改良容积黏度测试联合喉镜吞咽功能评估在脑卒中吞咽障碍患者进食训练中的应用

罗艳群; 陈爱连; 李媚希; 胡婷婷; 郑亚星

doi:10.16766/j.cnki.issn.1674-4152.004461

改良容积黏度测试联合喉镜吞咽功能评估在脑卒中吞咽障碍患者进食训练中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004461

湖南省人民医院(湖南师范大学附属第一医院)康复医学科, 湖南长沙 410016

基金项目:

湖南省卫生健康委一般科研项目 202103070833

详细信息

通讯作者:
陈爱连，E-mail：652326303@qq.com

中图分类号: 743.3
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出版历程
- 收稿日期: 2025-03-10

Application of modified volumetric viscosity test combined with laryngoscopic swallowing function assessment in feeding training of stroke patients with dysphagia

Department of Rehabilitation Medicine, Hunan Provincial People's Hospital(The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan 410016, China

摘要

摘要: 目的观察在脑卒中后吞咽障碍(PSD)患者进食训练中采用改良容积黏度测试(VVST-CV)联合喉镜吞咽功能评估(FEES)的效果，以期为临床提供更精准的评估方法和干预策略。方法应用奇偶法将2023年5月—2024年5月期间入住湖南省人民医院康复医学科的PSD患者60例分为试验组与对照组，每组30例。对照组采用VVST-CV，试验组采用VVST-CV联合FEES进行评估，比较2组患者进食训练效果。结果治疗前，2组患者洼田饮水试验等级、功能性经口进食等级、标准吞咽功能评估评分比较差异均无统计学意义(P＞0.05)；治疗后，试验组洼田饮水试验等级低于对照组(P＜0.05), 试验组功能性经口进食等级高于对照组(P＜0.05)，试验组标准吞咽功能评估(SSA)评分[(22.93±1.89)分]低于对照组[(24.87±2.05)分, F=14.562, P＜0.001]，差异有统计学意义(P＜0.05)。治疗后试验组临床疗效优于对照组(P＜0.05)。结论采用改良容积黏度测试联合喉镜进行吞咽功能评估，可显著提升脑卒中后吞咽障碍患者经口进食能力，改善其吞咽功能。
- 脑卒中 /
- 吞咽障碍 /
- 改良容积黏度测试 /
- 喉镜吞咽功能评估
Abstract: Objective To observe the effect of the modified volume-viscosity awallowing test-Chinese version (VVST-CV) combined with flexible endoscopic evaluation of swallowing (FEES) in the feeding training of patients with post-stroke dysphagia (PSD), aiming to provide a more precise assessment method and intervention strategy for clinical practice. Methods A total of 60 patients with PSD admitted to the Department of Rehabilitation Medicine, Hunan Provincial People ' s Hospital between May 2023 and May 2024 were enrolled. They were divided into an experimental group and a control group (30 cases each) using the odd-even number method. The control group was assessed using VVST-CV alone, while the experimental group underwent assessment with VVST-CV combined with FEES. The effects of feeding training were compared between the two groups. Results Before treatment, no statistically significant differences were found in the baseline characteristics between the two groups regarding kubota water swallowing test (KWST) grade, functional oral intake scale (FOIS) grade, or standardized swallowing assessment (SSA) scores (P>0.05). After treatment, the experimental group showed a significantly lower KWST grade (P < 0.05) and a significantly higher FOIS grade (P < 0.05) compared to the control group. The SSA score in the experimental group (22.93±1.89) was significantly lower than that in the control group (24.87±2.05, F=14.562, P < 0.001). Furthermore, the overall clinical efficacy grade was superior in the experimental group (P < 0.05). Conclusion The combined application of the modified volumetric viscosity test and laryngoscopic swallowing function assessment can significantly enhance oral feeding ability and improve swallowing function in stroke patients with dysphagia.
- Stroke /
- Dysphagia /
- Modified volumetric viscosity test /
- Laryngoscopic swallowing function evaluation
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表 1 2组PSD患者一般资料比较

