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science\uff0c\u4ee5\u53ca\u4e2d\u6587\u6570\u636e\u5e93\u5305\u62ec\u4e2d\u56fd\u77e5\u7f51(CNKI)\u3001\u4e2d\u56fd\u751f\u7269\u533b\u5b66\u6587\u732e\u670d\u52a1\u7cfb\u7edf(CBM)\u3001\u7ef4\u666e\u3001\u4e07\u65b9\u6570\u636e\u5e93\u8fdb\u884c\u5168\u9762\u68c0\u7d22\uff0c\u68c0\u7d22\u65f6\u95f4\u4e3a\u5efa\u5e93\u52302023\u5e748\u670831\u65e5\uff0c\u8bed\u8a00\u9650\u5b9a\u4e3a\u82f1\u6587\u6216\u4e2d\u6587\u3002\u5e76\u4f7f\u7528\u4e86MeSH\u672f\u8bed\u6765\u641c\u7d22PubMed\u548cCochrane Library\uff0c\u4ee5\u53ca\u4f7f\u7528Emtree\u672f\u8bed\u6765\u641c\u7d22Embase\u6570\u636e\u5e93\u3002\u7eb3\u5165\u7684\u6587\u732e\u4e3b\u8981\u4e3aMeta\u5206\u6790\u3001\u7cfb\u7edf\u7efc\u8ff0\u3001\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u3001\u75c5\u4f8b\u5bf9\u7167\u7814\u7a76\u3001\u961f\u5217\u7814\u7a76\u7b49\u3002\u6307\u5357\u5de5\u4f5c\u5c0f\u7ec4\u4e0e\u65b9\u6cd5\u5b66\u652f\u6301\u7ec4\u4e13\u5bb6\u3001\u5eb7\u590d\u4e13\u5bb6\u62df\u5b9a\u7eb3\u5165\/\u6392\u9664\u6807\u51c6\u540e\uff0c\u5bf9\u6307\u5357\u6587\u732e\u68c0\u7d22\u3001\u8bc1\u636e\u8bc4\u4ef7\u4ee5\u53ca\u6307\u5357\u64b0\u5199\u7b49\u5de5\u4f5c\u5c0f\u7ec4\u6210\u5458\u8fdb\u884c\u5168\u5458\u57f9\u8bad\u3002\u968f\u540e\u68c0\u7d22\u7684\u6587\u732e\u5bfc\u5165EndNote\u6587\u732e\u7ba1\u7406\u5de5\u5177\uff0c\u6709\u4e24\u540d\u72ec\u7acb\u57f9\u8bad\u8fc7\u7684\u4eba\u5458\u6839\u636e\u7eb3\u5165\/\u6392\u9664\u6807\u51c6\u5bf9\u6587\u7ae0\u7684\u9898\u76ee\u3001\u6458\u8981\u4ee5\u53ca\u5168\u6587\u4f9d\u6b21\u8fdb\u884c\u7b5b\u9009\u548c\u4fe1\u606f\u63d0\u53d6\uff0c\u5e76\u5bf9\u7eb3\u5165\u6587\u732e\u7684\u53c2\u8003\u6587\u732e\u8fdb\u884c\u6eaf\u6e90\u5206\u6790\uff0c\u4e0d\u786e\u5b9a\u662f\u5426\u7eb3\u5165\u7684\u6587\u732e\u7531\u65b9\u6cd5\u5b66\u652f\u6301\u7ec4\u4e13\u5bb6\u8fdb\u884c\u9605\u8bfb\u5e76\u8ba8\u8bba\u540e\u51b3\u5b9a\u3002<\/p>\n<\/p>\n<p>\u4e03\u3001\u8bc1\u636e\u8d28\u91cf\u8bc4\u4ef7\u4e0e\u5206\u7ea7<\/p>\n<p>\u5bf9\u786e\u5b9a\u7eb3\u5165\u7684\u6587\u732e\u8fdb\u884c\u6587\u732e\u8d28\u91cf\u7684\u8bc4\u4ef7\u548c\u5206\u7ea7\u3002\u91c7\u7528\u7cfb\u7edf\u8bc4\u4ef7\u504f\u501a\u98ce\u9669\u8bc4\u4ef7\u5de5\u5177(a measurement tool to assess systematic reviews\uff0cAMSTAR)\u91cf\u8868\u5bf9\u7eb3\u5165\u7684Meta\u5206\u6790\u3001\u7cfb\u7edf\u7efc\u8ff0\u7b49\u8fdb\u884c\u504f\u501a\u98ce\u9669\u8bc4\u4ef7\uff1b\u91c7\u7528Cochrane\u504f\u501a\u98ce\u9669\u8bc4\u4ef7\u5de5\u5177(risk of bias\uff0cROB)\u5bf9\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u7814\u7a76\u8fdb\u884c\u504f\u501a\u98ce\u9669\u8bc4\u4ef7\uff1b\u91c7\u7528\u8bca\u65ad\u51c6\u786e\u6027\u7814\u7a76\u7684\u8d28\u91cf\u8bc4\u4ef7\u5de5\u5177(quality assessment of diagnostic accuracy studies\uff0cQUADAS-2)\u5bf9\u8bca\u65ad\u51c6\u786e\u6027\u8bd5\u9a8c\u7814\u7a76\u8fdb\u884c\u8bc4\u4f30\u7b49<sup>[6]<\/sup>\u3002<\/p>\n<p>\u6839\u636eGRADE\u65b9\u6cd5\uff0c\u786e\u5b9a\u8bc1\u636e\u6c34\u5e73\u548c\u63a8\u8350\u7b49\u7ea7<sup>[7]<\/sup>\u3002\u8bc1\u636e\u6c34\u5e73\u7684\u8bc4\u4f30\u662f\u901a\u8fc7\u5bf9\u7eb3\u5165\u6587\u732e\u5305\u62ecMeta\u5206\u6790\u3001\u7cfb\u7edf\u7efc\u8ff0\u3001\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u7b49\u7684\u504f\u501a\u98ce\u9669\u3001\u4e00\u81f4\u6027\u3001\u95f4\u63a5\u6027\u3001\u7cbe\u786e\u6027\u8fdb\u884c\u8bc4\u4f30\uff0c\u6bcf\u4e2a\u5173\u952e\u95ee\u9898\u7684\u8bc1\u636e\u6c34\u5e73\u57fa\u4e8eGRADE\u65b9\u6cd5\u5b66\uff0c\u5206\u4e3a&#8217;\u9ad8(high)&#8217;\u3001&#8217;\u4e2d(moderate)&#8217;\u3001&#8217;\u4f4e(low)&#8217;\u548c&#8217;\u6781\u4f4e(very Low)&#8217;4\u4e2a\u7b49\u7ea7\uff0c\u5982\u88681\u6240\u793a\u3002\u6bcf\u4e00\u4e2a\u5173\u952e\u95ee\u9898\u81f3\u5c11\u6709\u4e24\u540d\u6307\u5357\u5de5\u4f5c\u5c0f\u7ec4\u6210\u5458\u53c2\u4e0e\u5ba1\u6838\u548c\u786e\u5b9a\u5206\u7ea7\uff0c\u5de5\u4f5c\u6210\u5458\u7ee7\u7eed\u8ba8\u8bba\u4ee5\u8fbe\u6210\u5171\u8bc6\u3002<\/p>\n<\/p>\n<p>\u516b\u3001\u63a8\u8350\u610f\u89c1\u5f62\u6210<\/p>\n<p>\u4e13\u5bb6\u7ec4\u57fa\u4e8e\u8bc1\u636e\u8bc4\u4ef7\u7ec4\u63d0\u4f9b\u7684\u56fd\u5185\u5916\u73b0\u6709\u8bc1\u636e\u6c47\u603b\u8868\uff0c\u540c\u65f6\u8003\u8651\u541e\u54bd\u969c\u788d\u5e72\u9884\u63aa\u65bd\u7684\u6210\u672c\u3001\u5229\u5f0a\u7b49\u56e0\u7d20\u540e\uff0c\u521d\u62df\u51fa\u7b26\u5408\u6211\u56fd\u4e34\u5e8a\u8bca\u7597\u5b9e\u8df5\u7684\u63a8\u8350\u610f\u89c123\u6761\uff0c\u7531\u5171\u8bc6\u4e13\u5bb6\u7ec4\u901a\u8fc7\u5728\u7ebf\u95ee\u5377\u7684\u5f62\u5f0f\u8fdb\u884c\u6295\u7968\u8bc4\u5206\u5e76\u63d0\u51fa\u4fee\u6539\u610f\u