软管喉镜吞咽功能评估在吞咽障碍患者渗漏和误吸诊断中的价值  

Clinical application of flexible endoscopic evaluation of swallowing in diagnosing penetration and aspiration in patients with dysphagia

作　　者：徐涵 顾琳 雷茵 严琳 陈玲 高怡 武军 XU Han;GU Lin;LEI Yin;YAN Lin;CHEN Ling;GAO Yi;WU Jun(Department of Rehabilitation Medicine,Shanghai Ruijin Rehabilitation Hospital,Shanghai 200023,China)

机构地区：[1]上海市瑞金康复医院康复医学科,上海200023

出　　处：《安徽医学》2025年第2期161-166,共6页Anhui Medical Journal

基　　金：上海市卫健委卫生行业临床研究专项面上项目(编号:202240203);上海市黄浦区卫生健康系统专业人才梯队建设项目(编号:2023GG05)。

摘　　要：目的 探讨软管喉镜吞咽功能评估在吞咽障碍患者渗漏和误吸诊断中的价值。方法 回顾性分析2022年1~12月在上海市瑞金康复医院住院的102例吞咽障碍患者资料,所有患者均进行吞咽造影检查(VFSS)及软管喉镜吞咽功能评估(FEES),分别观察患者吞咽5 mL液体、花蜜状、布丁状3种食团时的录像视频以进行渗漏-误吸量表分级,对比FEES与金标准VFSS的渗漏、误吸检出率差异。使用Kappa一致性检验比较FEES与VFSS诊断渗漏、误吸的一致性,同时进一步分析在中枢神经系统疾病中2种方法评估渗漏、误吸的一致性。结果 FEES诊断5 mL液体、花蜜状、布丁状食团的渗漏、误吸检出率与VFSS基本一致(P=0.807、0.199、0.513、0.350、0.978、0.308)。经Kappa一致性检验,2种方法诊断5 mL液体、花蜜状、布丁状食团的渗漏、误吸Kappa值分别为0.758、0.784、0.920、0.790、0.961、0.882(P均<0.05)。在中枢神经系统疾病所致吞咽障碍中,FEES诊断5 mL液体、花蜜状、布丁状食团的渗漏、误吸检出率与VFSS基本一致(P=0.883、0.564、0.884、0.291、0.473、0.886)。FEES与VFSS诊断5 mL液体、花蜜状、布丁状食团的渗漏、误吸Kappa值分别为0.806、0.917、0.979、0.751、0.897、0.979(P均<0.05)。结论 FEES在诊断5 mL液体、花蜜状及布丁状食团的渗漏、误吸情况和金标准VFSS存在较好的一致性。Objective To investigate the clinical application of flexible endoscopic evaluation of swallowing in diagnosing penetration and aspiration in patients with dysphagia.Methods From January to December 2022,102 patients with dysphagia who were hospitalized in Shanghai Ruijin Rehabilitation Hospital and underwent both video fluoroscopic swallowing study(VFSS)and fiberoptic endoscopic examina-tion of swallowing(FEES).Videos were observed of patients swallowing three types of boluses:5 mL of liquid,nectar-like consistency,and pudding-like consistency,to grade penetration and aspiration using the penetration-aspiration scale.The detection rates of penetration and as-piration by FEES were compared with those of the gold standard VFSS.The kappa statistic was used to assess the agreement between FEES and VFSS in diagnosing leakage and aspiration.Additionally,a further analysis was conducted on the consistency of the two methods in assessing penetration and aspiration in patients with central nervous system diseases.Results The detection rates of penetration and aspiration for 5 mL liquid,nectar-like,and pudding-like boluses diagnosed by FEES were essentially consistent with those of VFSS(P=0.807,0.199,0.513,0.350,0.978,0.308).The kappa value for diagnosing penetration and aspiration of 5 mL liquid,nectar-like,and pudding-like boluses by the two methods was 0.758,0.784,0.920,0.790,0.961,0.882 respectively(all P<0.05)as determined by the Kappa consistency test.In dysphagia caused by central nervous system diseases,the detection rates of penetration and aspiration for 5 mL liquid,nectar-like,and pudding-like bo-luses diagnosed by FEES were essentially consistent with those of VFSS(P=0.883,0.564,0.884,0.291,0.473,0.886).The kappa value for di-agnosing penetration and aspiration of 5 mL liquid,nectar-like,and pudding-like boluses by FEES and VFSS was 0.806,0.917,0.979,0.751,0.897,0.979 respectively(all P<0.05).Conclusion FEES demonstrates good consistency with the gold standard VFSS in diagnosing penetra-tion and aspiration of

关 键 词：吞咽障碍 软管喉镜吞咽功能评估 吞咽造影 误吸 

分 类 号：R49[医药卫生—康复医学]