Metrohealth评分在急性缺血性脑卒中患者吞咽障碍筛查中的应用研究  

Application of Metrohealth dysphagia screen in patients with acute ischemic stroke

作　　者：吴晓灵 王珏 黄振 刘天实 丁晶 黄新生 汪昕 Wu Xiaoling;Wang Jue;Huang Zhen;Liu Tianshi;Ding Jing;Huang Xinsheng;Wang Xin(Department of Neurology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Nursing,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Otolaryngology,Zhongshan Hospital,Fudan University,Shanghai 20032,China)

机构地区：[1]复旦大学附属中山医院神经内科,上海200032 [2]复旦大学附属中山医院护理部,上海200032 [3]复旦大学附属中山医院耳鼻喉科,上海200032

出　　处：《中华医学杂志》2021年第33期2594-2599,共6页National Medical Journal of China

基　　金：上海市科学技术委员会课题(17411953600,17411950105)。

摘　　要：目的比较Metrohealth评分与洼田饮水试验在急性缺血性脑卒中患者吞咽障碍筛查中的阳性率、灵敏度与特异度。方法选取2017年5月至2020年1月复旦大学附属中山医院神经内科住院格拉斯哥昏迷评分(GCS)15分的急性缺血性脑卒中患者270例,其中,男200例,女70例,年龄(65±12)岁。分别采用Metrohealth评分和洼田饮水试验进行吞咽障碍筛查,比较不同类型卒中、不同发病时期两种方法阳性率。选取其中55例患者完善金标准纤维内视镜吞咽功能检查(FEES),四格表法计算灵敏度、特异度以及与FEES结果一致性检验Kappa值。结果270例急性缺血性脑卒中患者中,Metrohealth评分吞咽障碍筛查阳性83例(30.7%),高于洼田饮水试验的76例(28.1%),但差异无统计学意义(P=0.371)。其中,前循环卒中组Metrohealth评分阳性53例(35.1%)、后循环卒中组阳性30例(25.2%),较洼田饮水试验的50例(33.1%)、26例(21.8%)差异亦均无统计学意义(均P>0.05)。发病3 d内、4~7 d、8~14 d急性缺血性脑卒中患者Metrohealth评分筛查阳性率分别为33.7%、29.8%、27.8%,而洼田饮水试验分别为31.7%、26.6%、25.0%,差异均无统计学意义(均P>0.05)。55例患者完善FEES,Metrohealth评分吞咽障碍筛查灵敏度为76.9%,特异度为73.8%,与FEES结果一致性检验Kappa值为0.418(P=0.001)。洼田饮水试验灵敏度为53.8%,特异度为78.6%,与FEES结果一致性检验Kappa值为0.300,一致性较差(P=0.025)。受试者工作特征曲线表明,Metrohealth评分曲线下面积为0.775,洼田饮水试验为0.686,差异无统计学意义(P=0.275)。结论Metrohealth评分无需饮水,安全易行,筛查能力与洼田饮水试验无明显差异,可早期应用于急性缺血性卒中患者吞咽障碍筛查。Objective To compare the positive detection rates,sensitivity and specificity of Metrohealth dysphagia screen(MDS)and Kubota water swallowing test in screening of dysphagia in patients with acute ischemic stroke.Methods Two hundred and seventy patients with acute ischemic stroke with Glasgow Coma Scale(GCS)score of 15 in the Department of Neurology,Zhongshan Hospital,Fudan university,from May 2017 to January 2020 were enrolled,including 200 males and 70 females,aged(65±12)years.All patients underwent MDS and Kubota water swallowing test respectively and the positive rates of the two methods were compared for different stroke subtypes and different onset periods.Fifty-five patients completed the golden standard test for dysphagia,flexible endoscopic examination of swallowing(FEES).Specificity and sensitivity of the two methods validated against FEES were calculated and compared.Results Eighty-three(30.7%)patients with acute ischemic stroke were detected with dysphagia by MDS and 76(28.1%)cases by Kubota water swallowing test,there was no statistical difference between two methods(P>0.05).Among them,53 cases(35.1%)were positive in MDS in the anterior circulation stroke group and 30 cases(25.2%)were positive in the posterior circulation stroke group,compared with 50 cases(33.1%)and 26 cases(21.8%)in Kubota water swallowing test respectively,and no statistically significant difference was observed between the two methods(both P>0.05).The positive rates of MDS in patients with acute ischemic stroke within 3 days,4-7 days,8-14 days after onset were 33.7%,29.8%and 27.8%,respectively,and it was 31.7%,26.6%,25.0%with Kubota water swallowing test(all P>0.05).Fifty-five patients completed FEES,the sensitivity,specificity of MDS for dysphagia screening against FEES was 76.9%and 73.8%,respectively.The Kappa value of the consistency test for MDS and FEES was 0.418(P=0.001).The sensitivity,specificity of Kubota water swallowing test was 53.8%and 78.6%,respectively.And the Kappa value of the consistency test for Kubota water sw

关 键 词：卒中 缺血性脑卒中 Metrohealth评分 吞咽障碍 洼田饮水试验 

分 类 号：R743.3[医药卫生—神经病学与精神病学]