摘要
目的探讨洼田吞咽功能评分联合荧光吞咽透视检查评分在神经性吞咽障碍患者营养不良中的预测价值。方法回顾性分析2018年5月至2021年5月浙江中医药大学附属温州中医院收治的92例神经性吞咽障碍患者的临床资料,根据患者是否发生营养不良将其分为发生组(n=24)和未发生组(n=68)。比较两组患者的洼田吞咽功能评分、荧光吞咽透视检查评分和临床特征,采用Logistic回归分析探讨影响神经性吞咽障碍患者发生营养不良的因素,绘制受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析洼田吞咽功能评分和荧光吞咽透视检查评分预测神经性吞咽障碍患者发生营养不良的价值。结果随访1个月,共有24例患者发生营养不良,营养不良发生率26.09%。发生组患者的洼田吞咽功能评分高于未发生组,荧光吞咽透视检查评分低于未发生组(P<0.05)。发生组患者的体质量指数<18.5kg/m^(2)、饮食≤正常1/2、意识障碍患者的构成比及美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分均显著高于未发生组(P<0.05)。多因素Logistic回归分析结果显示,饮食状况、意识障碍、NIHSS评分、洼田吞咽功能评分和荧光吞咽透视检查评分均是影响神经性吞咽障碍患者发生营养不良的独立危险因素(P<0.05)。ROC曲线显示,洼田吞咽功能评分、荧光吞咽透视检查评分预测神经性吞咽障碍患者发生营养不良的最佳截断值分别为2.73分、4.12分,敏感度分别为87.50%、79.17%,特异性分别为76.47%、85.29%,曲线下面积(area under the curve,AUC)分别为0.800,0.835,二者联合预测的AUC为0.851,敏感度和特异性分别为79.17%和97.06%。结论神经性吞咽障碍营养不良患者的洼田吞咽功能评分和荧光吞咽透视检查评分均发生异常变化,二者可作为预测神经性吞咽障碍患者发生营养不良的敏感指标。
Objective To explore the predictive value of Kubotaʼs swallowing function score combined with fluorescent swallowing fluoroscopy score in patients with neurological dysphagia.Methods The data of 92 patients with neurological dysphagia admitted to Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine from May 2018 to May 2021 were retrospectively analyzed,and according to whether the patients had malnutrition,they were divided into occurrence group(n=24)and non-occurrence group(n=68).The Kubotaʼs swallowing function score,fluorescent swallowing fluoroscopy score and the clinical characteristics of the two groups were compared.Logistic regression was used to analyze the factors affecting the occurrence of malnutrition in patients with neurological dysphagia,receiver operator characteristic(ROC)curve was used to analyze the value of Kubotaʼs swallowing function score and fluorescent swallowing fluoroscopy score to predict the occurrence of malnutrition in patients with neurological swallowing disorders.Results After one month of follow-up,24 patients developed malnutrition,and the incidence of malnutrition was 26.09%.Kubotaʼs swallowing function score in occurrence group was higher than that in non-occurrence group,and the fluorescent swallowing fluoroscopy score was lower than that in non-occurrence group(P<0.05).The composition ratio of patients with body mass index<18.5kg/m^(2),diet≤1/2 of normal,consciousness disorder and score of National Institute of Health stroke scale(NIHSS)in occurrence group were significantly higher than those in non-occurrence group(P<0.05).Multivariate Logistic regression analysis showed that dietary status,conscious disturbance,NIHSS score,Kubotaʼs swallowing function score,and fluorescent swallowing fluoroscopy score were all independent risk factors for malnutrition in patients with neurological dysphagia(P<0.05).ROC curve showed that the best cut-off points for the Kubotaʼs swallowing function score and fluorescent
作者
林书阳
陈妙
周荣
黄祖秀
胡万华
LIN Shuyang;CHEN Miao;ZHOU Rong;HUANG Zuxiu;HU Wanhua(Department of Neurology,Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine,Zhejiang,Wenzhou 325000,China)
出处
《中国现代医生》
2022年第31期25-30,共6页
China Modern Doctor
基金
浙江省中医药科技计划(2020ZB239)。
关键词
洼田吞咽功能评分
荧光吞咽透视检查评分
神经性吞咽障碍
营养不良
Kubotaʼs swallowing function score
Fluorescent swallowing fluoroscopy score
Neurological dysphagia
Malnutrition