Table 1. Comparison of general characteristics between two groups of patients with post-stroke dysphagia

组别	例数	性别(例)		年龄(x±s, 岁)	脑卒中类型(例)		病程[M(P₂₅, P₇₅), d]	住院时间(x±s, d)
组别	例数	男性	女性	年龄(x±s, 岁)	出血性	缺血性	病程[M(P₂₅, P₇₅), d]	住院时间(x±s, d)
对照组	30	25	5	58.60±10.39	20	10	18.00(10.00，59.75)	24.20±7.86
试验组	30	22	8	60.63±9.89	18	12	23.50(14.75，46.50)	25.40±9.96
统计量		0.884^a		0.778^b	0.287^a		-0.887^c	0.518^b
P值		0.347		0.441	0.592		0.375	0.606
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组PSD患者治疗前后SSA比较(x ±s，分)

Table 2. Comparison of SSA scores before and after treatment between two groups of patients with post-stroke dysphagia (x ±s, points)

组别	例数	治疗前	治疗后	t值	P值
对照组	30	29.77±2.06	24.87±2.05	9.475	＜0.001
试验组	30	29.87±1.83	22.93±1.89	16.174	＜0.001
统计量		0.198^a	14.562^b
P值		0.843	＜0.001
注：^a为t值，^b为F值。

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表 3 2组PSD患者治疗前后洼田饮水试验分级比较[例(%)]

Table 3. Comparison of Kubota water drinking test grades before and after treatment between two groups of patients with post-stroke dysphagia [cases (%)]

组别	例数	治疗前					治疗后
组别	例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级
对照组	30	0	0	6(20.0)	2(6.7)	22(73.3)	4(13.3)	11(36.7)	3(10.0)	8(26.7)	4(13.3)
试验组	30	0	2(6.7)	5(16.7)	5(16.7)	18(60.0)	10(33.3)	13(43.3)	6(20.0)	1(3.3)	0
Z值		-1.028					-2.865
P值		0.304					0.004

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表 4 2组PSD患者治疗前后FOIS分级比较[例(%)]

Table 4. Comparison of FOIS grades before and after treatment between two groups of patients with post-stroke dysphagia [cases (%)]

组别	例数	治疗前							治疗后
组别	例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级	Ⅵ级	Ⅶ级	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级	Ⅵ级	Ⅶ级
对照组	30	27(90.0)	2(6.7)	0	1(3.3)	0	0	0	0	1(3.3)	11(36.7)	1(3.3)	1(3.3)	12(40.0)	4(13.3)
试验组	30	27(90.0)	1(3.3)	0	2(6.7)	0	0	0	0	0	0	3(10.0)	6(20.0)	12(40.0)	9(30.0)
Z值		-0.043							-2.477
P值		0.966							0.013

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表 5 2组PSD患者临床疗效比较[例(%)]

Table 5. Comparison of clinical efficacy between two groups of patients with post-stroke dysphagia [cases (%)]

组别	例数	痊愈	显效	好转	无效
对照组	30	4(13.30)	12(40.00)	9(30.00)	5(16.70)
试验组	30	10(33.30)	14(46.70)	5(16.70)	1(3.33)
注：2组临床疗效比较，Z=2.504，P=0.012。

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参考文献(20)

