摘要
目的:超声技术与电视X射线透视吞咽功能检查(VFSS)进行对比分析,评价超声影像在脑卒中后吞咽功能检测中的应用价值.方法:选取2022年1月至2023年7月海南医学院第二附属医院收治的72例脑卒中后吞咽障碍患者纳入病例组,同时招募45名吞咽功能正常的健康老年人纳入健康对照组,均行VFSS和超声定量评估,超声定量评估评定2次,比较超声检测内部一致性.同时将超声检查与VFSS结果做相关性检验以验证超声定量评估的效度;以VFSS为"金标准",分析超声评估的灵敏度与特异度.比较两组超声半定量描述颏舌骨肌异常等级与运动时间、运动距离及舌肌厚度变化的差异.结果:病例组肌肉异常等级描述组内相关系数(ICC)为0.90、运动时间为(1.743±0.235)s,运动距离(6.323±0.823)mm,运动速度(3.826±0.778)mm/s,其组内信度高度相关(ICC=0.90、0.82、0.87、0.85,P＜0.01);组间肌肉异常等级描述、运动时间、运动距离及运动速度组间信度高度相关(ICC=0.86、0.85、0.88、0.87,P＜0.01).超声检测阳性与VFSS检查结果高度相关(r=0.91,P＜0.01).病例组患者运动距离、运动平均速度及舌肌厚度变化均小于健康对照组,运动时间大于健康对照组,两组比较差异有统计学意义(t=9.03、30.49、-7.02、22.69,P＜0.05);病例组患者肌肉超声均存在异常.结论:超声技术可定量评估脑卒中后吞咽功能障碍,相较于VFSS技术,超声影像可测定吞咽肌肉运动的相关数据,动态记录颏舌骨肌运动参数及舌肌厚度变化,同时可检测吞咽障碍患者肌肉异常等级,这将有助于进一步探索肌肉的潜在病理机制,促进吞咽障碍患者健康管理.
Abstract
Objective:To compare with video-fluoroscopic swallowing function test(VFSS),so as to evaluate the application value of ultrasonography in the test of dysphagia after stroke.Methods:A total of seventy-two patients with dysphagia after stroke who admitted to The Second Affiliated Hospital of Hainan Medical University from January 2022 to July 2023 were selected as cases group,and a total of 45 healthy aged with normal swallowing function were selected as healthy control group at the same time.All of them underwent video X-ray fluoroscopic examination of swallowing function and quantitative assessment of ultrasound.Quantitative assessment of ultrasound was performed by twice to compare the internal consistency of ultrasound test.Meanwhile,the correlation between ultrasound and VFSS results was tested to verify the validity of ultrasound quantitative assessment.The VFSS was used as gold standard to analyze the sensitivity and specificity of ultrasound assessment.The differences of abnormal grade of Geniohyoid muscle;movement time,movement distance and the change of tongue muscle thickness of semi quantitative description of ultrasound between two groups were compared.Results:The intra group correlation coefficient(ICC),movement time,movement distance and movement speed of grade description of muscle abnormalities of cases group were respectively 0.90,(1.743±0.235)s,(6.323±0.823)mm and(3.826±0.778)mm/s,which intra reliabilities were high correlation(ICC=0.90,0.82,0.87,0.85,P＜0.01),which inter reliabilities of these indicators were high correlation(ICC=0.86,0.85,0.88,0.87,P＜0.01),respectively.The positive results of ultrasound test highly correlated with the results of VFSS examination(r=0.91,P＜0.01).The movement distance,the average movement speed and the changes of the thickness of tongue muscle in patients of cases group were significantly smaller than those of healthy control group,but the movement time was larger than that of healthy control group(t=9.03,30.49,-7.02,22.69,P＜0.05),respectively.The results of the ultrasound on the muscles of all patients in cases group existed abnormality.Conclusion:Ultrasound technique can quantitatively assess dysphagia after stroke.Compared with VFSS technique,ultrasonography can measure and determine the related data of the movement of swallowing muscle,and dynamically record movement parameters of geniohyoid muscle and the changes of the thickness of tongue muscle.At the same time,it can detect the grade of muscle abnormalities of patients with dysphagia,which will contribute to further explore the potential pathological mechanism about muscle,and promote the healthy management for patients with dysphagia.
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