摘要
目的探讨二维超声评估脑卒中后神经源性吞咽功能障碍患者梨状隐窝残留的临床应用价值。方法选取我院脑卒中后神经源性吞咽功能障碍患者47例,依据X线下吞咽造影(VFSS)检查结果将其分为轻度残留组18例(VFSS 1级)、中度残留组(VFSS 2级)19例、重度残留组(VFSS 3级)10例,比较各组及左、右侧二维超声参数(梨状隐窝面积、高回声区域面积、高回声区域百分比)的差异。采用Kendall’s tau-b相关分析法分析二维超声参数与VFSS分级的相关性。绘制受试者工作特征(ROC)曲线分析二维超声参数评估吞咽功能障碍患者梨状隐窝中度及以上残留的诊断效能。结果各组梨状隐窝高回声区域面积及高回声区域百分比比较差异均有统计学意义(均P<0.05);轻度残留组梨状隐窝高回声区域面积及高回声区域百分比均小于中、重度残留组,差异均有统计学意义(均P<0.05);中、重度残留组上述参数比较差异均无统计学意义。各组梨状隐窝面积及左、右侧二维超声参数比较差异均无统计学意义。Kendall’s tau-b相关性分析显示,高回声区域百分比与VFSS分级呈正相关(Kendall’s tau-b=0.471,P<0.001),高回声区域面积与VFSS分级无相关性。ROC曲线分析显示,高回声区域面积及高回声区域百分比的截断值分别为0.29 cm^(2)、42.24%时,其评估吞咽功能障碍患者梨状隐窝中度及以上残留的曲线下面积分别为0.798(95%可信区间0.655~0.901,P<0.001)、0.841(95%可信区间0.705~0.931,P<0.001)。结论二维超声可有效评估脑卒中后神经源性吞咽功能障碍患者梨状隐窝残留情况,具有一定的临床应用价值。
Objective To investigate the clinical application value of two-dimensional ultrasound in assessing pyriform sinus residue in patients with post-stroke neurogenic dysphagia.Methods A total of 47 patients with post-stroke dysphagia diagnosed in our hospital were enrolled,according to videofluoroscopic swallowing study(VFSS)results,and they were classified into mild-residual group(VFSS grading 1,18 cases),moderate-residual group(VFSS grading 2,19 cases),and severe-residual group(VFSS grading 3,10 cases).The differences of left and right sides in two-dimensional ultrasound parameters(pyriform sinus area,hyperechoic area,and percentage of hyperechoic area)among groups were compared.Kendall’s tau-b correlation analysis was performed to assess the correlation between two-dimensional ultrasound parameters and VFSS grading.Receiver operating characteristic(ROC)curves were drawn to evaluate the diagnostic performance of two-dimensional ultrasound parameters in assessing moderate-to-severe pyriform sinus residue in patients with dysphagia.Results There were significant differences in hyperechoic area and percentage of hyperechoic area of the pyriform sinus among groups(all P<0.05).The mild-residual group had smaller hyperechoic area and lower percentage of hyperechoic area than those in the moderate-and severe-residual groups(all P<0.05).There were no significant difference in above parameters between the moderate-and severeresidual groups.There were no significant differences in pyriform simus area among groups,as well as two-dimensional ultrasound parameters between the left and right sides of the pyriform sinus.Kendall’s tau-b correlation analysis showed a positive correlation between percentage of hyperechoic area and VFSS grading(Kendall’s tau-b=0.471,P<0.001),whereas hyperechoic area was not correlated with VFSS grading.ROC curve analysis showed that the cutoff values for hyperechoic area and percentage of hyperechoic area in assessing moderate-to-severe pyriform sinus residue were 0.29 cm²and 42.24%,respectively,with the area under the curves of 0.798(95%CI:0.655-0.901,P<0.001)and 0.841(95%CI:0.705-0.931,P<0.001),respectively.Conclusion Two-dimensional ultrasound can effectively assess pyriform sinus residue in patients with post-stroke neurogenic dysphagia,which has certain clinical application value.
作者
孙梦伟
肖春莹
周剑宇
SUN Mengwei;XIAO Chunying;ZHOU Jianyu(Department of Ultrasound,Taizhou Central Hospital,Taizhou University Hospital,Taizhou 318000,China)
出处
《临床超声医学杂志》
2025年第12期1037-1041,共5页
Journal of Clinical Ultrasound in Medicine
关键词
超声检查
脑卒中
梨状隐窝
咽后残留
高回声区域
Ultrasonography
Stroke
Pyriform sinus
Pharyngeal residue
Hyperechoic area
