上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

洼田饮水试验在急性脑卒中后吞咽障碍患者中的应用价值

武文娟1，毕霞2，宋磊2，刘志浩2，张金明2，黄茜2   

  1. 1.宁夏医科大学 临床医学院， 银川 750004； 2.上海市浦东新区公利医院康复医学科， 上海 200135
  • 出版日期:2016-07-28 发布日期:2016-08-31
  • 通讯作者: 毕霞, 电子信箱: bxxb1123@163.com。
  • 作者简介:武文娟(1988—)， 女， 硕士生; 电子信箱: 18734898487@163.com。

Value of applying water swallowing test for patients with dysphagia after acute stroke

WU Wen-juan1, BI Xia2, SONG Lei2, LIU Zhi-hao2, ZHANG Jin-ming2, HUANG Qian2   

  1. 1.Clinical Medicine College, Ningxia Medical University, Yinchuan 750004, China; 2.Department of Rehabilitation, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China
  • Online:2016-07-28 Published:2016-08-31

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摘要：

目的 探讨洼田饮水试验对急性脑卒中后吞咽障碍患者误吸筛查及吞咽障碍诊断的应用价值。方法 选取2014年4月—2015年11月在上海市浦东新区公利医院康复医学科住院治疗的急性脑卒中患者45例，分别进行洼田饮水试验评估和吞咽造影检查（VFSS）。评估洼田饮水试验筛查误吸和诊断吞咽障碍的可靠性及两种方法的一致性，同时对比洼田饮水试验筛查误吸和诊断吞咽障碍的阳性检出率。结果 以VFSS为“金标准”，洼田饮水试验筛查误吸的灵敏度为43.75%，特异度为69.23%，阳性预测值为77.78%，阴性预测值为31.03%，洼田饮水试验和VFSS法一致性检验的Kappa值为0.098，两者不存在一致性（P=0.420）；洼田饮水试验诊断吞咽障碍的灵敏度为97.50%，特异度为20.00%，阳性预测值为90.70%，阴性预测值为50.00%，两者之间的Kappa值为0.237，不存在一致性（P=0.073）；洼田饮水试验筛查误吸的阳性检出率（40.00%）低于诊断吞咽障碍的阳性检出率（95.56%），差异具有统计学意义（P=0.000）。结论 洼田饮水试验筛查急性脑卒中后吞咽障碍患者误吸结果可能不可靠，但诊断吞咽障碍结果较可靠。

关键词: 洼田饮水试验, 吞咽造影, 脑卒中, 吞咽障碍, 误吸

Abstract:

Objective To explore the value of applying the water swallowing test to screening the aspiration and diagnosing dysphagia for patients with dysphagia after acute stroke. Methods Forty-five patients with acute stroke who were admitted by the Rehabilitation Medicine Department at the Gongli Hospital in Pudong New District of Shanghai from April 2014 to November 2015 were enrolled. Patients underwent the water swallowing test and videofluoroscopic swallowing study (VFSS). The reliability of the water swallowing test and the consistency between water swallowing test and VFSS for screening the aspiration and diagnosing dysphagia were evaluated. The positive detection rates of the water swallowing test for screening aspiration and diagnosing dysphagia were compared. Results The sensitivity, specificity, positive predictive value, and negative predictive value of the water swallowing test for screening aspiration against the VFSS were 43.75%, 69.23%, 77.78%, and 31.03%. The Kappa value of the consistency test for water swallowing test and VFSS was 0.098, indicating no consistency existed (P=0.420). The sensitivity, specificity, positive predictive value, and negative predictive value of the water swallowing test for diagnosing dysphagia against the VFSS study were 97.50%, 20.00%, 90.70%, and 50.00%. The Kappa value of the consistency test for water swallowing test and VFSS was 0.237, indicating no consistency existed (P=0.073). The positive detection rate (40.00%) of the water swallowing test for screening aspiration was lower than that for diagnosing dysphagia (95.56%) and the difference was statistically significant (P=0.000). Conclusion The water swallowing test may be unreliable for screening the aspiration for patients with dysphagia after acute stroke, but is relatively reliable for diagnosing dysphagia.

Key words: water swallowing test, videofluoroscopic swallowing study, stroke, dysphagia, aspiration