标准吞咽功能量表对阻塞性睡眠呼吸暂停综合征合并吞咽障碍患者发生吸入性肺炎的预测能力

Predictive value of the standardized swallowing assessment for aspiration pneumonia in patients with obstructive sleep apnea hypopnea syndrome and dysphagia

目的评价标准吞咽功能量表(Standardized Swallowing Assessment,SSA)对阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)合并吞咽困难患者发生吸入性肺炎的预测能力。方法选择2013年1月-2015年1月在海军总医院耳鼻喉科确诊的阻塞性睡眠呼吸暂停综合征合并吞咽功能障碍的患者进行SSA量表评价。以吸入性肺炎作为结局事件,采用ROC曲线分析评价SSA量表预测吸入性肺炎的准确性。结果共纳入患者66例,其中男性41例,女性病例25例,平均年龄(63.56±11.23)岁。随访8.5个月后,共有22例(33.33%)发生吸入性肺炎,ROC曲线结果显示,AUC值为0.681,当SSA为36.5分时,约登指数(Youden index,YI)最高为0.326。结论 SSA量表对OSAHS合并吞咽困难患者发生吸入性肺炎具有预测价值,当SSA评分>36分时,发生吸入性肺炎的可能性减小,评分≤36分时,吸入性肺炎可能性增大。

Objective To evaluate the predictive value of Standardized Swallowing Assessment（SSA） for the aspiration pneumonia in patients with Obstructive Sleep Apnea Hypopnea Syndrome（OSAHS） complicated with dysphagia.Methods From January 2013 to January 2015,65 patients diagnosed as OSAHS combined with swallowing dysfunction were enrolled.SSA scale was adopted to evaluate the risk of aspiration pneumonia.The ROC curve was used to evaluate the accuracy of SSA in predicting aspiration pneumonia.Results By the end of follow-up,aspiration pneumonia occurred in 22 cases（33.33%）,and the ROC analysis revealed a AUC value of 0.681.The cut-off value of SSA was 36.5 to achieve maximal Youden index of 0.326.Conclusion The SSA can predict aspiration pneumonia in patients with OSAHS and dysphagia.When the SSA score is over 36 points,the possibility of aspiration pneumonia will decrease.