Ibe Yoko, Tazawa Masayuki, Arii Hironori, Nakao Yumiko, Toyama Risa, Wada Naoki
Division of Rehabilitation Medicine, Gunma University Hospital, Maebashi, Japan.
Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
Arch Rehabil Res Clin Transl. 2025 Feb 20;7(2):100435. doi: 10.1016/j.arrct.2025.100435. eCollection 2025 Jun.
To analyze the characteristics of flexible endoscopic evaluation of swallowing (FEES) findings in patients with aspiration pneumonia using the Hyodo dysphagia score and to evaluate the risk of aspiration pneumonia.
Retrospective study.
Observation in a single primary care institution.
Inpatients aged ≥20 years who underwent FEES in our hospital between April 2012 and March 2022. A total of 178 patients were eligible to calculate the Hyodo dysphagia score and were enrolled in this study. The mean ± SD age of the subjects was 73.4±13.3 years, and 116 of 178 patients (65.2%) were men.
Not applicable.
The development of aspiration pneumonia.
Eighty-four of 178 patients (47.2%) developed aspiration pneumonia. Age, oral intake status, and serum albumin levels were not significantly different between the pneumonia and nonpneumonia groups. The total and each parameter of the Hyodo dysphagia score were significantly higher in the pneumonia group than in the nonpneumonia group. Logistic regression analysis showed that salivary retention (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.09-1.33; =.016) and poor cough reflex (OR, 1.88; 95% CI, 1.42-2.49; <.001) in the Hyodo dysphagia score were risk factors for aspiration pneumonia. The area under the curve of the receiver operating characteristic curve for the onset of pneumonia based on the total Hyodo dysphagia score was 0.75 (95% CI, 0.67-0.82). A cutoff value of 5 for the total Hyodo dysphagia score gave a sensitivity of 0.75 (95% CI, 0.67-0.83) and a specificity of 0.60 (95% CI, 0.49-0.71), with the Youden index having a maximum value of 0.35.
A cutoff value of 5 points for the total Hyodo dysphagia score was optimal in predicting the development of aspiration pneumonia. Salivary retention and poor cough reflex were risk factors for the development of pneumonia.
使用Hyodo吞咽困难评分分析吸入性肺炎患者的吞咽功能灵活内镜评估（FEES）结果特征，并评估吸入性肺炎的风险。
回顾性研究。
在一家初级保健机构进行观察。
2012年4月至2022年3月期间在我院接受FEES的年龄≥20岁的住院患者。共有178例患者符合计算Hyodo吞咽困难评分的条件并纳入本研究。受试者的平均年龄±标准差为73.4±13.3岁，178例患者中有116例（65.2%）为男性。
不适用。
吸入性肺炎的发生情况。
178例患者中有84例（47.2%）发生吸入性肺炎。肺炎组和非肺炎组在年龄、经口摄入状态和血清白蛋白水平方面无显著差异。肺炎组Hyodo吞咽困难评分的总分及各参数均显著高于非肺炎组。逻辑回归分析显示，Hyodo吞咽困难评分中的唾液潴留（比值比[OR]，1.60；95%置信区间[CI]，1.09 - 1.33；P =.016）和咳嗽反射减弱（OR，1.88；95% CI，1.42 - 2.49；P <.001）是吸入性肺炎的危险因素。基于Hyodo吞咽困难评分总分的肺炎发病的受试者工作特征曲线下面积为0.75（95% CI，0.67 - 0.82）。Hyodo吞咽困难评分总分的截断值为5时，敏感性为0.75（95% CI，0.67 - 0.83），特异性为0.60（95% CI，0.49 - 0.71），约登指数最大值为0.35。
Hyodo吞咽困难评分总分的截断值为5分在预测吸入性肺炎的发生方面最为理想。唾液潴留和咳嗽反射减弱是肺炎发生的危险因素。
