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腦中風患者吞嚥功能臨床評估可靠性之探討

Validation of the Clinical Swallowing Evaluation in Stroke Patients

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摘要


Although it has variable reliability, the bedside clinical swallowing evaluation (CSE) of dysphagia has long been accepted as the basic screening tool in the examination of the swallowing function of stroke patients. The purpose of this study was to define the reliability of the CSE by comparing it to the standard videofluoroscopic study of swallowing (VFSS). Thirty six stroke patients within a period of two years were included in this study, and all of them received the CSE and VFSS simultaneously. Three of them had a normal VFSS, whereas 21 (58%) aspirated during the VFSS examination. Ten of the people who aspirated had silent aspiration. Single clinical signs of dysphagia, including poor tongue movement, drooling, and facial muscle weakness, had unsatisfactory sensitivity and specificity, with a range of 55% to 72% in detecting their corresponding swallowing disorder in the VFSS. The sensitivity and specificity of detecting aspiration in the VFSS by a single clinical sign was around 70% to 78%. This rate rose markedly to a sensitivity of 90% and specificity of 93% when four factors, abnormal tongue movement, choking, wet voice, and delayed swallowing reflex, were taken into consideration together. In conclusion, the CSE is neither sensitive nor specific enough to replace the VFSS in the diagnosis and management of dysphagia. However, the combination of four clinical signs may provide a better and acceptable accuracy in detecting aspiration, especially when VFSS is unavailable.

關鍵字

腦中風 吞嚥障礙 診斷 吸入現象

並列摘要


Although it has variable reliability, the bedside clinical swallowing evaluation (CSE) of dysphagia has long been accepted as the basic screening tool in the examination of the swallowing function of stroke patients. The purpose of this study was to define the reliability of the CSE by comparing it to the standard videofluoroscopic study of swallowing (VFSS). Thirty six stroke patients within a period of two years were included in this study, and all of them received the CSE and VFSS simultaneously. Three of them had a normal VFSS, whereas 21 (58%) aspirated during the VFSS examination. Ten of the people who aspirated had silent aspiration. Single clinical signs of dysphagia, including poor tongue movement, drooling, and facial muscle weakness, had unsatisfactory sensitivity and specificity, with a range of 55% to 72% in detecting their corresponding swallowing disorder in the VFSS. The sensitivity and specificity of detecting aspiration in the VFSS by a single clinical sign was around 70% to 78%. This rate rose markedly to a sensitivity of 90% and specificity of 93% when four factors, abnormal tongue movement, choking, wet voice, and delayed swallowing reflex, were taken into consideration together. In conclusion, the CSE is neither sensitive nor specific enough to replace the VFSS in the diagnosis and management of dysphagia. However, the combination of four clinical signs may provide a better and acceptable accuracy in detecting aspiration, especially when VFSS is unavailable.

被引用紀錄


司麗雲、謝素英、曾素美、黃慈心(2017)。住院復健期腦中風患者吞嚥困難之決定因子探討護理雜誌64(3),43-55。https://doi.org/10.6224%2fJN.000039
方慧芬(2006)。頭頸部癌患進食及營養狀況之探討〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0007-1704200715050340

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