Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
Cerebrovasc Dis. 2013;35(3):276-81. doi: 10.1159/000348683. Epub 2013 Mar 26.
The water-swallowing test (WST) is frequently used in clinical practice as a functional assessment to detect aspiration and prevent pneumonia. It is a standardized test used all over the world, but the amount of water given varies depending on the examiner. Furthermore, there are very few reports on the simultaneous performance of the WST and videofluorography (VF). This study compared the amount of swallowed water to investigate the reliability of WST to exclude aspiration following acute stroke.
We assessed 111 stroke patients (65 men and 46 women) with suspected dysphagia/difficulty in swallowing and performed VF upon obtaining consent from the patients and their families. Patients were aged between 20 and 98 years (65.6 ± 13.4 years); 64 had cerebral infarction, 26 cerebral hemorrhage, 13 subarachnoid hemorrhage, and 8 had other cerebrovascular disease. The time from stroke onset to VF was 16.6 ± 10.3 days (range, 2-55). WSTs using 5, 10, 30, and 60 ml and the modified WST (MWST) were performed during VF.
We found that the number of instances of choking, cough, wet voice, and aspiration increased with higher amounts of water. The sensitivity and specificity of WST for aspiration ranged from 34.8 to 55.7% and from 78.9 to 93.2%, respectively. The MWST, which used only 3 ml of water, yielded a sensitivity of 55.3% and a specificity of 80.8% for aspiration. There was a positive correlation between the time for one swallow and age, but there was no difference between genders. There was also no connection between clinical findings during WST or the presence of aspiration with the number of swallows, swallowing speed, or time for one swallow.
WSTs are not as powerful as VF as a screening instrument in acute stroke. WSTs with more water detected aspiration with greater sensitivity, but there is no justification for overconfidence when investigating aspiration. We recommend using WST as well as VF to investigate swallowing in stroke patients.
吞咽水试验（WST）常被临床用于检测误吸并预防肺炎，是一种被全世界广泛使用的标准化检测方法，但给予的水量因检查者而异。此外，同时进行 WST 和荧光透视吞咽检查（VF）的报告很少。本研究比较了吞咽水量，旨在探讨 WST 在排除急性脑卒中后误吸方面的可靠性。
我们评估了 111 例疑似吞咽困难/吞咽障碍的脑卒中患者（65 例男性和 46 例女性），并在获得患者及其家属同意后进行 VF。患者年龄 2098 岁（65.6±13.4 岁）；64 例为脑梗死，26 例为脑出血，13 例为蛛网膜下腔出血，8 例为其他脑血管病。从卒中发病到 VF 的时间为 16.6±10.3 天（范围为 255 天）。在 VF 期间进行了 5、10、30 和 60 ml 的 WST 和改良 WST（MWST）。
我们发现，随着水量的增加，呛咳、咳嗽、湿音和误吸的次数增加。WST 对误吸的敏感性和特异性分别为 34.8%55.7%和 78.9%93.2%。仅使用 3 ml 水的 MWST 对误吸的敏感性为 55.3%，特异性为 80.8%。单次吞咽所需的时间与年龄呈正相关，但与性别无关。WST 期间的临床发现或误吸与吞咽次数、吞咽速度或单次吞咽所需时间之间也没有联系。
WST 作为急性脑卒中的筛查工具，不如 VF 有效。使用更多水的 WST 可以更敏感地检测到误吸，但在调查误吸时不应过分自信。我们建议在脑卒中患者中同时使用 WST 和 VF 进行吞咽检查。