89c1\uff0c\u6839\u636e\u6536\u96c6\u5230\u768438\u540d\u4e13\u5bb6\u610f\u89c1\u53cd\u9988\u53ca\u672c\u6307\u5357\u987e\u95ee\u548c\u5168\u4f53\u4e13\u5bb6\u9762\u5bf9\u9762\u7684\u8ba8\u8bba\u4f1a\uff0c\u4fee\u6539\u4e3a16\u6761\u63a8\u8350\u610f\u89c1\uff0c\u5bf9\u518d\u6b21\u4fee\u8ba2\u540e\u63a8\u8350\u610f\u89c1\u8fdb\u884c\u7b2c\u4e8c\u8f6e\u6295\u7968\uff0c\u6700\u7ec8\u5c3116\u6761\u63a8\u8350\u610f\u89c1\u8fbe\u6210\u5171\u8bc6\u3002<\/p>\n<p>\u672c\u6307\u5357\u8868\u8ff0\u65b9\u5f0f\u7684\u7279\u70b9\u4e3a\uff1a(1)\u63d0\u51fa\u95ee\u9898\u2014\u2014\u95ee\u9898\u7684\u51dd\u7ec3\u6765\u81ea\u4e8e\u4e34\u5e8a\u5b9e\u8df5\uff0c\u56f4\u7ed55\u4e2a\u65b9\u9762(\u7b5b\u67e5\u3001\u8bc4\u4f30\u3001\u5e72\u9884\u3001\u6cbb\u7597\u3001\u62a4\u7406)\u7ecf\u8fc7\u601d\u8003\u9700\u8981\u89e3\u7b54\u800c\u53c8\u4e92\u4e3a\u5173\u8054\u7684\u96c6\u5408\u95ee\u9898\uff1b(2)\u63a8\u8350\u610f\u89c1\u2014\u2014\u9488\u5bf9\u95ee\u9898\u7ed9\u51fa\u8bc1\u636e\u7b49\u7ea7\u3001\u63a8\u8350\u5f3a\u5ea6\uff0c\u57fa\u4e8e\u4e34\u5e8a\u4ef7\u503c\u7684\u63a8\u8350\u7406\u7531\uff1b(3)\u63a8\u8350\u610f\u89c1\u8bf4\u660e\u2014\u2014\u91c7\u7528\u4e09\u6bb5\u5f0f\u8bf4\u660e\uff0c\u2460\u4ea4\u4ee3\u80cc\u666f\uff0c\u5373\u8fd9\u4e2a\u95ee\u9898\u63d0\u53ca\u7684\u6280\u672f\u6216\u65b9\u6cd5\u7684\u5b9a\u4e49\u3001\u4e34\u5e8a\u5e94\u7528\u3001\u673a\u5236\u6216\u4f5c\u7528\uff1b\u2461\u5f15\u7528\u4f50\u8bc1\u6750\u6599\uff0c\u91c7\u75285W\u539f\u5219\u5448\u73b0\u5206\u6790\u540e\u6709\u4ee3\u8868\u6027\u7684\u6587\u732e\u8bc1\u636e\uff1b\u2462\u7b80\u77ed\u7684\u603b\u7ed3\uff0c\u5bf9\u5e94\u63d0\u51fa\u7684\u95ee\u9898\u7ed9\u4e88\u660e\u786e\u56de\u7b54\u3002<\/p>\n<p>\u4e5d\u3001\u5b9a\u7a3f<\/p>\n<p>\u5f62\u6210\u7684\u63a8\u8350\u610f\u89c1\u5728\u5357\u5b81\u4e3e\u529e\u76842023\u5e74\u4e2d\u56fd\u5eb7\u590d\u533b\u5b66\u4f1a\u541e\u54bd\u969c\u788d\u5eb7\u590d\u4e13\u4e1a\u59d4\u5458\u4f1a\u5e74\u4f1a\u4e13\u95e8\u4f1a\u8bae\u4e0a\uff0c\u7ecf\u8fc7\u987e\u95ee\u3001\u4e13\u5bb6\u59d4\u5458\u4f1a\u5ba1\u5b9a\u3001\u53cd\u9988\u610f\u89c1\uff0c\u518d\u7531\u6307\u5357\u5c0f\u7ec4\u6267\u7b14\u6210\u5458\u8fdb\u884c\u7cbe\u7b80\u4fee\u6539\uff0c\u6700\u7ec8\u5b9a\u7a3f\u53d1\u8868\u3002<\/p>\n<p>\u5341\u3001\u6307\u5357\u7684\u63a8\u5e7f<\/p>\n<p>\u6307\u5357\u53d1\u5e03\u540e\uff0c\u6307\u5357\u5de5\u4f5c\u59d4\u5458\u4f1a\u5c06\u4e3b\u8981\u901a\u8fc7\u4ee5\u4e0b\u65b9\u5f0f\u5bf9\u6307\u5357\u8fdb\u884c\u63a8\u5e7f\uff1a\u2460\u5728\u4e2d\u534e\u7269\u7406\u533b\u5b66\u4e0e\u5eb7\u590d\u6742\u5fd7\u53d1\u8868\uff1b\u2461\u5728\u76f8\u5173\u5b66\u672f\u4f1a\u8bae\u4e0a\u8fdb\u884c\u6c47\u62a5\u53ca\u89e3\u8bfb\uff1b\u2462\u5bf9\u4ece\u4e8b\u541e\u54bd\u969c\u788d\u8bc4\u4f30\u4e0e\u6cbb\u7597\u76f8\u5173\u4e13\u4e1a\u4eba\u5458\u8fdb\u884c\u57f9\u8bad\uff1b\u2463\u5728\u56fd\u5185\u4e0d\u540c\u533a\u57df\u3001\u4e0d\u540c\u5b66\u79d1\u7ec4\u7ec7\u6307\u5357\u63a8\u5e7f\u4e13\u573a\uff0c\u8ba9\u4e34\u5e8a\u76f8\u5173\u4e13\u4e1a\u4eba\u5458\u5145\u5206\u4e86\u89e3\u5e76\u81ea\u89c9\u5e94\u7528\u672c\u6307\u5357\uff1b\u2464\u901a\u8fc7\u5fae\u4fe1\u3001\u7f51\u7edc\u548c\u5176\u4ed6\u793e\u4ea4\u5a92\u4f53\u8fdb\u884c\u5ba3\u4f20\u63a8\u5e7f\u3002<\/p>\n<\/p>\n<p>\u7b2c\u4e8c\u90e8\u5206\u3000\u541e\u54bd\u969c\u788d\u7684\u7b5b\u67e5\u4e0e\u8bc4\u4f30\u7684\u95ee\u9898\u548c\u610f\u89c1<\/p>\n<p>\u95ee\u98981\uff1a\u541e\u54bd\u969c\u788d\u7b5b\u67e5\u9002\u7528\u54ea\u4e9b\u4eba\u7fa4\uff0c\u5bf9\u9ad8\u5371\u4eba\u7fa4\u5e38\u89c4\u884c\u541e\u54bd\u969c\u788d\u7b5b\u67e5\u662f\u5426\u80fd\u964d\u4f4e\u8bef\u5438\u98ce\u9669\u3001\u80ba\u708e\u53d1\u751f\u7387\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c11\uff1a\u8bc1\u636e\u7b49\u7ea7\u4e2d\u7b49(\uff0b\uff0b\uff0b)\uff0c\u63a8\u8350\u5f3a\u5ea6\u4e3a\u5f3a\u63a8\u8350\u3002\u5bf9\u6240\u6709\u5b58\u5728\u541e\u54bd\u969c\u788d\u98ce\u9669\u7684\u60a3\u8005\u8fdb\u884c\u65e9\u671f\u7b5b\u67e5\uff0c\u4ee5\u9884\u9632\u80ba\u708e\uff0c\u5e76\u964d\u4f4e\u6b7b\u4ea1\u7684\u98ce\u9669\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u541e\u54bd\u969c\u788d\u589e\u52a0\u591a\u79cd\u5e76\u53d1\u75c7\u7684\u98ce\u9669\uff0c\u5982\u8131\u6c34\u3001\u8425\u517b\u4e0d\u826f\u3001\u5438\u5165\u6027\u80ba\u708e\uff0c\u4e25\u91cd\u8005\u5f15\u8d77\u6b7b\u4ea1<sup>[8]<\/sup>\u3002\u7b5b\u67e5\u7684\u4e3b\u8981\u76ee\u7684\u662f\u8bc6\u522b\u541e\u54bd\u969c\u788d\u7684\u9ad8\u5371\u4eba\u7fa4\uff0c\u6307\u5bfc\u8fdb\u4e00\u6b65\u7684\u68c0\u67e5\u4e0e\u8bc4\u4f30\u3002\u76ee\u524d\u5df2\u6709\u591a\u79cd\u541e\u54bd\u969c\u788d\u7684\u7b5b\u67e5\u65b9\u6cd5\uff0c\u5305\u62ec\u7b80\u5355\u7684\u7b5b\u67e5\u548c\u6807\u51c6\u5316\u7684\u91cf\u8868\u7b5b\u67e5\u3002\u65e9\u671f\u7b5b\u67e5\u541e\u54bd\u969c\u788d\u80fd\u5426\u6709\u6548\u6539\u5584\u75be\u75c5\u9884\u540e\u5e76\u9884\u9632\u76f8\u5173\u7684\u5e76\u53d1\u75c7\u662f\u975e\u5e38\u91cd\u8981\u7684\u4e34\u5e8a\u95ee\u9898\u3002Sherman\u7b49<sup>[9]<\/sup>\u6240\u505a\u7684\u4e00\u9879Meta\u5206\u6790\u663e\u793a\uff0c\u65e0\u7b5b\u67e5\u4e0e\u7b5b\u67e5\u3001\u665a\u7b5b\u67e5\u4e0e\u65e9\u7b5b\u67e5\u3001\u975e\u6b63\u5f0f\u7b5b\u67e5\u4e0e\u6b63\u5f0f\u7b5b\u67e5\u76f8\u6bd4\uff0c\u80ba\u708e\u6bd4\u503c\u6bd4(odds