简易咳嗽反射诱发试验预测吞咽障碍患者隐性误吸的敏感性及特异性评价

The sensitivity and specificity of the simplified cough provoking test in predicting aspiration in persons with dysphagia

目的:探讨简易咳嗽反射诱发试验预测吞咽障碍患者隐性误吸的敏感性及特异性。方法:选取115例经吞咽造影检查确定存在误吸的吞咽障碍患者,均在吞咽造影检查后当日进行简易咳嗽反射诱发试验。以吞咽造影检查结果(显性误吸/隐性误吸)为标准,分析不同评价标准下简易咳嗽反射诱发试验预测隐性误吸的敏感性及特异性。结果:经吞咽造影检查发现,115例误吸患者中,显性误吸44例,隐性误吸71例。经简易咳嗽反射诱发试验发现,咳嗽反射正常36例、减弱22例、缺失57例。以未发生咳嗽作为吞咽异常的判断标准时,简易咳嗽反射诱发试验预测患者发生隐性误吸的敏感度为70.42%,特异度为84.09%,Youden指数为0.545;以咳嗽减弱及未发生咳嗽作为吞咽异常的判断标准时,简易咳嗽反射诱发试验预测患者发生隐性误吸的敏感度为85.92%,特异度为59.09%,Youden指数为0.45。结论:利用简易咳嗽反射诱发试验识别吞咽障碍患者存在隐性误吸的敏感度及特异度较高。以发生强烈咳嗽作为吞咽正常的判断标准时,其识别隐性误吸的敏感度更高。

Objective To explore the sensitivity and specificity of the simplified cough provoking test in predicting aspiration among patients with dysphagia.Methods A total of 115 aspirating patients were evaluated u-sing the simplified cough provoking test.Based on the overt and silent aspiration observed through video fluorography,the sensitivity and specificity of the test for predicting each type were quantified.Results The subjects presented 44 cases of overt aspiration and 71 of silent aspiration.The simplified cough provoking test found that 36 had a normal cough reflex,22 had a weakened reflex and 57 had none.When the cough's strength indicated a normal cough reflex,the sensitivity of the simplified cough provoking test predicting silent aspiration was 70.4%and its specificity was 84.1%.The Youden coefficient was 0.545.When the cough reflex was adjudged as abnormal,the test's sensitivity was 85.9%in predicting silent aspiration and its specificity was 59.1%with a Youden coefficient of 0.45.Conclu-sionThe simplified cough provoking test has good sensitivity and specificity in identifying silent aspiration.It can ef-fectively screen populations at risk of dysphagia.