洼田饮水试验联合脉搏血氧监测法对急性脑梗死后吞咽障碍的诊断价值

Diagnostic value of the combination of water swallow test and oxygen desaturation monitoring in assessing dysphagia after acute cerebral infarction

目的探讨洼田饮水试验联合脉搏血氧监测法对急性脑梗死后吞咽障碍的诊断价值。方法100例急性脑梗死患者分别采用洼田饮水试验、脉搏血氧监测法以及电视透视检查(VFSS)评定吞咽功能,以VFSS为金标准,研究洼田饮水试验、脉搏血氧监测法两者联合评估(床旁联合试验)对急性脑梗死后吞咽障碍的误吸诊断的灵敏度、特异度、阳性预测值和阴性预测值,同时观察对肺炎风险的预测价值。结果以VFSS为金标准,洼田饮水试验误吸诊断的灵敏度为65.2%,特异度为72.2%,阳性预测值为66.7%,阴性预测值为70.2%;脉搏血氧监测法误吸诊断的灵敏度为80.4%,特异度为75.9%,阳性预测值为74.0%,阴性预测值为82.0%;床旁联合试验误吸诊断的灵敏度为93.5%,特异度为68.5%,阳性预测值为71.6%,阴性预测值为92.5%。同时研究还发现,床旁联合试验阳性患者的肺炎发生率高于阴性患者,有统计学意义(P<0.05),而洼田饮水试验和脉搏血氧监测法评估阳性患者的肺炎发生虽高于阴性患者,但两者比较无统计学意义(P>0.05)。结论洼田饮水试验联合脉搏血氧监测法是评估脑梗死后吞咽障碍的一个安全、方便且有价值的方法。

Objective To explore the value of the combination of water swallow test and oxygen desaturation monitoring in assessing dysphagia after acute cerebral infarction.Methods One hundred acute cerebral infarction patients underwent an examination of their ability to swallow 30 ml of water,the oxygen desaturation test and videofluoroscopic swallowing study(VFSS).The water swallow test,the oxygen desaturation test and the combination of both(termed 'clinical combination test') was then measured against the VFSS for sensitivity,specificity,positive predictive value(PPV) and negative predictive value(NPV) for aspiration in acute cerebral infarction patients.The relation between the results of three assessment tools and pneumonia of post-stroke were analyzed.Results The water swallow test had a sensitivity of 65.2% and specificity of 72.2% for the detection of aspiration,with PPV of 66.7% and NPV of 70.2%.The oxygen desaturation test had a sensitivity of 80.4% and a specificity of 75.9%,with PPV of 74.0% and NPV of 82.0%.When both tests were combined,a sensitivity of 93.5% and a specificity of 68.5% was attained,with PPV of 71.6% and NPV of 92.5%.The patients with positive result on clinical combination test had a higher incidence of pneumonia(P< 0.05),but there were no significant difference in other two groups.The combination of water swallow test and oxygen desaturation monitoring is a valid and valuable assessing tool for dysphagia in acute cerebral infarction patients.Conclusion Cerebral infarction;Dysphagia;VFSS;Water swallow test;Oxygen desaturation