脑性瘫痪儿童喂养/吞咽困难和营养不良筛查工具的临床应用

doi:10.11852/zgetbjzz2022-0432

摘要/Abstract

摘要： 目的验证脑性瘫痪儿童喂养/吞咽困难和营养不良筛查工具(简称筛查工具)在临床应用中的有效性。方法纳入2021年1—10月于安徽省儿童医院康复医学科住院治疗的脑瘫儿童94例,分别使用筛查工具、Z评分、主观全面营养评估(SGNA)、饮食功能分级系统(EDACS)进行评估,重新确定筛查工具的截断值,并计算一致性和效度指标。结果评价营养不良时截断值取2,评价喂养/吞咽困难时截断值取3。筛查工具与传统的Z评分分级、2014年美国肠内肠外营养学会(ASPEN)共识声明中的Z评分分级、SGNA、EDACS的Kappa系数分别为0.349 (95%CI:0.177~0.521)、0.466 (95%CI:0.288~0.644)、0.574 (95%CI:0.409~0.739)、0.747 (95%CI:0.582~0.912)。以传统的Z评分分级为参照,筛查工具的灵敏度为80.0%,特异度为63.8%;以ASPEN的Z评分分级为参照,筛查工具的灵敏度为73.8%,特异度为73.1%;以SGNA为参照,筛查工具的灵敏度为76.6%,特异度为80.9%;以EDACS为参照,筛查工具的灵敏度为72.7%,特异度为97.2%。本研究中筛查工具得分≥3分对重度营养不良和严重进食障碍的识别率为100%。结论脑性瘫痪儿童喂养/吞咽困难和营养不良筛查工具对脑瘫儿童的营养和吞咽问题有良好的识别能力,有助于避免漏诊重度营养不良和严重进食障碍。

关键词: 脑性瘫痪, 喂养困难, 吞咽障碍, 营养不良, 筛查工具

Abstract: Objective To verify the effectiveness of a screening tool for feeding/swallowing difficulties and malnutrition in children with cerebral palsy (hereafter referred to as the screening tool) in clinical application. Methods A total of 94 children with cerebral palsy, who were hospitalized in the Department of Rehabilitation Medicine of Anhui Provincial Children's Hospital from January to October 2021, were enrolled in this study. The screening tool, Z-scores, Subjective Global Nutrition Assessment (SGNA), and Eating and Drinking Ability Classification System (EDACS) were used for evaluation. The cut-off value of the screening tool was re-determined, then the consistency and validity indicators were calculated. Results The cut-off value of evaluating malnutrition and feeding/swallowing difficulties was 2 and 3, respectively. The Kappa coefficients of the screening tool with traditional Z-scores classification, Z-scores classification in the 2014 American Society for Enteral and Parenteral Nutrition (ASPEN) consensus statement, SGNA, and EDACS were 0.349 (95%CI:0.177 - 0.521), 0.466 (95%CI:0.288 - 0.644), 0.574 (95%CI:0.409 - 0.739) and 0.747 (95%CI:0.582 - 0.912), respectively. When taking traditional Z-scores classification as reference, the sensitivity and specificity of the screening tool were 80.0% and 63.8%, respectively. When taking ASPEN Z-scores as reference, the sensitivity and specificity of the screening tool were 73.8% and 73.1%, respectively. When taking SGNA as reference, the sensitivity and specificity of the screening tool were 76.6% and 80.9%, respectively. When taking EDACS as reference, the sensitivity and specificity of the screening tool were 72.7% and 97.2%, respectively. The detection rate of severe malnutrition and severe eating disorders screened by ≥3 was 100%. Conclusion The screening tool for feeding/swallowing difficulties and malnutrition can be used to identify nutritional and swallowing problems in children with cerebral palsy, which is helpful for avoiding missed diagnosis of severe malnutrition and severe eating disorders.

Key words: cerebral palsy, feeding difficulties, swallowing disorders, malnutrition, screening tool

中图分类号:

施磊, 童光磊, 李红, 陈婧, 吴杉杉. 脑性瘫痪儿童喂养/吞咽困难和营养不良筛查工具的临床应用[J]. 中国儿童保健杂志, 2022, 30(9): 1024-1028.

SHI Lei, TONG Guang-lei, LI Hong, CHEN Jing, WU Shan-shan. Clinical application of a screening tool for feeding/swallowing difficulties and malnutrition in children with cerebral palsy[J]. Chinese Journal of Child Health Care, 2022, 30(9): 1024-1028.

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