颏下高频超声波检查对儿童口咽期吞咽障碍评估的价值*
Value of submental ultrasonography for assessing oropharyngeal swallowing disorder in children

目的:探讨颏下高频超声波(SUS)检查在儿童口咽期吞咽障碍评估中的价值。方法:选取20名口咽期吞咽障碍的儿童(8名依赖管饲进食,12名常规经口进食)和25名吞咽功能正常儿童,应用SUS测量吞咽5 mL水时舌肌厚度变化值和舌骨位移幅度。以经口摄食功能量表(FOIS)评估结果为参照,绘制ROC,评估舌肌厚度变化值和舌骨位移幅度对管饲依赖性吞咽障碍的诊断效能。结果:口咽期吞咽障碍的儿童舌肌厚度变化值和舌骨位移幅度均大于正常儿童(P＜0.05)。以舌肌厚度变化值诊断管饲依赖性吞咽障碍的ROC的AUC(95%CI)为0.853(0.689～1.000),诊断界值为0.95 cm时灵敏度和特异度分别为73.0%和87.5%,约登指数为0.605。以舌骨位移幅度诊断管饲依赖性吞咽障碍的ROC的AUC(95%CI)为0.829(0.609～1.000),诊断界值为1.35 cm时灵敏度和特异度分别为86.5%和75.0%,约登指数为0.615。结论:SUS检查能够辅助评估口咽期吞咽障碍儿童的吞咽功能。
Aim: To explore the value of submental ultrasonography(SUS)examination in the assessment of oropharyngeal swallowing disorder in children.Methods: A total of 20 children with oropharyngeal swallowing disorder(8 cases of nasal feeding, 12 cases of conventional oral feeding)and 25 normal children accepted SUS examination, the change of the thickness of the tongue muscle and the hyoid bone displacement range when swallowing 5 mL water were measured. According to the results of the dysphagia severity assessed by the functional oral intake scale(FOIS), the diagnostic efficacy of the change of tongue muscle thickness and the hyoid bone displacement range for tube-feeding-dependent dysphagia were assessed using ROC.Results: The change of tongue muscle thickness and the hyoid bone displacement range of the children with oropharyngeal swallowing disorder were higher than those of the normal children(P＜0.05). AUC(95%CI) of the change of tongue muscle thickness of ROC was 0.853(0.689-1.000),and the sensitivity, specificity and Youden index were 73.0%,87.5% and 0.605 when the cut-off point was 0.95 cm. AUC(95%CI) of the hyoid bone displacement range of ROC was 0.829(0.609-1.000),and the sensitivity, specificity and Youden index were 86.5%,75.0% and 0.615 when the cut-off point was 1.35 cm.Conclusion: SUS examination can assist to assess the swallowing function of children with oropharyngeal swallowing disorder