鼻咽癌放(化)疗后吞咽障碍的临床评估

Clinical evaluation of dysphagia after radiotherapy(chemotherapy)for nasopharyngeal carcinoma.

摘要:

目的 遴选出安全、有效、便捷的鼻咽癌放(化)疗后吞咽障碍的评估方法。方法 选取在邵阳市中心医院就诊的鼻咽癌患者37 例,应用吞咽 X 线荧光透视检查、进食评估问卷调查量表、安德森吞咽障碍量表、反复唾液吞咽试验和洼田饮水试验对入组患者进行吞咽功能的评估,筛选适合鼻咽癌放化疗后吞咽障碍评估的方法。结果 以吞咽 X 线荧光透视检查( VFSS) 为金标准,进食评估问卷调查量表(EAT-10)的灵敏度为83.33%,安德森吞咽障碍量表(MDADI)灵敏度为72.22%,反复唾液吞咽试验(RSST)特异度为84.21%,但这些方法与金标准的Kappa值都小于0.2,其一致性较低。洼田饮水试验(WST)特异度为78.95%,Kappa值大于0.2,具有相对较好的一致性。 结论 洼田饮水试验与吞咽 X 线荧光透视检查的一致性相对较好,可以作为鼻咽癌放(化)疗后吞咽障碍的筛查工具,其他方法也可辅助评估。

Abstract:

【 】 Objectives To select some safe, effective and convenient methods for the evaluation of dysphagia after radiotherapy for nasopharyngeal carcinoma. Methods A total of 37 patients with nasopharyngeal carcinoma in the Central Hospital of Shaoyang were selected. Video Fluoroscopic Swallowing Study (VFSS), Eating Assessment Tool (EAT-10), M.D.Anderson Dysphagia Inventory (MDADI), Repeated Saliva Swallowing Test (RSST) and Water swallowing test (WST)were used to evaluate the swallowing function of the patients, so as to seek some suitable methods for the evaluation of dysphagia after radiotherapy(chemotherapy)for nasopharyngeal carcinoma. Results Taking Video Fluoroscopic Swallowing Study (VFSS) as the gold standard, the sensitivity of Eating Assessment Tool (EAT-10) was 83.33%, the sensitivity of M.D.Anderson Dysphagia Inventory (MDADI) was 72.22%, and the specificity of Repeated Saliva Swallowing Test (RSST) was 84.21%. However, the Kappa values of these methods with gold standard are all less than 0.2, which means their consistency is low. The specificity of Water swallowing test (WST) was 78.95%, and the Kappa value was more than 0.2, which means its consistency with gold standard is better than other methods. Conclusion The Water swallowing test (WST) is relatively consistent, and can be used as a screening tool for dysphagia after radiotherapy (chemotherapy) for nasopharyngeal carcinoma, and other methods can also assist in the evaluation.