FEES联合DSS对卒中后咽反射消失吞咽障碍的诊断价值  

Diagnostic value of FEES combined with DSS for swallowing disorders in patients with post-stroke loss of pharyngeal reflex

作　　者：张莉 孙洁 唐艳[3] 高思宇 司徒功瑶 ZHANG Li;SUN Jie;TANG Yan;GAO Siyu;SITU Gongyao(Graduate School of Bengbu Medical College,Bengbu 233000,China;Xuzhou Central Hospital,Xuzhou 221009,China;The Second Clinical College,Xuzhou Medical University,Xuzhou 221009,China)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233000 [2]徐州市中心医院,江苏徐州221009 [3]徐州医科大学第二临床学院,江苏徐州221009

出　　处：《中国实用神经疾病杂志》2024年第2期170-175,共6页Chinese Journal of Practical Nervous Diseases

基　　金：江苏省老年健康科研项目(编号:LKM2022046);江苏省科技项目(编号:BE2020638);徐州市医学领军人才培养项目(编号:XWRCHT20210024)。

摘　　要：目的评估纤维鼻咽喉镜吞咽功能检查(FEES)联合视频透视吞咽造影(DSS)在卒中后咽反射消失患者中的应用价值。方法选取徐州市中心医院卒中后咽反射消失的住院患者90例,均进行FEES及DSS检查。结果(1)FEES与DSS对不同稠度食物误吸检出率的差异均无统计学意义(P>0.05)。(2)咽期FEES检查结果:咽期吞咽障碍40例,其中渗漏34例,误吸29例,梨状窝残留35例,会厌谷残留38例。咽期DSS检查结果:咽期吞咽障碍38例,其中渗漏34例,误吸27例,梨状窝残留31例,会厌谷残留35例。以FEES检查为金标准,DSS检查在渗漏、误吸、梨状隐窝残留及会厌谷残留方面的灵敏度分别为100.00%、93.10%、88.57%、92.11%,特异度高达100.00%。两种检查方法在评估咽期吞咽障碍上一致性较强,Kappa值为0.85。(3)FEES检查结果:咽部感觉障碍25例,咽肌收缩无力21例,Yale分级法3级及以上43例,咽部异常分泌10例。DSS检查结果:唇闭合障碍7例,咀嚼失用3例,口腔残留15例,舌骨上抬障碍15例,环咽肌开放障碍13例,食管蠕动异常2例。结论FEES与DSS对误吸检出率基本一致、咽期吞咽障碍检出一致性较强,DSS评估包括从口腔期到咽期到食道期,而FEES能直接观察咽期、咽部感觉及咽肌收缩,在卒中后咽反射消失病变中有不可替代的价值。两种检查方法联用既能相互佐证,又能相互补充。Objective To assess of the application value of flexible endoscopic evaluation of swallowing(FEES)combined with dynamic swallowing study(DSS)in patients with absent pharyngeal reflex after stroke.Methods Ninety inpatients with absent pharyngeal reflex after stroke in Xuzhou Central Hospital were selected and underwent FEES and DSS examination.Results There was no statistically significant difference(P>0.05)in the detection rates of different viscosity food aspiration between FEES and DSS.Results of pharyngeal FEES examination:40 cases of pharyngeal swallowing disorder,34 cases of penetration,29 cases of aspiration,35 cases of pyriform sinus retention,and 38 cases of valley of epiglottis residue.Results of pharyngeal DSS examination:38 cases of pharyngeal swallowing disorder,34 cases of penetration,27 cases of aspiration,31 cases of pyriform sinus retention,and 35 cases of valley of epiglottis residue.Using FEES examination as the gold standard,the sensitivity of DSS examination in leakage,aspiration,piriform recess residue and epiglottic residue was 100.00%,93.10%,88.57%,92.11%,respectively,and the specificity was up to 100.00%.The two examination methods showed strong consistency in evaluating pharyngeal swallowing disorders,with a Kappa value of 0.85.FEES detected 25 cases of pharyngeal sensory disorders,21 cases of pharyngeal muscle weakness,43 cases of Yale classification grade 3 or above,and 10 cases of pharyngeal abnormal secretion.DSS detected 7 cases of lip closure disorders,3 cases of masticatory dysfunction,15 cases of oral residue,15 cases of hyoid bone elevation disorder,13 cases of incomplete opening of the cricopharyngeal muscle,and 2 cases of esophageal peristalsis disorder.Conclusion FEES and DSS have a basic consistency in detecting aspiration rates and pharyngeal swallowing disorders,but DSS can evaluate from the oral phase to the pharyngeal phase to the esophageal phase,while FEES can directly observe the pharyngeal phase,pharyngeal sensory and muscle contractions,which have irreplaceable value

关 键 词：纤维内镜下吞咽功能检查 动态吞咽造影 脑卒中 咽反射消失 吞咽障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学]