改良容积黏度吞咽测试联合吞咽造影在吞咽功能动态评估中的应用

Application of modified volume viscosity swallowing test and swallowing angiography in dynamic assessment of swallowing function

目的探讨改良容积黏度吞咽测试(VVST)联合吞咽造影在吞咽功能动态评估中的应用效果。方法选取2020年7月至2021年8月徐州医科大学附属徐州市立医院收治的80例吞咽功能障碍患者进行随机对照试验,采用随机数字表法将其分为对照组与观察组,各40例。对照组男26例,女14例,年龄(56.23±6.12)岁;疾病类型:脑卒中25例,食管癌8例,喉癌3例,鼻咽癌2例,其他2例。观察组男25例,女15例,年龄(56.12±6.08)岁;疾病类型:脑卒中24例,食管癌8例,喉癌4例,鼻咽癌2例,其他2例。对照组采用VVST评估病情,观察组采用VVST和吞咽造影评估病情,并给予个性化指导。对比两组临床有效率、胃管留置率、拔管成功率、并发症发生率、吞咽功能状态分级情况及生活质量评分。采用χ^(2)检验。结果观察组治疗有效率高于对照组[95.00%(38/40)比75.00%(30/40),χ(2)=6.275,P<0.05]。观察组胃管留置率低于对照组[5.00%(2/40)比22.50%(9/40),χ(2)=5.165,P<0.05]。观察组拔管成功率100.00%(40/40),对照组92.50%(37/40),差异无统计学意义(χ(2)=3.117,P>0.05)。观察组并发症发生率低于对照组[7.50%(3/40)比30.00%(12/40),χ(2)=6.646,P<0.05]。观察组摄食-吞咽功能Ⅰ级占比高于对照组[70.00%(28/40)比45.00%(18/40),χ(2)=5.115,P<0.05],观察组摄食-吞咽功能Ⅲ级占比低于对照组[12.50%(5/40)比32.50%(13/40),χ(2)=4.588,P<0.05]。结论VVST+吞咽造影评估吞咽功能障碍便于临床结合患者具体情况改善干预措施,以有效改善其摄食-吞咽功能,降低并发症发生风险及胃管留置率,使患者获得良好预后。

Objective To investigate the effect of modified volume viscosity swallowing test(VVST)combined with swallowing angiography in the dynamic assessment of swallowing function.Methods Eighty patients with swallowing dysfunction treated at Xuzhou Municipal Hospital,Xuzhou Medical University from July 2020 to August 2021 were selected for the randomized controlled trial,and were divided into a control group and an observation group by the random number table method,with 40 cases in each group.There were 26 males and 14 females in the control group;they were(56.23±6.12)years old;there were 25 cases of stroke,8 cases of esophageal cancer,3 cases of laryngeal cancer,2 cases of nasopharyngeal cancer,and 2 cases of other diseases.There were 25 males and 15 females in the observation group;they were(56.12±6.08)years old;there were 24 cases of stroke,8 cases of esophageal cancer,4 cases of laryngeal cancer,2 cases of nasopharyngeal cancer,and 2 cases of other diseases.The control group were evaluated by VVST,and the observation group were evaluated by VVST and swallowing angiography and were guided individualizedly.The clinical efficacies,gastric tube retention rates,extubation success rates,incidences of complications,swallowing function status classification,and scores of quality of life were compared between the two groups.χ^(2) test was used.Results The treatment efficacy in the observation group was higher than that in the control group[95.00%(38/40)vs.75.00%(30/40);χ(2)=6.275;P<0.05].The gastric tube retention rate in the observation group was lower than that in the control group[5.00%(2/40)vs.22.50%(9/40);χ(2)=5.165;P<0.05].The extubation success rate in the observation group was 100.00%(40/40),and that in the control group 92.50%(37/40),with no statistical difference(χ(2)=3.117;P>0.05).The incidence of complications in the observation group was lower than that in the control group[7.50%(3/40)vs.30.00%(12/40);χ(2)=6.646;P<0.05].The proportion of grade I feeding-swallowing function in the observation group was higher than that in the control group[70.00%(28/40)vs.45.00%(18/40);χ(2)=5.115,P<0.05];the proportion of gradeⅢfeeding-swallowing function in the observation group was lower than that in the control group[12.50%(5/40)vs.32.50%(13/40);χ(2)=4.588;P<0.05].Conclusion VVST+swallowing angiography in the evaluation of swallowing dysfunction is helpful to develop personalized intervention programs to improve the patients'feeding-swallowing function,reduce the risk of complications and gastric tube retention rate,and achieve good prognosis.