Shaw D W, Williams R B H, Cook I J, Wallace K L, Weltman M D, Collins P J, McKay E, Smart R, Simula M E
Department Medicine, Royal Adelaide Hospital, South Australia, Australia.
Dysphagia. 2004 Winter;19(1):36-42. doi: 10.1007/s00455-003-0033-7.
A valid and reliable technique to quantify the efficiency of the oral-pharyngeal phase of swallowing is needed to measure objectively the severity of dysphagia and longitudinal changes in swallowing in response to intervention. The objective of this study was to develop and validate a scintigraphic technique to quantify the efficiency of bolus clearance during the oral-pharyngeal swallow and assess its diagnostic accuracy. To accomplish this, postswallow oral and pharyngeal counts of residual for technetium-labeled 5- and 10-ml water boluses and regional transit times were measured in 3 separate healthy control groups and in a group of patients with proven oral-pharyngeal dysphagia. Repeat measures were obtained in one group of aged (> 55yr) controls to establish test-retest reliability. Scintigraphic transit measures were validated by comparison with radiographic temporal measures. Scintigraphic measures in those with proven dysphagia were compared with radiographic classification of oral vs. pharyngeal dysfunction to establish their diagnostic accuracy. We found that oral ( p = 0.04), but not pharyngeal, isotope clearance is swallowed bolus-dependently. Scintigraphic transit times do not differ from times derived radiographically. All scintigraphic measures have extremely good test-retest reliability. The mean difference between test and retest for oral residual was -1% (95% CI -3%-1%) and for pharyngeal residual it was -2% (95% CI -5%-1%). Scintigraphic transit times have very poor diagnostic accuracy for regional dysfunction. Abnormal oral and pharyngeal residuals have positive predictive values of 100% and 92%, respectively, for regional dysfunction. We conclude that oral-pharyngeal scintigraphic clearance is highly reliable, bolus volume-dependent, and has a high predictive value for regional dysfunction. It may prove useful in assessment of dysphagia severity and longitudinal change.
需要一种有效且可靠的技术来量化吞咽口咽期的效率，以便客观地测量吞咽困难的严重程度以及吞咽功能在干预后的纵向变化。本研究的目的是开发并验证一种闪烁扫描技术，以量化口咽吞咽过程中食团清除的效率，并评估其诊断准确性。为实现这一目标，在3个独立的健康对照组和一组经证实存在口咽吞咽困难的患者中，测量了吞咽后口腔和咽部中锝标记的5毫升和10毫升水食团的残留计数以及区域传输时间。在一组年龄大于55岁的对照组中进行重复测量，以确定重测信度。通过与放射影像学时间测量结果进行比较，验证闪烁扫描传输测量结果。将经证实存在吞咽困难者的闪烁扫描测量结果与口腔和咽部功能障碍的放射影像学分类进行比较，以确定其诊断准确性。我们发现，口腔（p = 0.04）而非咽部的同位素清除与吞咽食团有关。闪烁扫描传输时间与放射影像学得出的时间无差异。所有闪烁扫描测量结果均具有极佳的重测信度。口腔残留测量的测试值与重测值之间的平均差异为-1%（95%可信区间-3%至1%），咽部残留测量的平均差异为-2%（95%可信区间-5%至1%）。闪烁扫描传输时间对区域性功能障碍的诊断准确性很差。口腔和咽部残留异常对区域性功能障碍的阳性预测值分别为100%和92%。我们得出结论，口咽闪烁扫描清除高度可靠，与食团体积有关，对区域性功能障碍具有较高的预测价值。它可能在评估吞咽困难严重程度和纵向变化方面有用。
