Morgan A T, Omahoney R, Francis H
Developmental Cognitive Neuroscience Unit, UCL, Institute of Child Health, UK.
Dev Neurorehabil. 2008 Jan-Mar;11(1):25-38. doi: 10.1080/17518420701439910.
Early screening and intervention for dysphagia is crucial to offset potential outcomes such as compromised nutrition or reduced respiratory function. Current paediatric dysphagia screening tests are subjective with poor sensitivity and specificity. The present study examined whether an objective method, pulse oximetry (measuring oxygen saturation (SpO2) levels), could differentiate between children with and without dysphagia, in relation to (1) Average pre-feeding baseline SpO2 levels; (2) Average feeding SpO2 levels; (3) Average post-feeding SpO2 levels; and (4) The number of events of oxygen desaturation pre-, during and after feeding.
Nine participants with chronic neurological disability (CND) (7 F, 2 M) (9; 7-15; 11 years) and nine control participants matched for age (9; 5-16; 0 years) and sex were assessed using a clinical bedside evaluation (CBE) and pulse oximetry.
A statistically significant difference was found in SpO2 levels between the two groups (p < 0.001) during oral feeding only (sensitivity, 88.9%; specificity, 88.9%). Only three children with dysphagia experienced 'events' of SpO2 desaturation during feeding.
Pulse oximetry may provide a useful adjunct to the CBE for dysphagia screening, with average SpO2 levels during feeding predicting those with and without dysphagia with moderate levels of sensitivity and specificity. The finding of individual variation in desaturation 'events', however, warrants the provision of further data on large homogenous populations to provide definitive criterion for pathological SpO2 levels associated with dysphagia during oral feeding.
吞咽困难的早期筛查和干预对于抵消潜在后果（如营养受损或呼吸功能下降）至关重要。当前的儿科吞咽困难筛查测试主观性强，敏感性和特异性较差。本研究调查了一种客观方法——脉搏血氧饱和度测定法（测量血氧饱和度（SpO2）水平）能否区分有吞咽困难和无吞咽困难的儿童，具体涉及：（1）喂食前平均基线SpO2水平；（2）喂食期间平均SpO2水平；（3）喂食后平均SpO2水平；以及（4）喂食前、期间和之后的氧饱和度降低事件数量。
对9名患有慢性神经功能障碍（CND）的参与者（7名女性，2名男性）（年龄9岁7个月至15岁11个月）和9名年龄（9岁5个月至16岁）及性别匹配的对照参与者进行了临床床边评估（CBE）和脉搏血氧饱和度测定。
仅在经口喂食期间，两组之间的SpO2水平存在统计学显著差异（p < 0.001）（敏感性为88.9%；特异性为88.9%）。只有3名吞咽困难儿童在喂食期间出现SpO2饱和度降低“事件”。
脉搏血氧饱和度测定法可能为吞咽困难筛查的临床床边评估提供有用的辅助手段，喂食期间的平均SpO2水平以中等水平的敏感性和特异性预测有无吞咽困难。然而，氧饱和度降低“事件”中个体差异的发现需要更多关于大量同质人群的数据，以提供与经口喂食期间吞咽困难相关的病理性SpO2水平的明确标准。
