Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
PLoS One. 2021 Jun 4;16(6):e0252837. doi: 10.1371/journal.pone.0252837. eCollection 2021.
A dysphagia diet is important for patients with stroke to help manage their nutritional state and prevent aspiration pneumonia. Tongue pressure measurement is a simple, non-invasive, and objective method for diagnosing dysphagia. We hypothesized that tongue pressure may be useful in making a choice of diet for patients with acute stroke. Using balloon-type equipment, tongue pressure was measured in 80 patients with acute stroke. On admission, a multidisciplinary swallowing team including doctors, nurses, speech therapists, and management dietitians evaluated and decided on the possibility of oral intake and diet form; the tongue pressure was unknown to the team. Diet form was defined and classified as dysphagia diet Codes 0 to 4 and normal form (Code 5 in this study) according to the 2013 Japanese Dysphagia Diet Criteria. In multivariate analysis, only tongue pressure was significantly associated with the dysphagia diet form (p<0.001). Receiver operating characteristic analyses revealed that the optimal cutoff tongue pressure for predicting diet Codes 1, 2, 3, 4, and 5 was 3.6 (p<0.001, area under the curve [AUC] = 0.997), 9.6 (p<0.001, AUC = 0.973), 12.8 (p<0.001, AUC = 0.963), 16.5 (p<0.001, AUC = 0.979), and 17.3 kPa (p<0.001, AUC = 0.982), respectively. Tongue pressure is one of the sensitive indicators for choosing dysphagia diet forms in patients with acute stroke. A combination of simple modalities will increase the accuracy of the swallowing assessment and choice of the diet form.
吞咽困难饮食对脑卒中患者很重要，有助于维持营养状态，预防吸入性肺炎。舌压测量是一种简单、无创、客观的吞咽困难诊断方法。我们假设舌压可能有助于选择急性脑卒中患者的饮食。使用球囊式设备测量了 80 例急性脑卒中患者的舌压。入院时，包括医生、护士、言语治疗师和管理营养师在内的多学科吞咽团队评估并决定了经口摄入和饮食形式的可能性；团队并不知道舌压情况。根据 2013 年日本吞咽困难饮食标准，饮食形式被定义并分类为吞咽困难饮食代码 0 到 4 和正常形式（本研究中为代码 5）。多变量分析显示，只有舌压与吞咽困难饮食形式显著相关（p<0.001）。受试者工作特征分析显示，预测饮食代码 1、2、3、4 和 5 的最佳截断舌压分别为 3.6kPa（p<0.001，曲线下面积 [AUC] = 0.997）、9.6kPa（p<0.001，AUC = 0.973）、12.8kPa（p<0.001，AUC = 0.963）、16.5kPa（p<0.001，AUC = 0.979）和 17.3kPa（p<0.001，AUC = 0.982）。舌压是选择急性脑卒中患者吞咽困难饮食形式的敏感指标之一。结合简单的方法将提高吞咽评估和饮食形式选择的准确性。
