9种吞咽障碍筛查量表准确性的网状Meta分析  

Bedside screening accuracy for elderly patients with dysphagia:a network meta-analysis

作　　者：郑晓娜[1] 陈秋华[1] 邵庭芳[1] 林烁[1] ZHENG Xiaona;CHEN Qiuhua;SHAO Tingfang;LIN Shuo

机构地区：[1]福建省立医院干部特诊二科48区

出　　处：《中华护理杂志》2019年第10期1561-1566,共6页Chinese Journal of Nursing

摘　　要：目的评价不同老年吞咽障碍床旁筛查量表对老年吞咽障碍患者的诊断价值,为准确筛查吞咽障碍患者提供依据。方法计算机检索Pubmed、Cochrane Library、Embase、中国知网、维普数据库、万方数据库中与老年吞咽障碍护理相关的床旁筛查量表研究。经过文献筛选、文献质量评估、资料提取后,采用Stata 15.0软件进行Meta分析。结果最终纳入16篇英文文献,4篇中文文献,共1970名受试者。Meta分析结果显示:与金标准相比,床旁筛查量表诊断灵敏度的合并点估计为[ES=1.503,95%CI(1.033,1.973),P<0.001];特异度的合并点估计为[ES=1.074,95%CI(0.633,1.515),P<0.001]。综合受试者工作特征曲线和秩次排序:不同工具的诊断灵敏度及特异度均存在差异,其中灵敏度较强的前3种筛查工具为两步骤饮水加强试验、巴恩斯-犹太医院中风吞咽困难筛查及柠檬酸咳嗽反射;特异性较强的前3种工具为进食评估问卷调查工具、两步骤饮水加强试验及柠檬酸咳嗽反射。结论床旁筛查量表中两步骤饮水加强试验的灵敏度较高,而进食评估问卷调查工具的特异度较高,该结论仍需大样本、多中心的研究进一步证明。Objective To evaluate the diagnostic value of bedside screening tools for elderly patients with dysphagia and provide evidence for standardized nursing.Methods Pubmed,Cochrane Library,Embase,CNKI,VIP database,and Wanfang database were electronically searched for literature about bedside screening tools for elderly patients with dysphagia.After literature screening,quality appraisal,data extraction,meta-analysis was performed using stata 15.0 software.Results A total of 16 English and 4 Chinese articles were included with 1970 subjects.Meta-analysis results showed that compared with the gold standard,the consolidation point of the diagnostic sensitivity of the bedside screening tool was estimated to be[ES=1.503,95%CI(1.033,1.973),P<0.001];the specificity of the combined point was estimated as[ES=1.074,95%CI(0.633,1.515),P<0.001].SROC curve and rank ordering showed there existed differences in diagnostic sensitivity and specificity of different tools.The top three screening tools with strong sensitivity were Two-Step Thickened Water Test,Barnes-Jewish Hospital Stroke Dysphagia Screen and Cough Test,while the top three screening tools with strong specificity were Eating Assessment Tool-10,Two-Step Thickened Water Test and Cough Test.Conclusion Among bedside screening tools,the sensitivity of Two-Step Thickened Water Test is highest,while the specificity of Eating Assessment Tool-10 is strongest.The results still need to be validated by large-sample,multi-center studies.

关 键 词：吞咽障碍 灵敏度 特异度 老年护理 网状Meta分析 

分 类 号：R47[医药卫生—护理学]