药物诱导睡眠内镜VOTE评分一致性分析及影响因素探讨  

Consistency analysis and influencing factors of performing VOTE scores for drug-induced sleep endoscopy

作　　者：陈怀宏[1] 黄远授 董一女[3] 黄晓星[1] 鲁娟[1] 叶燕清 李湘平[1] Chen Huaihong;Huang Yuanshou;Dong Yinv;Huang Xiaoxing;Lu Juan;Ye Yanqing;Li Xiangping(Department of Otolaryngology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;the First Clinical Medical College of Southern Medical University,Guangzhou 510515,China;Department of Anesthesiology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院耳鼻咽喉科,广州510515 [2]南方医科大学第一临床医学院,广州510515 [3]南方医科大学南方医院麻醉科,广州510515

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第11期1043-1049,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨临床经验相当的2名医师之间对不同病情程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的腭咽、口咽、舌根和会厌(VOTE)评分一致性情况,并分析导致评分差异的影响因素。方法该研究为横断面研究。分析南方医科大学南方医院耳鼻咽喉科2014年12月至2018年7月64例OSAHS患者(男55例,女9例,年龄20~54岁)的术前药物诱导睡眠内镜(drug-induced sleep endoscopy,DISE)检查视频。由2名经验相当的医师单盲行VOTE评分,第3名研究者计算2名评分者间的Kappa值,并根据病例特征使用Fisher精确检验或卡方检验法进一步探讨影响评分一致性因素。结果将64例OSAHS患者依据病情严重程度分为轻度(7例)、中度(30例)、重度(18例)、极重度(9例)4组,并对2名评分者的评估结果行一致性检验。对于轻度OSAHS患者,腭咽及会厌平面的阻塞形态及程度的评估完全一致(Kappa值=1),但对该两个平面是否存在阻塞及口咽及舌根平面的阻塞情况(包括是否阻塞、阻塞形态及程度)的评估则无一致性(P>0.05)。对于中度OSAHS患者,2名评分者对腭咽平面的阻塞形态及程度一致性良好(0.61≤Kappa值≤0.80),在舌根及会厌平面阻塞程度的评估中无一致性(P>0.05),而对4个平面其余阻塞情况评估的一致性一般或中等(0.21≤Kappa值≤0.60)。在对重度OSAHS患者腭咽及会厌平面的评估中,2名评分者对是否存在阻塞的评估完全一致,但阻塞程度则无一致性。虽然口咽平面阻塞程度能达到良好的评估一致性,但对该平面是否阻塞的评估一致性一般。对重度OSAHS患者4个平面其他阻塞情况的评估中,2名评分者间的一致性中等或一般。在对极重度OSAHS患者的评估中,2名评分者在腭咽平面阻塞情况的评估完全一致,但对口咽及舌根平面的阻塞程度、会厌平面的阻塞形态及程度评估则无一致性。而4个平面其他阻塞情况的评估一致性良好或中等。Objective To investigate the consistency of Velum,Oropharygneal,Tongue base,Epiglottis(VOTE)scores between two surgeons with similar clinical experience in obstructive sleep apnea hypopnea syndrome(OSAHS)patients with different degree of disease,and to analyze the influencing factors leading to the difference in score.Methods This was a cross-sectional study.64 preoperative drug-induced sleep endoscopy(DISE)videos of OSAHS patients during December 2014 to July 2018,from Nanfang Hospital,Southern Medical University were analyzed.The VOTE score was assessed single-blind by two similar experienced surgeons,and the Kappa value between the two scorers was calculated by the third researcher.According to the characteristics of the case,Fisher's exact test or chi-square test method was used to further explore the factors that influenced the consistency.Results Sixty-four patients were divided into four groups according to the severity of the disease,including mild(7 cases),moderate(30 cases),severe(18 cases),and extremely severe(9 cases).The scores evaluated between two researchers were analysed for consistency.For mild patients,the two scorers were completely consistent in the configuration and degree of obstruction in the velum and epiglottis(Kappa=1).There was no agreement on whether obstruction or not,obstructed configuration,obstructed degree of the oropharynx and tongue base,and presence of velum and epiglottis obstruction.For moderate patients,the two scorers had a good consistency in the configuration and degree of the velum(0.61≤Kappa≤0.80),and there was no consistency in the evaluation of the degree of tongue base and epiglottis(P>0.05).The consistency of the remaining obstructed conditions in the four planes was generally or moderate(0.21≤Kappa≤0.60).For patients with severe OSAHS,the two raters were completely consistent in the evaluation of palatopharyngeal and epiglottic planes for the presence of obstruction,but there was no consistency in the degree of obstruction.Although the degree of obstructio

关 键 词：睡眠呼吸暂停 阻塞性 药物诱导睡眠内镜 VOTE分型 扁桃体分度 

分 类 号：R766[医药卫生—耳鼻咽喉科]