纤维鼻咽喉镜吞咽功能检查在脑卒中后吞咽困难评估中的应用

Fiberoptic endoscopic evaluation of swallowing for evaluation of dysphagia after stroke

目的探讨纤维鼻咽喉镜吞咽功能检查(FEES)在脑卒中后吞咽困难评估中的应用价值。方法选取温州市中医院2019年1月至2020年12月收治的脑卒中后存在吞咽困难患者200例,所有患者分别进行咽动态造影检查(VFFS)和FEES,比较两种检查结果及不良反应发生率。结果VFFS结果发现,口腔残留122例,渗漏168例,误吸170例,会厌谷残留179例,梨状隐窝残留184例,环咽肌开放不全61例,食管蠕动异常58例;FEES结果发现,食物渗漏173例,食物穿透151例,食物误吸180例,食物潴留166例,声带新生物21例。FEES过程中不良反应发生率(5.5%)低于VFFS(12.0%)(χ^(2)=5.29,P<0.05)。结论FEES在脑卒中后吞咽困难患者中的检出率有较高的敏感性和安全性,对吞咽困难的治疗具有重要的指导意义。

Objective To investigate the application value of fiberoptic endoscopic evaluation of swallowing(FEES)in patients with dysphagia after stroke.Methods A total of 200 patients with dysphagia who received treatment in Wenzhou Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were included in this study.All patients underwent videofluoroscopic swallowing study(VFFS)and FEES.Examination results and the incidence of adverse reactions were compared between VFFS and FEES.Results VFFS results revealed that oral food residue occurred in 122 patients,food leakage in 168 patients,food aspiration in 170 patients,epiglottis valley residue in 179 patients,pyriform sinus residue in 184 patients,cricopharyngeus muscle dysfunction in 61 patients,and abnormal esophageal peristalsis in 58 patients.FEES results revealed that food leakage occurred in 173 patients,food penetration in 151 patients,food aspiration in 180 patients,food retention in 166 patients,and vocal neoplasm in 21 patients.The incidence of adverse reactions generated in FEES was lower than that in VFFS(5.5%vs.12.0%,χ^(2)=5.29,P<0.05).Conclusion FEES has high sensitivity and safety in the detection of dysphagia after stroke,and it has important guiding significance for the treatment of dysphagia.