ratio\uff0cOR\uff1d0.57)\uff0c\u6b7b\u4ea1\u7387(OR\uff1d0.52)\uff0c\u4f9d\u8d56\u6027(OR\uff1d0.54)\uff0c\u4f4f\u9662\u65f6\u95f4\u6807\u51c6\u5316\u5e73\u5747\u5dee\u4e3a\uff0d0.62\uff0c\u63d0\u793a\u6210\u4eba\u6025\u6027\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u7b5b\u67e5\u5bf9\u80ba\u708e\u3001\u6b7b\u4ea1\u7387\u3001\u4f9d\u8d56\u6027\u548c\u4f4f\u9662\u65f6\u95f4\u7684\u663e\u8457\u4fdd\u62a4\u76ca\u5904\u3002\u5c3d\u7ba1\u8bc1\u636e\u8d28\u91cf\u666e\u904d\u8f83\u4f4e\uff0c\u4f46\u662fMeta\u5206\u6790\u7ed3\u679c\u603b\u4f53\u4e0a\u662f\u4e00\u81f4\u7684<sup>[9,10]<\/sup>\u3002\u6240\u6709\u5b58\u5728\u541e\u54bd\u969c\u788d\u98ce\u9669\u7684\u60a3\u8005\u90fd\u5e94\u8fdb\u884c\u7b5b\u67e5\uff0c\u5e38\u89c1\u7684\u9ad8\u5371\u4eba\u7fa4\u5305\u62ec\u8eab\u4f53\u865a\u5f31\u7684\u8001\u5e74\u4eba\u3001\u8111\u5352\u4e2d\u60a3\u8005\u3001\u795e\u7ecf\u9000\u884c\u6027\u75be\u75c5\u60a3\u8005(\u5982\u5e15\u91d1\u68ee\u75c5\u548c\u963f\u5c14\u8328\u6d77\u9ed8\u75c5\u60a3\u8005)\u3001\u8111\u762b\u513f\u7ae5\u3001\u5934\u9888\u90e8\u80bf\u7624\u60a3\u8005\u7b49<sup>[11,12]<\/sup>\u3002<\/p>\n<p>\u91c7\u7528\u7b80\u5355\u3001\u53ef\u9760\u3001\u6709\u6548\u7684\u7b5b\u67e5\u65b9\u6cd5\u5bf9\u4e8e\u9884\u9632\u548c\u51cf\u5c11\u5e76\u53d1\u75c7\u81f3\u5173\u91cd\u8981\u3002\u4e34\u5e8a\u4e0a\u7b5b\u67e5\u591a\u4f7f\u7528\u7efc\u5408\u591a\u4e2a\u6761\u76ee\u7684\u91cf\u8868\u8fdb\u884c\u6d4b\u8bd5\uff0c\u5982Gugging\u541e\u54bd\u529f\u80fd\u8bc4\u4f30\u91cf\u8868(gugging swallowing screen\uff0cGUSS)\u3001\u6807\u51c6\u5316\u541e\u54bd\u8bc4\u4f30(standar-dized swallowing assessment\uff0cSSA)\u3001\u591a\u4f26\u591a\u5e8a\u65c1\u541e\u54bd\u7b5b\u67e5\u8bd5\u9a8c(Toronto bedside swallowing screening test\uff0cTOR-BSST)\u3001\u8fdb\u98df\u8bc4\u4f30\u8c03\u67e5\u5de5\u5177-10(eating assessment tool-10\uff0cEAT-10)\u7b49\uff0c\u4e0a\u8ff0\u7b5b\u67e5\u91cf\u8868\u5747\u5df2\u5728\u56fd\u5185\u5f97\u5230\u5e7f\u6cdb\u7684\u63a8\u5e7f\u5e94\u7528\u3002\u4e24\u9879\u7814\u7a76\u90fd\u663e\u793a\u6807\u51c6\u5316\u7b5b\u67e5\u5de5\u5177\u53ef\u4ee5\u5728\u4e0d\u76f4\u63a5\u541e\u54bd\u98df\u7269\u7684\u60c5\u51b5\u4e0b\u66f4\u5b89\u5168\u5730\u8bc4\u4f30\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd<sup>[13,14]<\/sup>\u3002\u6d3c\u7530\u996e\u6c34\u6d4b\u8bd5\u548c\u5bb9\u79ef\u9ecf\u5ea6\u541e\u54bd\u6d4b\u8bd5(volume-viscosity swallow test\uff0cV-VST)\uff0c\u524d\u8005\u541e\u54bd\u6c34\uff0c\u540e\u8005\u76f4\u63a5\u541e\u54bd\u7ecf\u8c03\u5236\u7684\u4f4e\u4e2d\u9ad8\u7a20\u5ea6\u7684\u6db2\u4f53\uff0c\u901a\u8fc7\u54b3\u55fd\u3001\u58f0\u97f3\u548c\u6c27\u9971\u548c\u5ea6\u53d8\u5316\u6765\u68c0\u67e5\u662f\u5426\u5b58\u5728\u8bef\u5438<sup>[15,16]<\/sup>\u3002\u6797\u4f9d\u79cb\u7b49<sup>[17]<\/sup>\u63d0\u51fa\u4e86\u9002\u5408\u4e2d\u56fd\u6587\u5316\u7279\u70b9\u7684\u6539\u826fV-VST\uff0c\u91c7\u75283 ml\u30015 ml\u300110 ml\u4e09\u79cd\u5bb9\u79ef\uff0c\u6c34\u3001\u4f4e\u7a20\u3001\u4e2d\u7a20\u3001\u9ad8\u7a20\u56db\u79cd\u7a20\u5ea6\uff0c\u6539\u826fV-VST\u5bf9\u4e8e\u8bc6\u522b\u795e\u7ecf\u6027\u541e\u54bd\u969c\u788d\u60a3\u8005\u5177\u6709\u8f83\u9ad8\u7684\u654f\u611f\u6027(96.6%)\u548c\u7279\u5f02\u6027(83.3%)\u3002<\/p>\n<p>\u541e\u54bd\u969c\u788d\u7b5b\u67e5\u5229\u5927\u4e8e\u5f0a\uff0c\u56e0\u6b64\u5f3a\u63a8\u8350\u5165\u9662\u540e\u5c3d\u65e9\u8fdb\u884c\u7b5b\u67e5\uff0c\u4ee5\u9884\u9632\u8bef\u5438\u548c\u5438\u5165\u6027\u80ba\u708e\u7684\u98ce\u9669\u3002\u4e34\u5e8a\u4e0a\u5e94\u89c6\u60a3\u8005\u60c5\u51b5\uff0c\u9009\u62e9\u541e\u54bd\u7b5b\u67e5\u7684\u79cd\u7c7b\u3002<\/p>\n<\/p>\n<p>\u95ee\u98982\uff1a\u541e\u54bd\u9020\u5f71\u548c\/\u6216\u5589\u955c\u541e\u54bd\u68c0\u67e5\u662f\u5426\u662f\u53e3\u54bd\u90e8\u541e\u54bd\u969c\u788d\u7684\u9996\u9009\u65b9\u6cd5\uff0c\u662f\u5426\u63a8\u8350\u5c3d\u65e9\u5b9e\u65bd\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c12\uff1a\u8bc1\u636e\u7b49\u7ea7\u4e2d\u7b49(\uff0b\uff0b\uff0b)\uff0c\u63a8\u8350\u5f3a\u5ea6\u4e3a\u5f3a\u63a8\u8350\u3002VFSS\u548cFEES\u4e34\u5e8a\u4e0a\u53ef\u4f5c\u4e3a\u786e\u8bca\u541e\u54bd\u969c\u788d\u7684\u91d1\u6807\u51c6\uff0c\u53e3\u54bd\u671f\u541e\u54bd\u969c\u788d\u60a3\u8005\u5e94\u5c3d\u65e9\u8fdb\u884c\u4eea\u5668\u68c0\u67e5\uff0c\u6392\u9664\u8bef\u5438\u98ce\u9669\uff0c\u964d\u4f4e\u80ba\u708e\u7684\u53d1\u751f\u7387\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u541e\u54bd\u969c\u788d\u53ef\u4ee5\u901a\u8fc7\u4e34\u5e8a\u541e\u54bd\u529f\u80fd\u8bc4\u4f30(clinical