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題 名 | 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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作 者 | 林怡年; 王亭貴; 張允中; 謝富美; 連倚南; | 書刊名 | 復健醫學會雜誌 |
卷 期 | 26:4 1998.12[民87.12] |
頁 次 | 頁175-180 |
分類號 | 415.922 |
關鍵詞 | 腦中風; 吞嚥障礙; 診斷; 吸入現象; Cerebrovascular disorders; Deglutitive disorders; Diagnosis; Aspiration; |
語 文 | 中文(Chinese) |
中文摘要 | 臨床檢查是最基本且重要的吞嚥功能評估方法,但其可靠性仍有待商確。本研究 的目的是利用螢光透視吞嚥錄影檢查來檢驗臨床檢查對於評估吞嚥功能的可靠性。本研究回 顧2年間36名轉介至本部之腦中風合併吞嚥障礙患者。每位患者均接受語言治療師的臨床吞 嚥評估及標準的螢光透視吞嚥錄影檢查。結果顯示螢光透視吞嚥錄影檢查完全正常的患者有 3名,21(58%)名患者有吸入現象,其中10位屬於潛在性吸入。各單項臨床表徵的敏感度與 特異性為55%∼72%,以各單項臨床表徵診斷吸入現象的敏感度與特異性為71% ∼ 78%,若綜 合多項臨床表徵可提高診斷吸入現象的敏感度與特異性至 90% ∼ 93%。舌頭活動度異常、 嗆咳、吞嚥反射延遲與吸入現象有明顯相關(P<0.05)。 由本研究的結果可知,臨床吞嚥檢查目前仍無法取代螢光透視吞嚥錄影檢查於診斷或治 療吞嚥困難的重要性。然而在無法進行螢光透視吞嚥錄影檢查的情況下,可綜合多項臨床表 徵來診斷吸入現象,仍然有不錯之準確度。 |
英文摘要 | 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 specificty, 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. |
本系統中英文摘要資訊取自各篇刊載內容。