梯度柠檬酸咳嗽反射试验在脑卒中误吸筛查中的临床价值

关键词：脑卒中  误吸  咳嗽反射  柠檬酸  筛查

Keywords:stroke  aspiration  cough reflex  citric acid  screening

摘要：

      摘要 目的：采用不同浓度梯度的柠檬酸进行咳嗽反射试验（CRT），评估脑卒中后吞咽障碍患者的误吸风险，并与金标准对比探讨其诊断价值，为探索新的误吸筛查方法提供循证依据。 方法：62例康复期脑卒中后吞咽障碍患者分别接受4种不同浓度梯度柠檬酸（0.2mol/L，0.4mol/L，0.6mol/L，0.8mol/L）以及电视透视检查吞咽评估（VFSS）或纤维光学内窥镜吞咽评估（FEES）。以VFSS/FEES为金标准，计算不同浓度梯度柠檬酸咳嗽反射试验对于误吸和隐匿性误吸诊断的敏感度、特异性和约登指数等。 结果：随着柠檬酸浓度的升高，误吸筛查的敏感性降低而特异性升高。0.4mol/L柠檬酸CRT对于卒中后误吸筛查具有较高的敏感性76.9%和特异性69.4%，约登指数0.46。同样浓度对于隐匿性误吸的敏感性达80%，特异性55.8%，约登指数为0.36；而0.6mol/L柠檬酸CRT对SA的敏感性为66.7%，特异性71.2%，约登指数0.38。 结论：柠檬酸CRT是脑卒中误吸评估中有价值的筛查工具，其中较低浓度柠檬酸CRT对误吸和隐匿性误吸诊断价值最大。

Abstract:

      Abstract Objective： To validate the cough reflex test(CRT) induced by different concentration of citric acid for identification of aspiration following stroke compared with instrumental assessment. Method： Cough reflex induced by the citric acid inhalation test were studied at four different concentrations (0.2mol/L，0.4mol/L，0.6mol/L，0.8mol/L) of citric acid in 62 patients with dysphasia after stroke. Meanwhile, videofluoroscopic study of swallowing (VFSS) or fibrotic endoscopic evaluation of swallowing (FEES) was administrated to those patients within 48h. All tests were recorded by two researchers blinded to the results of alternative test. Result： Sensitivity of tests decreased while specificity rose following the increasing of concentration of citric acid. For detecting aspiration, when the concentration of citric acid optimized at 0.4mol/L, sensitivity, specificity and Youden's index were 76.9%, 69.4%, 0.46 respectively. But for detecting silent aspiration when the concentration of citric acid was at 0.4mol/L, sensitivity, specificity and Youden's index changed to 80%, 55.8%, 0.36 respectively; and at 0.6mol/L those were 66.7%, 71.2%, 0.38 respectively. Conclusion： CRT induced by citric acid is a valuable tool for screening aspiration following stroke. Lower concentration of citric acid provide a better predictive measure of aspiration and silent aspiration.