swallowing examination\uff0cCSE)\u6216\u66f4\u5ba2\u89c2\u7684\u4eea\u5668\u8bc4\u4f30\uff0c\u5982VFSS\u3001FEES\u8fdb\u884c\u8bca\u65ad\u3002<\/p>\n<p>VFSS\u88ab\u8ba4\u4e3a\u662f\u541e\u54bd\u969c\u788d\u8bc4\u4f30\u7684\u91d1\u6807\u51c6\uff0c\u5b83\u80fd\u591f\u53ef\u89c6\u5316\u53e3\u8154\u671f\u3001\u54bd\u671f\u548c\u98df\u7ba1\u671f\u7684\u4e00\u7cfb\u5217\u541e\u54bd\u8fc7\u7a0b\u3002\u68c0\u67e5\u65f6\u5728\u60a3\u8005\u77e2\u72b6\u4f4d\u3001\u524d\u540e\u4f4d\u89c2\u5bdf\u6dfb\u52a0\u4e86\u9020\u5f71\u5242\u7684\u4e0d\u540c\u7a20\u5ea6\u53ca\u4e00\u53e3\u91cf\u98df\u7269\u7684\u541e\u54bd\u8fc7\u7a0b\uff0c\u8fdb\u884c\u5b9a\u6027\u5206\u6790\uff0c\u4e5f\u53ef\u4ee5\u5bf9\u65f6\u95f4\u5b66\u548c\u8fd0\u52a8\u5b66\u53c2\u6570\u505a\u5b9a\u91cf\u5206\u6790\uff0c\u5982\u53e3\u8154\u3001\u54bd\u90e8\u901a\u8fc7\u65f6\u95f4\u3001\u820c\u9aa8\u4f4d\u79fb\u4ee5\u53ca\u98df\u7ba1\u4e0a\u62ec\u7ea6\u808c(upper esophageal sphincter\uff0cUES)\u5f00\u653e\u6301\u7eed\u65f6\u95f4\u548c\u5bbd\u5ea6\u7b49<sup>[18]<\/sup>\u3002\u7814\u7a76\u8868\u660e\uff0c\u7279\u5b9a\u7684VFSS\u53c2\u6570(\u5982\u5589\u5173\u95ed\u7684\u6f5c\u4f0f\u671f\u548cUES\u5f00\u653e)\u4e0e\u6e17\u6f0f\u548c\u8bef\u5438\u76f8\u5173<sup>[19]<\/sup>\u3002\u9664\u6b64\u4e4b\u5916\uff0c\u534a\u5b9a\u91cf\u5206\u6790\uff0c\u5982\u534a\u5b9a\u91cf\u541e\u54bd\u9020\u5f71\u5206\u6790(modified barium swallow study impairment profiles, MBSimP\u00a9\u2122)\u591a\u5e94\u7528\u4e8e\u4e34\u5e8a\u7814\u7a76<sup>[20]<\/sup>\u3002VFSS\u5bf9\u4e8e\u541e\u54bd\u969c\u788d\u7684\u7ba1\u7406\u81f3\u5173\u91cd\u8981\u3002Hwang\u7b49<sup>[21]<\/sup>\u62a5\u9053\u4e86VFSS\u6307\u5bfc\u8fdb\u98df\u7b56\u7565\u7684\u5b89\u5168\u6027\uff0c\u8be5\u7814\u7a76\u62db\u52df\u4e86499\u4f8b\u8111\u5352\u4e2d\u540e\u7ba1\u9972\u8fdb\u98df\u7684\u60a3\u8005\uff0c\u5747\u5728\u53d1\u75c52\u5468\u5185\u8fdb\u884c\u4e86VFSS\uff0c\u5176\u4e2d199\u4f8b\u60a3\u8005VFSS\u7ed3\u679c\u663e\u793a\u53ef\u62d4\u9664\u9f3b\u80c3\u7ba1\u5e76\u5f00\u59cb\u7ecf\u53e3\u8fdb\u98df\u3002\u5728\u968f\u8bbf\u671f\u95f4\uff0c\u53ea\u67095\u4f8b\u60a3\u8005\u53d1\u751f\u80ba\u708e\uff0c\u63d0\u793aVFSS\u53ef\u63d0\u9ad8\u541e\u54bd\u6cbb\u7597\u7684\u5b89\u5168\u6027\u3002\u56db\u9879\u89c2\u5bdf\u6027\u7814\u7a76\u6bd4\u8f83\u4e86\u4e34\u5e8a\u8bc4\u4f30\u548cVFSS\u7684\u6709\u6548\u6027\uff0c\u53d1\u73b0VFSS\u8f83CSE\u5177\u6709\u66f4\u4f73\u7684\u6210\u672c\u6548\u76ca<sup>[22,23]<\/sup>\u3002<\/p>\n<p>FEES\u662f\u541e\u54bd\u969c\u788d\u8bc4\u4f30\u7684\u53e6\u4e00\u79cd\u91d1\u6807\u51c6\u3002FEES\u8bc4\u4f30\u5229\u7528\u4e00\u6761\u8f6f\u7ba1\u5185\u955c\uff0c\u7ecf\u9f3b\u8fdb\u5165\u54bd\u5589\u90e8\uff0c\u8bc4\u4f30\u5185\u5bb9\u4e3b\u8981\u5305\u62ec\u4e09\u4e2a\u65b9\u9762\uff1a\u89e3\u5256\u751f\u7406\u529f\u80fd\u89c2\u5bdf\u3001\u8fdb\u98df\u89c2\u5bdf\u4ee5\u53ca\u6cbb\u7597\u65b9\u6cd5\u7684\u6709\u6548\u6027\uff0c\u5e76\u91c7\u7528\u6807\u51c6\u5316\u91cf\u8868\u8fdb\u884c\u8bc4\u5206\uff0c\u5982\u6e17\u6f0f\u8bef\u5438\u91cf\u8868\u3001\u8036\u9c81\u6b8b\u7559\u5206\u7ea7\u3001Murray\u5206\u6ccc\u7269\u5206\u7ea7\u7b49<sup>[24]<\/sup>\u3002FEES\u8bc4\u4f30\u5728\u56fd\u9645\u4e0a\u5e94\u7528\u8f83\u4e3a\u5e7f\u6cdb\uff0c\u4e00\u9879\u56fd\u9645\u8c03\u67e5\u663e\u793a\uff0c\u8d85\u8fc780%\u7684\u533b\u751f\u5c06FEES\u4f5c\u4e3a\u541e\u54bd\u8bc4\u4f30\u7684\u5e38\u89c4\u8bca\u65ad\u65b9\u6cd5<sup>[25,26]<\/sup>\u3002\u5728\u56fd\u5185FEES\u7684\u5e94\u7528\u5904\u4e8e\u8d77\u6b65\u9636\u6bb5\uff0c\u4e3b\u8981\u96c6\u4e2d\u5728\u8111\u5352\u4e2d\u3001\u91cd\u75c7\u808c\u65e0\u529b\u3001\u5934\u9888\u764c\u5408\u5e76\u541e\u54bd\u969c\u788d\u60a3\u8005\u3001\u6c14\u7ba1\u5207\u5f00\u60a3\u8005\u7b49<sup>[27,28]<\/sup>\u3002<\/p>\n<p>\u6839\u636e\u65e2\u5f80\u7814\u7a76\u62a5\u9053\uff0cFEES\u8bc4\u4f30\u7684\u5b89\u5168\u6027\u8f83\u9ad8\u3002Dziewas\u7b49<sup>[29]<\/sup>\u8c03\u67e5\u4e862014\u81f32017\u5e74\uff0c23\u5bb6\u533b\u9662\u6536\u6cbb\u76842401\u4f8b\u795e\u7ecf\u7cfb\u7edf\u75be\u75c5\u60a3\u8005\uff0c\u8c03\u67e5\u7ed3\u8bba\u662f\u65e0\u8bba\u64cd\u4f5c\u4eba\u5458\u7684\u7ecf\u9a8c\u5982\u4f