电子喉镜评估老年肺部感染患者的吞咽功能

Clinical application of FEES-based swallowing function assessment in elderly patients with pulmonary infections

摘要

目的 探讨使用电子喉镜在神经内科60岁以上怀疑有吞咽障碍的患者进行吞咽功能评估，从而尽早干预，防止肺部感染迁延不愈，减少其复发率及死亡率。方法 选取老年患者70例，肺炎组35例，均有肺部感染病史，非肺炎组35例，均无肺部感染病史。所有患者均进行吞咽障碍简易筛查、EAT-10进食评估问卷调查、洼田饮水试验及软式喉内窥镜吞咽功能检查(flexible endoscopic examination of swallowing, FEES)。比较两组患者FEES对渗漏以及误吸检出率；通过各项检查在两组患者中评分进行比较，评估肺部感染与吞咽障碍的相关性；同时对FEES与洼田饮水试验误吸阳性似然比、阴性似然比、敏感度和特异度进行比较，评估FEES的可靠性以及对隐形误吸诊断的可靠性。结果 在FEES中，肺炎组的渗漏及误吸与非肺炎组间有统计学差异。所有检查中，肺炎组的吞咽障碍患者人数均高于非肺炎组。FEES检查提高隐性误吸检出率。结论 电子喉镜FEES对神经内科存在隐性误吸老年患者防治肺部感染有指导作用。

Abstract

Objective This study aimed to investigate the use of electronic laryngoscopy to assess swallowing function in patients over 60 years of age suspected of dysphagia within the neurology department. The goal was to enable early intervention to prevent long-lasting lung infections and reduce their rates of recurrence and mortality. Methods Seventy elderly subjects hospitalized in the neurology department for neurological disorders were enrolled and divided into two groups: a pneumonia group (n=35) with a history of pulmonary infection and a non-pneumonia group (n=35) without such a history. All participants underwent a simple screening for dysphagia, the Eating Assessment Tool-10 (EAT-10) questionnaire, the Water Swallowing Test, and a flexible endoscopic examination of swallowing (FEES). Detection rates of penetration/aspiration in FEES were compared between groups. Scores from all assessments were compared to assess the correlation between pulmonary infection and dysphagia. Furthermore, the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of FEES versus the Water Swallowing Test to detect aspiration were compared to assess the reliability of FEES, particularly for diagnosing silent aspiration. Results Statistically significant differences were observed between the pneumonia and non-pneumonia groups with respect to penetration and aspiration detected by FEES. In all assessments, the number of patients with dysphagia identified by all assessments was significantly higher in the pneumonia group compared to the non-pneumonia group. FEES significantly increased the detection rate of silent aspiration. Conclusion FEES using a laryngoscope is of leading importance for preventing and treating pulmonary infections in elderly neurology patients with silent aspiration.

关键词

电子喉镜 / 老年患者 / 肺部感染 / 吞咽障碍

Key words

Electronic laryngoscopy / Elderly patients / Pulmonary infection / Swallowing disorders

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基金资助

2023年上海市康复医学会健康管理科研基金课题项目(2023JGKT02)