[1]	李玲, 孙洁, 宁博. 卒中后吞咽障碍患者的咽喉感觉功能与吞咽功能的相关性[J]. 中国康复, 2022, 37(12): 747-750. LI L, SUN J, NING B. Correlation between pharyngeal sensory function and swallowing function in patients with post 813s6Atr5o3k2e dysphagia[J]. Chinese Journal of Rehabilitation, 2022, 37(12): 747-750.
[2]	林茜, 李秀宇, 陈玲莉, 等. 基于纤维喉镜吞咽功能评估观察针刺对中风后吞咽障碍的影响[J]. 中国针灸, 2022, 42(5): 486-490. LIN Q, LI X Y, et al. Effect of acupuncture for dysphagia after stroke based on fiberoptic endoscopic swallowing function evaluation[J]. Chinese Acupuncture & Moxibustion, 2022, 42(5): 486-490.
[3]	许平, 陆中军. 容积黏度吞咽测试(VVST)联合吞咽造影(VFSS)在神经外科吞咽障碍患者摄食指导中的应用[J]. 系统医学, 2021, 6(17): 88-90. XU P, LU Z J. NOT_FOUND[J]. Systems Medicine, 2021, 6(17): 88-90.
[4]	潘维花, 胡薇薇, 宋裕如. 纤维鼻咽喉镜吞咽功能检查对脑卒中吞咽障碍患者摄食训练的指导价值[J]. 中国内镜杂志, 2023, 29(2): 41-48. PAN W H, HU W W, SONG Y R. The guiding value of fiber optic endoscopic examination of swallowing in feeding training of stroke patients with dysphagia[J]. China Journal of Endoscopy, 2023, 29(2): 41-48.
[5]	中国康复医学会吞咽障碍康复专业委员会. 中国吞咽障碍康复管理指南(2023版)[J]. 中华物理医学与康复志, 2023, 45(12): 1057-1072. Swallowing Dysfunction Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine. NOT_FOUND[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2023, 45(12): 1057-1072.
[6]	罗艳群, 唐雪琴, 张泓, 等. 吞咽五穴针刺联合神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能的影响[J]. 中医药导报, 2023, 29(4): 62-65, 70. LUO Y Q, TANG X Q, ZHANG H, et al. The Effect of Swallowing Five Points Acupuncture Combined with Neuromuscular Electrical Stimulation on Dysphagia in Patients after Stroke[J]. Guiding Journal of Traditional Chinese Medicine, 2023, 29(4): 62-65, 70.
[7]	谢逍, 魏继鸿, 刘双, 等. 低频脉冲电刺激联合摄食-吞咽训练在AIS后吞咽障碍的应用及疗效[J]. 西部医学, 2023, 35(6): 875-880. XIE X, WEI J H, LIU S, et al. Application of low-frequency pulsed electrical stimulation combined with ingestion-swallowing training in dysphagia after AIS and its efficacy[J]. Medical Journal of West China, 2023, 35(6): 875-880.
[8]	胡晓, 林海燕, 陈燕燕, 等. 基于容积黏度吞咽试验联合训练对脑卒中吞咽障碍患者的影响[J]. 中华全科医学, 2022, 20(11): 1938-1940, 1991. doi: 10.16766/j.cnki.issn.1674-4152.002740 HU X, LIN H Y, CHEN Y Y, et al. The effect of combined training on patients with dysphagia after stroke based on volume viscosity swallowing test[J]. Chinese Journal of General Practice, 2022, 20(11): 1938-1940, 1991. doi: 10.16766/j.cnki.issn.1674-4152.002740
[9]	戴苏云, 向文海, 崔丽笙, 等. 脑卒中后吞咽障碍及流涎患者的口腔感知觉训练[J]. 实用临床医药杂志, 2022, 26(2): 6-10. DAI S Y, XIANG W H, CUI L S, et al. Oral sensation training in patients with dysphagia and salivation after stroke[J]. Journal of Clinical Medicine in Practice, 2022, 26(2): 6-10.
[10]	贺媛, 贾维维, 王海英, 等. 舌压抗阻反馈训练在缺血性脑卒中患者吞咽障碍康复中的效果研究[J]. 实用临床医药杂志, 2025, 29(8): 102-107. HE Y, JIA W W, WANG H Y, et al. Effect of tongue pressure resistance feedback training on rehabilitation of swallowing disorders in patients with ischemic stroke[J]. Journal of Clinical Medicine in Practice, 2025, 29(8): 102-107.
