自主咳嗽气流测定能区分肌萎缩侧索硬化症患者安全与不安全的吞咽
2016/08/22
摘要
吞咽困难和误吸在肌萎缩侧索硬化症（ALS）中是普遍的，可导致营养不良、吸入性肺炎、和死亡。早期发现危险个体在确保维持口服摄入的安全性和理想的肺功能中至关重要。因此我们旨在确定自主咳嗽气流测试方法在发现ALS患者渗透/误吸状态的判别能力。70位ALS患者（El-Escorial标准）完成了自主咳嗽的肺功能测试并接受了标准化电视透视吞咽评估（VFSE）。对误吸状态未知的评估者（评估者盲）对自主咳嗽气流产生六项客观评价，并利用渗透误吸量（PAS）评估气道安全。进行组间方差分析（安全与不安全吞咽者），对敏感性、特异性、曲线下面积（AUC）和似然比进行了计算。电视透视吞咽评估（VFSE）分析显示有24个渗透/误吸（PAS≥3）和46个非渗透/误吸（PAS≤2）患者。咳嗽体积加速度（CVA），呼气峰流速上升时间（PEFRT），呼气峰流速（PEFR）在气道安全组之间存在显著性差异（P＜0.05），AUC值分别为：0.85，0.81，和0.78，表明其对检测渗透/误吸存在显著的判别能力。用于检测ALS 渗透/误吸的CVA＜45.28L/s/s，PEFR＜3.97 L/s，PEFRT >76 ms，灵敏度分别为91.3%、82.6%和73.9%，特异性分别为82.2%，73.9%，78.3%。自主咳嗽气流测试方法能确定鉴别出存在渗透/误吸的风险的ALS患者，可能是一个具有较高的临床实用价值的筛选工具。
（苏欣 审校）
Dysphagia.2016 Jun;31(3):383-90.doi:10.1007/s00455-015-9687-1.Epub2016Jan 23.
Voluntary Cough Airflow Differentiates Safe Versus Unsafe Swallowing in Amyotrophic Lateral Sclerosis.
Plowman EK1,2, Watts SA3,4, Robison R5,3, Tabor L5,3, Dion C4, Gaziano J4, Vu T6, Gooch C6.
Author information
Abstract
Dysphagia and aspiration are prevalent in amyotrophic lateral sclerosis (ALS) and contribute to malnutrition, aspiration pneumonia, and death. Early detection of at risk individuals is critical to ensure maintenance of safe oral intake and optimal pulmonary function. We therefore aimed to determine the discriminant ability of voluntary cough airflow measures in detecting penetration/aspiration status in ALS patients. Seventy individuals with ALS (El-Escorial criteria) completed voluntary cough spirometry testing and underwent a standardized videofluoroscopic swallowing evaluation (VFSE). A rater blinded to aspiration status derived six objective measures of voluntary cough airflow and evaluated airway safety using the penetration-aspiration scale (PAS). A between groups ANOVA (safe vs. unsafe swallowers) was conducted and sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated. VFSE analysis revealed 24 penetrator/aspirators (PAS ≥3) and 46 non-penetrator/aspirators (PAS ≤2). Cough volume acceleration (CVA), peak expiratory flow rise time (PEFRT), and peak expiratory flow rate (PEFR) were significantly different between airway safety groups (p < 0.05) and demonstrated significant discriminant ability to detect the presence of penetration/aspiration with AUC values of: 0.85, 0.81, and 0.78, respectively. CVA <45.28 L/s/s, PEFR <3.97 L/s, and PEFRT >76 ms had sensitivities of 91.3, 82.6, and 73.9 %, respectively, and specificities of 82.2, 73.9, and 78.3 % for identifying ALS penetrator/aspirators. Voluntarycough airflow measures identified ALS patients at risk for penetration/aspiration and may be a valuable screening tool with high clinical utility.
KEYWORDS:Amyotrophic lateral sclerosis; Aspiration; Cough; Deglutition; Deglutition disorders; Screen
Dysphagia.2016 Jun;31(3):383-90.doi:10.1007/s00455-015-9687-1.Epub2016Jan 23.
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儿童慢性咳嗽特异性生活质量测试：发展与验证
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与感冒有关的想咳嗽和咳嗽症状的特征：美国互联网的调查结果
