CAJ | 학술논문

目的探讨吞咽障碍的评估方法.方法回顾性分析2010年6月至2012年7月间诊治的37例吞咽障碍患者的临床资料.神经系统疾病12例,咽食管入口部因素14例,头颈部恶性肿瘤及咽部反复溃疡放疗后远期吞咽障碍6例,无明显原因5例.评估方法包括:洼田饮水试验、藤岛吞咽障碍评价标准评估、吞咽造影检查(videofluoroscopic swallowing study,VFSS)和内镜吞咽检查(fibroptic endoscopic evaluation of swallowing,FEES).结果洼田饮水试验有14例(14/37)表现为异常；吞咽障碍评价标准异常为29例(29/37)；VFSS误吸评分异常为27例(27/37),VFSS吞咽困难评分异常为33例(33/37),FEES评估异常为19例(19/21).洼田饮水试验、吞咽障碍评价标准与VFSS 之间一致性分析的Kappa值分别为0.137和0.416.以VFSS为评价“金标准”,FEES评价喉渗漏或误吸的敏感度、特异度、阳性预测值和阴性预测值分别为88.9％,66.7％,94.1％和50.0％.结论洼田饮水试验和吞咽障碍评价标准可用于临床筛查和效果初评,使用方便；VFSS和FEES能精确评估吞咽障碍性质、部位及程度.多种评估方法的联合运用是吞咽障碍的诊治的最重要依据.
목적 탐토탄인장애적평고방법.방법 회고성분석2010년6월지2012년7월간진치적37례탄인장애환자적림상자료.신경계통질병12례,인식관입구부인소14례,두경부악성종류급인부반복궤양방료후원기탄인장애6례,무명현원인5례.평고방법포괄:와전음수시험、등도탄인장애평개표준평고、탄인조영검사(videofluoroscopic swallowing study,VFSS)화내경탄인검사(fibroptic endoscopic evaluation of swallowing,FEES).결과 와전음수시험유14례(14/37)표현위이상；탄인장애평개표준이상위29례(29/37)；VFSS오흡평분이상위27례(27/37),VFSS탄인곤난평분이상위33례(33/37),FEES평고이상위19례(19/21).와전음수시험、탄인장애평개표준여VFSS 지간일치성분석적Kappa치분별위0.137화0.416.이VFSS위평개“금표준”,FEES평개후삼루혹오흡적민감도、특이도、양성예측치화음성예측치분별위88.9％,66.7％,94.1％화50.0％.결론 와전음수시험화탄인장애평개표준가용우림상사사화효과초평,사용방편；VFSS화FEES능정학평고탄인장애성질、부위급정도.다충평고방법적연합운용시탄인장애적진치적최중요의거.
Objective To explore the assessment methods of dysphagia.Methods The data of 37patients with dysphagia were retrospectively analyzed.These patients took the Kubota drinking test,Tengdao's evaluation,videofluoroscopic swallowing study(VFSS)and fibroptic endoscopic evaluation of swallowing (FEES).Results Fourteen out of thirty-seventh patients showed abnormal results during Kubota drinking test.Tengdao's evaluation results showed that 29/37 patients were abnormal.There 27/37and 33/37 patients showed abnormalities in positive-aspiration score and swallow dysfunction score of VFSS.The number of abnormal patients in aspiration score of FEES was 19/21.The Kappa values were 0.137,0.416 between Kubota drinking test.Tengdao's evaluation and VFSS.The FEES was measured against the VFSS for sensibility,specificity,positive predictive value,and negative predictive value,the values were 88.9％,66.7％,94.1％ and 50.0％.Conclusions Kubota drinking test and Tengdao's evaluation can be applied for screening purpose and evaluating result after treatment;VFSS and FEES can be used as more accurate assessments,they can study the dysphagia's character,position and severity.The combination of a variety of dysphagia evaluation methods is the most important basis for diagnosis and treatment of deglutition disorders.