临床资料。神经系统疾病12例，咽食管入口部因素14例，头颈部恶性肿瘤及咽部反复溃疡放疗后远期吞咽障碍6例，无明显原因5例。评估方法包括：洼田饮水试验、藤岛吞咽障碍评价标准评估、吞咽造影检查（videofluoroscopic swallowing study，VFSS）和内镜吞咽检查（fibroptic endoscopic evaluation of swallowing，FEES）。结果洼田饮水试验有14例（14／37）表现为异常；吞咽障碍评价标准异常为29例（29／37）；VFSS误吸评分异常为27例（27／37），VFSS吞咽困难评分异常为33例（33／37），FEES评估异常为19例（19／21）。洼田饮水试验、吞咽障碍评价标准与VFSS之间一致性分析的Kappa值分别为0．137和0．416。以VFSS为评价“金标准”，FEES评价喉渗漏或误吸的敏感度、特异度、阳性预测值和阴性预测值分别为88．9％，66．7％，94．1％和50．0％。结论洼田饮水试验和吞咽障碍评价标准可用于临床筛查和效果初评，使用方便；VFSS和FEES能精确评估吞咽障碍性质、部位及程度。多种评估方法的联合运用是吞咽障碍的诊治的最首墨依据．
Objective To explore the assessment methods of dysphagia. Methods The data of 37 patients with dysphagia were retrospectively analyzed. These patients took the Kubota drinking test, Tengdao＇s evaluation, videofluoroscopic swallowing study （ VFSS ） and fibroptic endoscopic evaluation of swallowing （FEES）. Results Fourteen out of thirty-seventh patients showed abnormal results during Kubota drinking test. Tengdao＇s evaluation results showed that 29/37 patients were abnormal. There 27/37 and 33/37 patients showed abnormalities in positive-aspiration score and swallow dysfunction score of VFSS. The number of abnormal patients in aspiration score of FEES was 19/21. The Kappa values were 0. 137, O. 416 between Kubota drinking test. Tengdao＇s evaluation and VFSS. The FEES was measured against the VFSS for sensibility, specificity, positive predictive value, and negative predictive value, the values were 88.9%, 66.7%, 94.1% and 50.0%. Conclusions Kubota drinking test and Tengdao＇s evaluation can be applied for screening purpose and evaluating result after treatment; VFSS and FEES can be used as more accurate assessments, they can study the dysphagia＇s character, position and severity. The combination of a variety of dysphagia evaluation methods is the most important basis for diagnosis and treatment of deglutition disorders.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2012年第11期889-893,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
吞咽障碍
诊断技术和方法
Deglutition disorders
Diagnostic techniques and procedures