[11]	冯晓瑜, 黎静雯, 张咏军, 等. 脑卒中吞咽障碍患者安全进食行为及影响因素研究[J]. 中华全科医学, 2023, 21(2): 333-336. doi: 10.16766/j.cnki.issn.1674-4152.002876 FENG X Y, LI J W, ZHANG Y J, et al. Safe eating behaviour and influencing factors in patients with dysphagia after stroke[J]. Chinese Journal of General Practice, 2023, 21(2): 333-336. doi: 10.16766/j.cnki.issn.1674-4152.002876
[12]	BOWEN A J, MACIELAK R J, FUSSELL W, et al. Single-use versus reusable rhinolaryngoscopes for inpatient otorhinolaryngology consults: resident and patient experience[J]. Laryngoscope Investig Otolaryngol, 2023, 9(1): e1203. DOI: 10.1002/lio2.1203.
[13]	张莉, 孙洁, 唐艳, 等. FEES联合DSS对卒中后咽反射消失吞咽障碍的诊断价值[J]. 中国实用神经疾病杂志, 2024, 27(2): 170-175. ZHANG L, SUN J, TANG Y, et al. Diagnostic value of FEES combined with DSS for swallowing disorders in patients with post-stroke loss of pharyngeal reflex[J]. Chinese Journal of Practical Nervous Diseases, 2024, 27(2): 170-175.
[14]	金洁, 徐时乐, 潘学威, 等. 电子鼻咽喉镜联合改良容积黏度吞咽测试在脑梗死伴吞咽障碍患者康复中的应用[J]. 中国现代医学杂志, 2025, 35(6): 91-96. JIN J, XU S L, PAN X W, et al. Application of video nasopharyngoscopy combined with modified Volume-Viscosity Swallow Test in the rehabilitation of patients with cerebral infarction and dysphagia[J]. China Journal of Modern Medicine, 2025, 35(6): 91-96.
[15]	陆敏, 祁玉军, 张芳芳. 电子纤维喉镜联合吞咽造影评估脑卒中后吞咽障碍患者经吞咽神经电刺激治疗后的康复效果研究[J]. 中国现代医学杂志, 2025, 35(10): 7-12. LU M, QI Y J, ZHANG F F. Assessment of swallowing rehabilitation using combined fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study after pharyngeal electrical stimulation in patients with post-stroke dysphagia[J]. China Journal of Modern Medicine, 2025, 35(10): 7-12.
[16]	厉巧兰, 徐琼, 金鑫鑫. 摄食训练结合神经肌肉电刺激治疗脑卒中后吞咽障碍[J]. 浙江实用医学, 2024, 29(3): 208-212. LI Q L, XU Q, JIN X X. Swallowing training combined with neuromuscular electrical stimulation for post-stroke dysphagia[J]. Zhejiang Journal of Practical Medicine, 2024, 29(3): 208-212.
[17]	钱颖吉, 唐红, 蒋菊芳, 等. 改良容积黏度测试在神经康复科吞咽障碍患者中的应用[J]. 护理与康复, 2022, 21(1): 47-50. QIAN Y J, TANG H, JIANG J F, et al. Application of modified volume-viscosity test in patients with dysphagia in department of neurological rehabilitation[J]. Nursing and Rehabilitation, 2022, 21(1): 47-50.
[18]	刘环环. v-vst容积黏度测试在吞咽障碍中的应用进展[J]. 中华养生保健, 2024, 42(3): 90-91, 95. LIU H H. Progress of volume-viscosity swallow test in dysphagia[J]. Zhonghua Yangsheng Baojian, 2024, 42(3): 90-91, 95.
[19]	戴丽华, 杜晓梅, 肖泽埠, 等. 改良容积黏度测试在脑卒中吞咽障碍患者中的应用[J]. 中国当代医药, 2023, 30(33): 78-81, 85. DAI L H, DU X M, XIAO Z B, et al. Application of improved volumetric viscosity test in patients with swallowing disorders after stroke[J]. China Modern Medicine, 2023, 30(33): 78-81, 85.
[20]	徐涵, 顾琳, 雷茵, 等. 软管喉镜吞咽功能评估在吞咽障碍患者渗漏和误吸诊断中的价值[J]. 安徽医学, 2025, 46(2): 161-166. XU H, GU L, LEI Y, et al. Value of flexible endoscopic evaluation of swallowing in diagnosing penetration and aspiration in patients with dysphagia[J]. Anhui Medical Journal, 2025, 46(2): 161-166.