Standardization of quantitative evaluation for swallowing disturbance

吞咽功能的定量标准化评估是治疗吞咽困难患者的生活质量的必要条件。然而，目前还没有任何既定的吞咽障碍的评价标准。为多方面、定量地评价吞咽困难患者吞咽功能的病理严重程度，建立标准化的吞咽功能评价标准，选择42例脑血管或神经肌肉疾病所致吞咽困难患者，男35例，女12例，平均年龄68.9岁。通过电视内窥镜和荧光造影检查患者的吞咽功能。通过电视内窥镜观察，1）谷和梨状窦内的唾液淤积，2）声门闭合反射，3）吞咽反射，4）吞咽3 ml蓝色染料水后的咽清除率分别为0-3分。通过电视透视检查，吞咽5 ml钡剂后咽部间隙评分为0-3分，并进行误吸评估，电视内镜评分结果在检查者之间差异无统计学意义，说明电视内镜可定量评估吞咽困难的严重程度。通过视频内窥镜检查的咽部清除与通过视频透视检查的咽部清除或抽吸相关。总之，1）在山谷和梨状窦中的唾液淤积，2）声门闭合反射，3）吞咽反射，和4）吞咽3 ml蓝色染料水后的咽清除率是评估吞咽障碍的有用工具。对这些参数进行评分可以定量评价吞咽困难的严重程度。

Quantitative standardized evaluation of swallowing function is mandatory for treating patients with dysphagia in consideration of their quality of life. However, there has not been any established evaluation criteria for swallowing disturbance. In this study, we aimed to assess the pathological severity of swallowing function of the dysphagic patients multifacetedly and quantitatively, and establish standardized evaluation criteria.Forty-two patients with dysphagia due to cerebrovascular or neuromuscular diseases (35 males and 12 females, mean age : 68.9 years) were enrolled in this study. Their swallowing functions were examined by videoendoscopy and videofluorography. By videoendoscopic observation, 1) salivary pooling in the vallecula and piriform sinuses, 2) glottal-closure reflex, 3) swallowing reflex, and 4) pharyngeal clearance after swallowing 3ml of blue-dye water were scored into 0-3, respectively. By videofluorographic study, pharyngeal clearance after swallowing 5ml of balium was also scored into 0-3, and aspiration was evaluated.The results of scoring of videoendoscopy varied insignificantly among examiners, demonstrating that videoendoscopy can quantitatively evaluate the severity of dysphagia. Pharyngeal clearance by videoendoscopy correlated with pharyngeal clearance or aspiration by videofluoroscopy. In conclusion, 1) salivary pooling in the vallecula and piriform sinuses, 2) glottal-closure reflex, 3) swallowing reflex, and 4) pharyngeal clearance after swallowing 3ml of blue-dye water are useful tools for evaluating swallowing disturbance. And scoring of these parameters can quantitatively evaluate the severity of dysphagia.