55\uff0c\u60a3\u8005\u5bf9FEES\u7684\u8010\u53d7\u6027\u826f\u597d\u3002\u6b64\u5916\uff0cDziewas<sup>[29]<\/sup>\u548cBraun\u7b49<sup>[25]<\/sup>\u7684\u7814\u7a76\u7ed3\u679c\u4e00\u81f4\u8ba4\u4e3a\uff0cFEES\u7684\u5b9e\u65bd\u5bf9\u541e\u54bd\u969c\u788d\u7684\u7ba1\u7406\u5177\u6709\u91cd\u5927\u5f71\u54cd\uff0c\u6839\u636eFEES\u7ed3\u679c\uff0c\u8d85\u8fc750%\u7684\u60a3\u8005\u9700\u8981\u6539\u53d8\u8fdb\u98df\u7b56\u7565\uff0c\u8d85\u8fc725%\u7684\u6c14\u7ba1\u5207\u5f00\u60a3\u8005\u53ef\u4ee5\u62d4\u7ba1\u3002Giraldo-Cadavid\u7b49<sup>[30]<\/sup>\u7684Meta\u5206\u6790\u62a5\u9053\u4e86FEES\u68c0\u6d4b\u5230\u7684\u541e\u54bd\u969c\u788d\u95ee\u9898\u4e0e\u80ba\u708e\u3001\u6b7b\u4ea1\u7387\u53ca\u5176\u4ed6\u4e0d\u5b89\u5168\u56e0\u7d20\u4e4b\u95f4\u7684\u5173\u7cfb\uff0c\u5171\u7eb3\u51658\u7bc7\u6587\u7ae0\uff0c\u5176\u4e2d7\u7bc7\u4e3a\u4e34\u5e8a\u7814\u7a76\uff0c1\u7bc7\u4e3a\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c(randomized controlled trial\uff0cRCT)\u6587\u7ae0\u3002\u7814\u7a76\u8868\u660e\uff0cFEES\u89c2\u5bdf\u5230\u7684\u8bef\u5438\u4f1a\u589e\u52a0\u5438\u5165\u6027\u80ba\u708e\u53d1\u751f\u7684\u98ce\u9669(OR\uff1d2.97)\uff0c\u8bef\u5438\u60a3\u8005\u6b7b\u4ea1\u98ce\u9669\u66f4\u9ad8(OR\uff1d4.08)\u3002\u56e0\u6b64FEES\u89c2\u5bdf\u5230\u7684\u8bef\u5438\u4e0e\u80ba\u708e\u548c\u6b7b\u4ea1\u7684\u98ce\u9669\u589e\u52a0\u6709\u5173\u3002Bax\u7b49<sup>[31]<\/sup>\u7814\u7a76\u53d1\u73b0\uff0c\u5728FEES\u68c0\u67e5\u540e\uff0c\u80ba\u708e\u53d1\u751f\u7387\u4ece12.3%\u663e\u8457\u4e0b\u964d\u52306.4%\uff0c\u51fa\u9662\u65f6\u996e\u98df\u6b63\u5e38\u7684\u60a3\u8005\u6bd4\u4f8b\u4ece51.1%\u663e\u8457\u589e\u52a0\u523065.6%\u3002<\/p>\n<p>\u6b64\u5916\uff0c\u5173\u4e8e\u4eea\u5668\u8bc4\u4f30\u7684\u65f6\u673a\uff0cBray\u7b49<sup>[32]<\/sup>\u62a5\u9053\u768463 650\u4f8b\u6025\u6027\u8111\u5352\u4e2d\u60a3\u8005\u4e2d\uff0c\u670938.6%\u5728\u5165\u9662\u540e\u7684\u4e2d\u4f4d\u65f6\u95f422.9 h(6.2 h~49.4 h)\u540e\u8fdb\u884c\u4e86\u5b8c\u6574\u7684\u4eea\u5668\u8bc4\u4f30\uff0c\u53d1\u73b0\u8bc4\u4f30\u5ef6\u8fdf\u4e0e\u80ba\u708e\u53d1\u751f\u7387\u4e4b\u95f4\u5b58\u5728\u5f3a\u76f8\u5173\u6027\u3002\u541e\u54bd\u8bc4\u4f30\u5ef6\u8fdf\u768424 h\u5185\u80ba\u708e\u98ce\u9669\u589e\u52a03%\uff1b\u8bc4\u4f30\u5ef6\u8fdf\u8d85\u8fc724 h\u80ba\u708e\u98ce\u9669\u589e\u52a04%\u3002\u56e0\u6b64\u63a8\u8350\u5c3d\u65e9\u5b8c\u5584\u4eea\u5668\u8bc4\u4f30\u3002<\/p>\n<p>\u7efc\u4e0a\u6240\u8ff0\uff0c\u5728\u8fdb\u884c\u541e\u54bd\u969c\u788d\u7b5b\u67e5\u548c\u4e34\u5e8a\u8bc4\u4f30\u540e\uff0c\u5bf9\u541e\u54bd\u969c\u788d\u8005\u5e94\u5c3d\u65e9\u8fdb\u884cVFSS\u548cFEES\uff0c\u4e14\u9488\u5bf9\u541e\u54bd\u529f\u80fd\u8bc4\u4f30\uff0c\u4e24\u8005\u5404\u6709\u7279\u70b9\uff0c\u76f8\u8f85\u76f8\u6210\uff0c\u4e92\u4e3a\u8865\u5145\uff0c\u56e0\u6b64\u63a8\u8350VFSS\u548cFEES\u7406\u60f3\u72b6\u51b5\u4e0b\u90fd\u53ef\u8fdb\u884c\u8bc4\u4f30\u3002<\/p>\n<\/p>\n<p>\u7b2c\u4e09\u90e8\u5206\u3000\u541e\u54bd\u969c\u788d\u6cbb\u7597\u7684\u95ee\u9898\u548c\u610f\u89c1<\/p>\n<p>\u95ee\u98983\uff1a\u4f53\u8868\u795e\u7ecf\u808c\u8089\u7535\u523a\u6fc0\u8054\u5408\u5e38\u89c4\u541e\u54bd\u8bad\u7ec3\u80fd\u5426\u66f4\u597d\u6539\u5584\u8111\u5352\u4e2d\u540e\u541e\u54bd\u529f\u80fd\u969c\u788d\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c13\uff1a\u8bc1\u636e\u7b49\u7ea7\u9ad8(\uff0b\uff0b\uff0b\uff0b)\uff0c\u5f3a\u63a8\u8350\u3002\u4f53\u8868\u795e\u7ecf\u808c\u8089\u7535\u523a\u6fc0\u8054\u5408\u5e38\u89c4\u541e\u54bd\u8bad\u7ec3\u53ef\u6539\u5584\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\uff0c\u63d0\u9ad8\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u751f\u6d3b\u8d28\u91cf\uff0c\u964d\u4f4e\u5e76\u53d1\u75c7\u53d1\u751f\u7387\uff0c\u4e14\u5176\u6548\u679c\u4f18\u4e8e\u5355\u7eaf\u7684\u541e\u54bd\u8bad\u7ec3\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u795e\u7ecf\u808c\u8089\u7535\u523a\u6fc0\u662f\u6cbb\u7597\u541e\u54bd\u969c\u788d\u7684\u5e38\u7528\u65b9\u6cd5\uff0c\u5e7f\u6cdb\u7528\u4e8e\u4e34\u5e8a\u4e0a\u5404\u79cd\u539f\u56e0\u5bfc\u81f4\u7684\u541e\u54bd\u969c\u788d\u60a3\u8005\u3002\u795e\u7ecf\u808c\u8089\u7535\u523a\u6fc0\u53ef\u4ee5\u901a\u8fc7\u8868\u9762\u7535\u6781\u523a\u6fc0\u808c\u8089\u6216\u8005\u7535\u6781\u523a\u6fc0\u5468\u56f4\u795e\u7ecf\u89e6\u53d1\u541e\u54bd\u808c\u8089\u6536\u7f29\u9884\u9632\u5e9f\u7528\u840e\u7f29\uff0c\u6216\u8005\u589e\u5f3a\u611f\u89c9\u4f20\u5165\uff0c\u540c\u65f6\u4fc3\u8fdb\u8fd0\u52a8\u76ae\u8d28\u5174\u594b\u6027\uff0c\u589e\u5f3a\u8fd0\u52a8\u518d\u5b66\u4e60\u80fd\u529b\u6765\u6539\u5584\u541e\u54bd\u529f\u80fd