Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration
Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration
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DOI：
10.1016/j.clnu.2008.06.011
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发表时间：
2008-12-01
影响因子：
6.3
通讯作者：
Serra-Prat, Mateu
中科院分区：
文献类型：
--
作者：
Clave, Pere;Arreola, Viridiana;Serra-Prat, Mateu
目的：探讨床边容量-黏度吞咽试验(V-VST)在吞咽障碍患者临床筛查中的准确性。方法：对85例吞咽障碍患者和12例健康者进行研究。在V-VST和电视透视检查中给予5-20毫升花蜜(295.02 mPa.s)、液体(21.61 mPa.s)和布丁(3682.21 mPa.s)。结果：视频透视显示患者吞咽反应延长(1064ms)；52.1%的患者在花蜜、液体(p<；0.05)和布丁黏度(p<；0.05)下安全吞咽；29.4%的患者有渴望，45.8%的患者有口咽残留。V-VST对团注进入喉的敏感性和特异性分别为83.7%和64.7%，对抽吸的敏感性和特异性分别为100%和28.8%。V-VST对残留物的敏感度为69.2%，对零碎吞咽的敏感度为88.4%，对通过增加团注黏度改善吞咽症状的患者的敏感度为84.6%。特异性分别为80.6%、87.5%和73.7%。结论：V-VST是一种敏感的临床诊断方法，可用于诊断有呼吸和营养并发症风险的吞咽困难患者，以及通过增加团注粘度改善吞咽功能的患者。检测呈阳性的患者应接受视频透视检查。(C)2008年爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Aims: To determine the accuracy of the bedside volume-viscosity swallow test (V-VST) for clinical screening of impaired safety and efficacy of deglutition.Methods: We studied 85 patients with dysphagia and 12 healthy subjects. Series of 5-20 mL nectar (295.02 mPa.s), liquid (21.61 mPa.s) and pudding (3682.21 mPa.s) bolus were administered during the V-VST and videofluoroscopy. Cough, fall in oxygen saturation >= 3%, and voice changes were considered signs of impaired safety, and piecemeal deglutition and oropharyngeal residue, signs of impaired efficacy.Results: Videofluoroscopy showed patients had prolonged swallow response (>= 1064 ms); 52.1% had safe swallow at nectar, 32.9%, at liquid (p < 0.05), and 80.6% at pudding viscosity (p < 0.05); 29.4% had aspirations, and 45.8% oropharyngeal residue. The V-VST showed 83.7% sensitivity and 64.7% specificity for bolus penetration into the larynx and 100% sensitivity and 28.8% specificity for aspiration. Sensitivity of V-VST was 69.2% for residue, 88.4% for piecemeal deglutition, and 84.6% for identifying patients whose deglutition improved by enhancing bolus viscosity. Specificity was 80.6%, 87.5%, and 73.7%, respectively.Conclusions: The V-VST is a sensitive clinical method to identify patients with dysphagia at risk for respiratory and nutritional complications, and patients whose deglutition could be improved by enhancing bolus viscosity. Patients with a positive test should undergo video-fluoroscopy. (C) 2008 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.