文章摘要
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
投稿时间：2024-03-22  
DOI：10.3969/j.issn.1000-0399.2025.02.005
中文关键词: 吞咽障碍  软管喉镜吞咽功能评估  吞咽造影  误吸
英文关键词: Dysphagia  Fiberoptic endoscopic examination of swallowing  Videofluoroscopic swallowing study aspiration
基金项目: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）
作者单位E-mail
徐涵 200023 上海 上海市瑞金康复医院康复医学科  
顾琳 200023 上海 上海市瑞金康复医院康复医学科 gulin365@126.com 
雷茵 200023 上海 上海市瑞金康复医院康复医学科  
严琳 200023 上海 上海市瑞金康复医院康复医学科  
陈玲 200023 上海 上海市瑞金康复医院康复医学科  
高怡 200023 上海 上海市瑞金康复医院康复医学科  
武军 200023 上海 上海市瑞金康复医院康复医学科  
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中文摘要:
      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。
英文摘要:
      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 examination 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 aspiration 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 boluses 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 diagnosing 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 penetration and aspiration of 5ml liquid, nectar, and pudding-like food boluses.
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