\u3002Kletzien\u7b49<sup>[33]<\/sup>\u901a\u8fc7\u4e00\u9879RCT\u8868\u660e\uff0c\u7279\u5b9a\u5f3a\u5ea6\u7684\u7535\u523a\u6fc0\u820c\u54bd\u808c\u7fa4\uff0c\u53ef\u4ee5\u589e\u5f3a\u808c\u8089\u6536\u7f29\u80fd\u529b\uff0c\u589e\u52a0\u6fc0\u6d3b\u7a0b\u5ea6\uff0c\u9632\u6b62\u5e9f\u7528\u6027\u808c\u840e\u7f29\u3002Wang\u7b49<sup>[34]<\/sup>\u7eb3\u516546\u9879RCT\u51713346\u4f8b\u60a3\u8005\u548cDoan\u7b49<sup>[35]<\/sup>\u7eb3\u516524\u9879RCT\uff0c\u51711200\u4f8b\u60a3\u8005\u8fdb\u884cMeta\u5206\u6790\uff0c\u8fd9\u4e24\u9879Meta\u5206\u6790\u5747\u63d0\u793a\uff0c\u795e\u7ecf\u808c\u8089\u7535\u523a\u6fc0\u4e0e\u5176\u4ed6\u5e38\u89c4\u541e\u54bd\u8bad\u7ec3(\u5305\u62ec\u6e29\u5ea6\u89c9\u523a\u6fc0\u3001\u89e6\u89c9\u523a\u6fc0\u3001\u8fd0\u52a8\u8bad\u7ec3\u53ca\u98df\u7269\u6027\u72b6\u3001\u4e00\u53e3\u91cf\u8c03\u6574\u7b49)\u8054\u5408\u4f7f\u7528\uff0c\u80fd\u63d0\u9ad8\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u7ecf\u53e3\u8fdb\u98df\u529f\u80fd[\u6807\u51c6\u5316\u5747\u6570\u5dee(standard mean difference\uff0cSMD)\uff1d0.91\uff0c95%\u7f6e\u4fe1\u533a\u95f4(95% confidence interval\uff0c95% CI)(0.68~1.14)]\uff0c\u589e\u52a0\u820c\u9aa8\u5411\u4e0a\u5411\u524d\u8fd0\u52a8\u8ddd\u79bb\uff0c\u51cf\u5c11\u8bef\u5438\uff0c\u8be5\u65b9\u6cd5\u7b80\u5355\u5bb9\u6613\u64cd\u4f5c\uff0c\u4e34\u5e8a\u4e0a\u5e94\u63a8\u8350\u4f7f\u7528\u3002<\/p>\n<p>\u820c\u9aa8\u4e0a\u4e0b\u808c\u7fa4\u5728\u541e\u54bd\u529f\u80fd\u4e2d\u8d77\u91cd\u8981\u4f5c\u7528\u3002\u5f53\u7535\u6781\u7f6e\u4e8e\u988f\u4e0b\u6216\u5589\u90e8\u533a\u57df\u65f6\uff0c\u7535\u523a\u6fc0\u6fc0\u6d3b\u820c\u9aa8\u4e0a\u808c\u65f6\uff0c\u53ef\u4fc3\u8fdb\u820c\u9aa8\u5411\u524d\u5411\u4e0a\u79fb\u52a8\u3002\u523a\u6fc0\u820c\u9aa8\u4e0b\u808c\u65f6\uff0c\u820c\u5589\u590d\u5408\u4f53\u7684\u8fd0\u52a8\u53d7\u6291\u5236\u3002Doan\u7b49<sup>[35]<\/sup>\u7684Meta\u5206\u6790\u4e5f\u63d0\u793a\uff0c\u5728\u820c\u9aa8\u4e0a\u65b9\u6c34\u5e73\u653e\u7f6e\u7535\u6781\u65f6\u7597\u6548\u66f4\u597d[SMD\uff1d0.94\uff0c95% CI(0.72\uff0c1.16)]\uff0c\u5176\u6b21\u662f\u820c\u9aa8\u4e0a\u4e0b\u65b9\u8054\u5408\u6c34\u5e73\u65b9\u5411\u653e\u7f6e\u7535\u6781\u4e5f\u80fd\u53d6\u5f97\u8f83\u597d\u6548\u679c[SMD\uff1d0.87\uff0c95% CI(0.59\uff0c1.14)]\u3002\u7532\u72b6\u820c\u9aa8\u808c\u548c\u820c\u9aa8\u4e0a\u808c\u7684\u5171\u540c\u6fc0\u6d3b\u53ef\u4fc3\u8fdb\u820c-\u5589\u590d\u5408\u4f53\u5411\u524d\u4e0a\u65b9\u8fd0\u52a8\uff0c\u4e5f\u6709\u52a9\u4e8e\u98df\u9053\u4e0a\u62ec\u7ea6\u808c\u5f00\u653e\u53ca\u589e\u5f3a\u6c14\u9053\u4fdd\u62a4\u673a\u5236\u3002\u5982\u679c\u80fd\u6839\u636e\u541e\u54bd\u56f0\u96be\u8bc4\u4f30\u8fdb\u884c\u4e2a\u4f53\u5316\u7535\u6781\u653e\u7f6e\uff0c\u5219\u7597\u6548\u6700\u597d(SMD\uff1d1.65\uff0c95% CI(0.38\uff0c2.91)\uff0cI<sup>2<\/sup>\uff1d90%)\u3002<\/p>\n<p>\u7efc\u4e0a\uff0c\u4f53\u8868\u795e\u7ecf\u808c\u8089\u7535\u523a\u6fc0\u8054\u5408\u4f20\u7edf\u541e\u54bd\u8bad\u7ec3\u53ef\u6539\u5584\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\uff0c\u9488\u5bf9\u820c\u9aa8\u4e0a\u808c\u6216\u540c\u65f6\u9488\u5bf9\u820c\u9aa8\u4e0a\u808c\u548c\u7532\u72b6\u820c\u9aa8\u808c\u8054\u5408\u8fdb\u884c\u6c34\u5e73\u65b9\u5411\u653e\u7f6e\u7535\u6781\u65f6\uff0c\u4e88\u4ee5\u7535\u523a\u6fc0\u53ef\u53d6\u5f97\u66f4\u597d\u6548\u679c\uff0c\u5efa\u8bae\u6839\u636e\u541e\u54bd\u969c\u788d\u8bc4\u4f30\u7ed3\u679c\u8fdb\u884c\u4e2a\u4f53\u5316\u7535\u6781\u653e\u7f6e\u3002<\/p>\n<\/p>\n<p>\u95ee\u98984\uff1a\u54bd\u8154\u7535\u523a\u6fc0\u662f\u5426\u53ef\u4ee5\u66f4\u597d\u7684\u6539\u5584\u53e3\u54bd\u671f\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c14\uff1a\u8bc1\u636e\u7b49\u7ea7\u9ad8(\uff0b\uff0b\uff0b\uff0b)\uff0c\u63a8\u8350\u5f3a\u5ea6\u4e3a\u5f3a\u63a8\u8350\u3002\u54bd\u8154\u7535\u523a\u6fc0(pharyngeal electrical stimulation\uff0cPES)\u53ef\u964d\u4f4e\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\u3001\u6e17\u6f0f\u8bef\u5438\u8bc4\u5206(penetration aspiration scale\uff0cPAS)\u3001\u7f29\u77ed\u4f4f\u9662\u65f6\u95f4\uff0c\u5e76\u663e\u8457\u964d\u4f4e\u80ba\u708e\u53d1\u751f\u7387\u548c\u54bd\u8fd0\u9001\u65f6\u95f4\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1aPES\u901a\u8fc7\u60ac\u7f6e\u5728\u54bd\u90e8\u8868\u9762\u7684\u7535\u6781\u76f4\u63a5\u523a\u6fc0\u54bd\u90e8\u9ecf\u819c\uff0c\u901a\u8fc7\u76ae\u8d28\u5ef6\u9ad3\u795e\u7ecf\u901a\u8def\u6fc0\u6d3b\u54bd\u8fd0\u52a8\u76ae\u8d28\u800c\u53d1\u6325\u4f5c\u7528\uff0c\u662f\u76ee\u524d\u4e00\u79cd\u8f83\u65b0\u578b\u7684\u5468\u56f4\u795e\u7ecf\u8c03\u63a7\u541e\u54bd\u7684\u6280\u672f\u3002Scutt\u7b49<sup>[36]<\/sup>\u7684Meta\u5206\u6790\u8868\u660e\uff0c\u5bf9\u4e8e\u53d1\u75c53\u4e2a\u6708\u4ee5\u5185\u7684\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\uff0c\u67094\u9879RCT\u7814\u7a76\u8868\u660e\uff0cPES\u53ef\u663e\u8457\u964d\u4f4ePAS\u8bc4\u5206\u3001\u7f29\u77ed\u4f4f\u9662\u65f6\u95f4\uff0c\u63a8\u8350\u91c7\u75285 