Kuo Chia-Wei, Allen Clint Tanner, Huang Chu-Chun, Lee Chia-Jung
Department of Otolaryngology, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95, Wen-Chang Road, Shih-Lin District, Taipei, Taiwan.
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2513-2519. doi: 10.1007/s00405-017-4522-y. Epub 2017 Mar 12.
The objective of this retrospective review is to evaluate the ability of the Murray secretion scale to predict aspiration as determined by fiberoptic endoscopic evaluation of swallowing. Patients with dysphagia undergoing a fiberoptic endoscopic evaluation of swallowing study between January 2013 and November 2015 from a single, tertiary care institution were retrospectively reviewed. The Murray secretion scale and penetration aspiration scale on fiberoptic endoscopic evaluation of swallowing examination were determined. Spearman's correlation analysis, sensitivity, specificity, predictive values, and relative risk evaluating the relationship between the Murray secretion scale and aspiration on fiberoptic endoscopic evaluation of swallowing were calculated. Subgroups of head and neck cancer patients, penetration group, and aspiration group were also analyzed. The mean age of the cases (N = 212) was 62.4 years. Eighty percent were male. There was a strong correlation between Murray secretion scale grade and penetration aspiration scale score (r = 0.785, p < 0.001). The sensitivity and specificity of a Murray secretion scale grade 2 or higher in predicting aspiration were 74 and 90%, respectively. Individuals with a Murray secretion scale grade of 2 or higher were 13.6 times more likely to aspirate than patients with a lower Murray secretion scale grade. All subgroups showed similar trend. Determination of a Murray secretion scale grade, determined by flexible nasopharyngoscopy, may predict patients at high risk for aspiration. In clinical scenarios where more complete assessments of aspiration risk are immediately impossible or impractical, the Murray secretion scale grade may add valuable information to assist in clinical decision-making in patients with dysphagia.
本回顾性研究的目的是评估默里分泌物量表预测误吸的能力，误吸通过吞咽的纤维内镜评估来确定。对2013年1月至2015年11月期间在一家三级医疗机构接受吞咽纤维内镜评估研究的吞咽困难患者进行回顾性分析。确定吞咽纤维内镜检查时的默里分泌物量表和渗透误吸量表。计算斯皮尔曼相关性分析、敏感性、特异性、预测值以及评估默里分泌物量表与吞咽纤维内镜评估误吸之间关系的相对风险。对头颈部癌症患者亚组、渗透组和误吸组也进行了分析。病例的平均年龄（N = 212）为62.4岁。80%为男性。默里分泌物量表分级与渗透误吸量表评分之间存在强相关性（r = 0.785，p < 0.001）。默里分泌物量表2级及以上预测误吸的敏感性和特异性分别为74%和90%。默里分泌物量表2级及以上的个体误吸的可能性是默里分泌物量表分级较低患者的13.6倍。所有亚组均显示出相似趋势。通过软性鼻咽喉镜检查确定的默里分泌物量表分级，可能预测误吸风险高的患者。在无法立即进行或不切实际进行更全面误吸风险评估的临床情况下，默里分泌物量表分级可为吞咽困难患者的临床决策提供有价值的信息。
