纤维喉镜下咽期吞咽启动延迟的半定量评价方法研究

关键词：咽期吞咽启动延迟  喉镜吞咽功能检查  视频吞钡造影检查  半定量评价方法

Keywords:pharyngeal delay  fiberoptic endoscopic evaluation of swallowing  video fluoroscopic swallowing study  semi-quantitative evaluation method

摘要：

      摘要 目的：探究纤维喉镜下咽期吞咽延迟的半定量评价方法评估吞咽启动延迟严重程度的可靠性和准确性。 方法：回顾57个纤维喉镜吞咽功能检查（fiberoptic endoscopic evaluation of swallowing， FEES）视频和相对应的57个吞钡造影检查（video fluoroscopic swallowing study， VFSS）视频，由两名研究者独立分析，使用《中国吞咽障碍评估与治疗专家共识（2017年版）》中咽期吞咽启动延迟的半定量评价方法对FEES视频中吞咽启动延迟的严重程度进行评级，并计算相对应的VFSS视频中的咽期延迟时间（pharyngeal delay time， PDT）。使用组内相关系数（intraclass correlation coefficient， ICC）为指标验证VFSS和FEES中吞咽启动时食团滞留位置的一致性；采用Kruskal-Wallis H检验进行不同等级的组间PDT差异性比较，使用Spearman等级相关分析检验吞钡造影和纤维喉镜下吞咽启动时食团滞留位置和误吸的相关性。 结果：VFSS和FEES中吞咽时食团滞留位置的判断一致性指标ICC为0.707（P<0.001），一致性较好，因此，FEES中咽期吞咽启动延迟的不同等级对应的VFSS测得PDT可进行组间比较，结果显示：正常组与轻度组之间（P=0.003）、正常组与中度组之间（P<0.0001）、正常组与重度组之间（P<0.0001）均存在显著差异；然而轻度组与中度组（P=1.000）、轻度组与重度组（P=0.141）、中度组与重度组（P=1.000）之间无显著差异。吞咽启动时食团滞留位置和误吸的相关性不显著（吞钡下P=0.642，喉镜下P=0.920）。 结论：FEES下咽期吞咽启动延迟的半定量评价量表反映吞咽延迟严重程度的能力有限，等级间区分程度低，仅能区分正常组与异常组，因此，建议将该评价量表调整为三级：正常级：食团头部到达舌根处，吞咽启动；异常级：食团到达舌根部以下的部位并有一定时间的滞留，之后才启动吞咽；无吞咽级：食团在舌根以下任何位置滞留，没有观察到吞咽启动。

Abstract:

      Abstract Objective： To investigate the reliability and accuracy of a semi-quantitative evaluation method for assessing the severity of pharyngeal delay by fiberoptic laryngoscopy. Method： Fifty-seven fiberoptic endoscopic evaluation of swallowing （FEES） videos and the corresponding 57 video fluoroscopic swallowing study （VFSS） videos were reviewed and analyzed independently by two investigators. The semiquantitative evaluation method of pharyngeal delay in the expert consensus on assessment and treatment of swallowing disorders in China （2017 version） was used to rate fiberoptic endoscopic evaluation of swallowing videos. The pharyngeal delay time （PDT） was calculated by the corresponding video fluoroscopic swallowing study videos. The intraclass correlation coefficient （ICC） was used as an indicator to verify the consistency of the retention position of the bolus on set of swallowing in VFSS and FEES. The Kruskal-Wallis H test was used to compare the difference in PDT between the different classes. Spearman's rank correlation analysis was used to test the correlation between the retention position of bolus on set of swallowing and aspiration under VFSS and FEES. The correlation was statistically significant at P<0.05. Result： The consistency index ICC for determining retention position of bolus on set of swallowing in VFSS and FEES was 0.707 （P<0.001）indicating moderate agreement. Therefore, the PDT measured by VFSS corresponding to different grades of pharyngeal delay in FEES could be compared between groups. The results showed that： between normal and mild groups （P=0.003）， between normal and moderate groups （P<0.0001）， and between the normal and severe groups （P<0.0001）. However， there were no significant differences between the mild and moderate groups （P=1.000）， the mild and severe groups （P=0.141）， and the moderate and severe groups （P=1.000）. The correlation between retention position of bolus on set of swallowing and aspiration was not significant （P=0.642 under VFSS and P=0.920 under FEES）. Conclusion：The semi-quantitative evaluation scale of pharyngeal delay under FEES has limited ability to reflect the severity of swallowing delay， and the degree of differentiation between grades is low， only distinguishing the normal group from the abnormal group. Thus, it is recommended that this evaluation scale be adjusted to three levels： normal level： the head of the bolus reaches the root of the tongue and swallowing is initiated； abnormal level： the bolus reaches a site below the tongue base and lingers for a certain period of time before swallowing is initiated. No swallowing level： the bolus lingered anywhere below the tongue base and no swallowing initiation was observed.