Hz\u300175%\u9608\u503c\u7684\u523a\u6fc0\u5f3a\u5ea6\u3002\u5bf9\u4e8e\u5408\u5e76\u6709\u6c14\u7ba1\u5207\u5f00\u7684\u60a3\u8005\uff0c\u4ec53\u6b21\u6cbb\u7597\u5373\u53ef\u53d6\u5f97\u4e0a\u8ff0\u5373\u65f6\u6548\u5e94\uff0c\u63d0\u9ad8\u62d4\u7ba1\u6210\u529f\u7387\uff1b\u67093\u9879RCT\u8bc1\u636e\u8868\u660e\uff0cPES\u53ef\u663e\u8457\u964d\u4f4e\u541e\u54bd\u969c\u788d\u7a0b\u5ea6\u8bc4\u5206(dysphagia severity rating scale\uff0cDSRS)\u3002\u9664\u4e86\u8111\u5352\u4e2d\u60a3\u8005\uff0cRestivo\u7b49<sup>[37]<\/sup>\u7684\u7814\u7a76\u8ba4\u4e3a\uff0c\u5bf9\u4e8e\u591a\u53d1\u6027\u786c\u5316\u76f8\u5173\u7684\u541e\u54bd\u969c\u788d\u60a3\u8005\uff0c\u8fde\u7eed5 d(\u65b9\u6ce2\uff0c5 Hz\uff0c75%\u5f3a\u5ea6\u5dee\uff0c\u6bcf\u65e510 min)PES\u65b9\u6848\u4e5f\u53ef\u51cf\u5c11\u6e17\u6f0f\u8bef\u5438\u8bc4\u5206\u3002<\/p>\n<p>\u5bf9\u4e8e\u6162\u6027\u91cd\u5ea6\u795e\u7ecf\u6e90\u6027\u541e\u54bd\u969c\u788d\uff0c\u76ee\u524d\u4e34\u5e8a\u5e38\u89c4\u541e\u54bd\u5eb7\u590d\u6cbb\u7597\u65b9\u6cd5\u7597\u6548\u975e\u5e38\u6709\u9650\u3002\u5f20\u96ea\u7b49<sup>[38]<\/sup>\u91c7\u7528\u6539\u826f\u54bd\u8154\u7535\u523a\u6fc0(modified pharyngeal electrical stimulation\uff0cmPES)\u6cbb\u7597\u6162\u6027\u91cd\u5ea6\u795e\u7ecf\u6e90\u6027\u541e\u54bd\u969c\u788d\u60a3\u800530\u4f8b\uff0c\u5176\u6539\u826f\u7684\u6cbb\u7597\u53c2\u6570\u4e3a\uff1a\u6ce2\u5f62\u4e3a\u4e09\u89d2\u6ce2\u65b9\u6ce2\u6df7\u5408\u578b\u3001\u8109\u5bbd10 ms\u3001\u9891\u73875 Hz\uff0c\u523a\u6fc0\u5f3a\u5ea6\u4e3a\u8010\u53d7\u9608\uff0c\u6bcf\u65e51\u6b21\uff0c\u6bcf\u6b21\u6cbb\u759710 min\u3002\u8be5\u7814\u7a76\u7ed3\u679c\u53d1\u73b0\uff0c\u7ecf20\u6b21\u7684mPES\u6cbb\u7597\u540e\uff0c30\u4f8b\u60a3\u8005\u7684\u4e0b\u54bd\u538b\u529b\u5cf0\u503c\u3001\u4e0b\u54bd\u6536\u7f29\u6301\u7eed\u65f6\u95f4\u3001\u816d\u54bd\u538b\u529b\u5cf0\u503c\u548c\u816d\u54bd\u6536\u7f29\u6301\u7eed\u65f6\u95f4\u5747\u663e\u8457\u589e\u52a0\uff1b\u6e17\u6f0f\u8bef\u5438\u8bc4\u5206\u3001\u5206\u6ccc\u7269\u8bc4\u5206\u3001\u4f1a\u538c\u8c37\u6b8b\u7559\u3001\u68a8\u72b6\u7aa6\u6b8b\u7559\u51cf\u5c11\uff1b3\u4e2a\u6708\u968f\u8bbf\u65f6\uff0c30\u4f8b\u60a3\u8005\u7684\u529f\u80fd\u6027\u7ecf\u53e3\u8fdb\u98df\u8bc4\u5206(functional oral intake scale\uff0cFOIS)\u663e\u8457\u63d0\u9ad8\uff0c\u4e14\u5728\u6cbb\u7597\u8fc7\u7a0b\u4e2d\u548c\u968f\u8bbf\u671f\u95f4\u672a\u53d1\u73b0\u4e25\u91cd\u7684\u4e0d\u826f\u53cd\u5e94\u3002<\/p>\n<p>\u7efc\u4e0a\u6240\u8ff0\uff0cPES\u53ef\u7528\u4e8e\u8111\u5352\u4e2d\u60a3\u8005\uff0c\u5c24\u5176\u662f\u6025\u6027\u8111\u5352\u4e2d\u80fd\u53d6\u5f97\u5373\u65f6\u6548\u679c\uff0c\u63d0\u9ad8\u541e\u54bd\u5b89\u5168\u6027\uff1b\u5bf9\u4e8e\u6c14\u7ba1\u5207\u5f00\u60a3\u8005\uff0c\u6709\u5229\u4e8e\u63d0\u9ad8\u62d4\u7ba1\u7387\uff1b\u5bf9\u4e8e\u6162\u6027\u91cd\u5ea6\u795e\u7ecf\u6027\u541e\u54bd\u969c\u788d\u60a3\u8005\uff0c\u91c7\u7528mPES\u4e5f\u53ef\u53d6\u5f97\u5f88\u597d\u6548\u679c\u3002<\/p>\n<\/p>\n<p>\u95ee\u98985\uff1a\u7ecf\u9885\u76f4\u6d41\u7535\u523a\u6fc0\u548c\u91cd\u590d\u7ecf\u9885\u78c1\u523a\u6fc0\u80fd\u5426\u6539\u5584\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c15\uff0d1\uff1a\u8bc1\u636e\u7b49\u7ea7\u9ad8(\uff0b\uff0b\uff0b\uff0b)\uff0c\u5f3a\u63a8\u8350\u3002\u5728\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u4eba\u7fa4\u4e2d\u8fdb\u884c\u7ecf\u9885\u76f4\u6d41\u7535\u523a\u6fc0(transcranial direct current stimulation\uff0ctDCS)\u5e72\u9884\uff0c\u6539\u5584\u541e\u54bd\u529f\u80fd\u7684\u603b\u4f53\u6548\u5e94\u826f\u597d\uff0c\u53ef\u6709\u6548\u5730\u6539\u5584\u60a3\u8005\u7684\u541e\u54bd\u7ed3\u5c40\u548c\u4e25\u91cd\u7a0b\u5ea6\u91cf\u8868(dysphagia outcome and severity scale\uff0cDOSS)\u8bc4\u5206\u548cFOIS\u8bc4\u5206\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1atDCS\u662f\u901a\u8fc7\u5728\u5934\u76ae\u4e0a\u653e\u7f6e\u7535\u6781\u5e76\u5e94\u7528\u5fae\u5f31\u7684\u76f4\u6d41\u7535\u6d41\uff0c\u4ee5\u6539\u53d8\u5927\u8111\u76ae\u8d28\u5174\u594b\u6027\uff0c\u8fdb\u800c\u5f71\u54cd\u795e\u7ecf\u6d3b\u52a8\u3002tDCS\u5206\u4e3a\u9633\u6781(\u6b63\u6781)\u548c\u9634\u6781(\u8d1f\u6781)\u523a\u6fc0\uff0c\u5b83\u4eec\u53ef\u4ee5\u5206\u522b\u589e\u5f3a\u6216\u51cf\u5f31\u7279\u5b9a\u8111\u533a\u7684\u5174\u594b\u6027\uff0c\u4ece\u800c\u8c03\u8282\u795e\u7ecf\u7f51\u7edc\u7684\u6d3b\u52a8\u3002<\/p>\n<p>\u5728\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u7684\u5e94\u7528\u65b9\u9762\uff0c\u76ee\u524d\u7814\u7a76\u7edd\u5927\u591a\u6570\u91c7\u7528\u9633\u6781tDCS\u523a\u6fc0\u7684\u65b9\u5f0f\uff0c\u4e2a\u522b\u4f7f\u7528\u53cc\u6781\u523a\u6fc0<sup>[39,40]<\/sup>\u3002Zhao\u7b49<sup>[39]<\/sup>\u7eb3\u516516\u9879RCT\uff0c\u5bf9tDCS\u6539\u5584\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u7684\u4f5c\u7528\u8fdb\u884c\u4e86\u835f\u8403\u5206\u6790\uff0c\u7ed3\u679c\u663e\u793a\uff1a\u9633\u6781tDCS\u4f5c\u7528\u4e8e\u75c5\u7076\u540c\u4fa7\u6216\u53cc\u4fa7\u54bd\u671f\u541e\u54bd\u76ae\u8d28\u65f6\u7684\u603b\u4f53\u6cbb\u7597\u6548\u5e94\u826f\u597d\uff0cDOSS\u548c\u529f\u80fd\u6027\u541e\u54bd\u969c\u788d\u8bc4\u5206(functional dysphagia scale\uff0cFDS)\u6539\u5584\u3002\u4e9a\u7ec4\u5206\u6790\u63d0\u793a\uff0c\u5728\u6162\u6027\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u4e2d\u5177\u6709\u826f\u597d\u7684\u6cbb\u7597\u6548\u5e94[\u76f8\u5bf9\u5371\u9669\u5ea6(relative risk\uff0cRR)\uff1d0.80\uff0c95% CI(0.43\uff0c1.16)]\uff1b\u523a\u6fc0\u5f3a\u5ea6\u65b9\u9762\uff0c1 mA\u548c1.6 mA\u7684\u6cbb\u7597\u6548\u5e94\u4e2d\u7b49[\u5206\u522b\u4e3aRR\uff1d0.47\uff0c95% CI(0.13\uff0c0.81)\u548cSMD\uff1d1.39\uff0c95% CI(0.69\uff0c2.08)]\uff1b\u523a\u6fc0\u90e8\u4f4d\u65b9\u9762\uff0c\u60a3\u4fa7\u4e0e\u5065\u4fa7\u5927\u8111\u534a\u7403\u7684\u5e72\u9884\u5747\u6709\u663e\u8457\u7684\u6cbb\u7597\u6548\u679c\uff0c\u4e14\u60a3\u4fa7\u5927\u8111\u534a\u7403\u5e72\u9884\u7684\u6548\u679c\u66f4\u4f73[SMD\uff1d0.87\uff0c95% CI(0.26\uff0c1.48)]\u3002Pingue\u7b49<sup>[41]<\/sup>\u4e5f\u5bf9\u8111\u5352\u4e2d\u540e1\u6708\u5185\u7684\u60a3\u8005\u91c7\u7528\u4e86\u60a3\u4fa7\u534a\u7403\u9633\u6781tDCS\u52a0\u5065\u4fa7\u534a\u7403\u7684\u9634\u6781\u523a\u6fc0\u65b9\u6848\uff0c\u7ed3\u679c\u53d1\u73b0\uff0c\u8be5\u65b9\u6848\u8f83\u5047\u523a\u6fc0\u7ec4\u53ef\u66f4\u6709\u6548\u5730\u63d0\u9ad8\u60a3\u8005\u7684DOSS\u8bc4\u5206\uff0c\u63d0\u793a\u53cc\u4fa7\u76ae\u8d28tDCS\u6cbb\u7597\u4e5f\u6709\u4e00\u5b9a\u7684\u5e94\u7528\u6f5c\u529b\u3002\u6b64\u5916\uff0cSuntrup-Krueger\u7b49<sup>[42]<\/sup>\u5173\u4e8e\u60a3\u8005\u4e0d\u540c\u8111\u5352\u4e2d\u90e8\u4f4d\u7684\u4e9a\u7ec4\u5206\u6790\u663e\u793a\uff0ctDCS\u5bf9\u5355\u4fa7\u8111\u534a\u7403\u5352\u4e2d\u3001\u7403\u9ebb\u75f9\u548c\u8111\u5e72\u5352\u4e2d\u540e\u7684\u541e\u54bd\u969c\u788d\u6709\u6548\uff0c\u4f46\u5bf9\u5171\u6d4e\u5931\u8c03\u548c\u57fa\u5e95\u8282\u5352\u4e2d\u540e\u7684\u541e\u54bd\u969c\u788d\u65e0\u6548\u3002<\/p>\n<p>\u7efc\u4e0a\u6240\u8ff0\uff0c\u975e\u4fb5\u5165\u5f0f\u4e2d\u67a2\u795e\u7ecf\u8c03\u63a7\u523a\u6fc0\u6280\u672frTMS\u548ctDCS\u53ef\u7528\u4e8e\u5404\u7c7b\u6025\u6162\u6027\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\uff0c\u63a8\u8350\u6709\u8be5\u8bbe\u5907\u7684\u533b\u7597\u673a\u6784\u4f7f\u7528\u3002\u4f46\u7531\u4e8e\u523a\u6fc0\u53c2\u6570\u7684\u4e0d\u540c\uff0c\u5404\u7814\u7a76\u5b58\u5728\u9ad8\u5ea6\u7684\u5f02\u8d28\u6027\uff0c\u8fd8\u9700\u8981\u66f4\u591a\u3001\u66f4\u5927\u6837\u672c\u7684\u7814\u7a76\uff0c\u5c1a\u672a\u6709\u6700\u4f73\u65b9\u6848\uff1b\u672a\u6765\u5728\u5e94\u7528\u8fc7\u7a0b\u4e2d\u8fd8\u5e94\u7ed3\u5408\u76f8\u5173\u6cbb\u7597\u7684\u7981\u5fcc\u8bc1\u3001\u9002\u5e94\u8bc1\u9009\u62e9\u5408\u9002\u7684\u4eba\u7fa4\u4ee5\u53ca\u5408\u7406\u7684\u6cbb\u7597\u65b9\u6848\u3002<\/p>\n<\/p>\n<p>\u63a8\u8350\u610f\u89c15\uff0d2\uff1a\u8bc1\u636e\u7b49\u7ea7\u4f4e(\uff0b\uff0b)\uff0c\u5f31\u63a8\u8350\u3002\u4e0e\u5e38\u89c4\u541e\u54bd\u6cbb\u7597\u76f8\u6bd4\uff0c\u91cd\u590d\u7ecf\u9885\u78c1\u523a\u6fc0(repetitive transcranial magnetic stimulation\uff0crTMS)\u53ef\u6539\u5584\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u541e\u54bd\u969c\u788d\u4e25\u91cd\u7a0b\u5ea6\u8bc4\u5206\u548c\u6e17\u6f0f\u8bef\u5438\u8bc4\u5206\uff0c\u53d6\u51b3\u4e8e\u523a\u6fc0\u65b9\u5f0f\u548c\u9891\u7387\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1arTMS\u662f\u4e00\u79cd\u975e\u4fb5\u5165\u6027\u7ecf\u9885\u523a\u6fc0\u6280\u672f\uff0c\u5728\u8ba4\u77e5\u969c\u788d\u3001\u8fd0\u52a8\u969c\u788d\u3001\u8bed\u8a00\u529f\u80fd\u969c\u788d\u7b49\u9886\u57df\u5747\u6709\u5e7f\u6cdb\u7684\u5e94\u7528\uff0crTMS\u5728\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u4e2d\u7684\u5e94\u7528\u5df2\u6709\u4e00\u5b9a\u7814\u7a76\u3002rTMS\u7684\u523a\u6fc0\u65b9\u5f0f\u548c\u9891\u7387\u53ef\u4ee5\u6839\u636e\u6cbb\u7597\u7684\u76ee\u6807\u8fdb\u884c\u8c03\u6574\uff0c\u901a\u5e38\u4f4e\u9891rTMS\u53ef\u964d\u4f4e\u5c40\u90e8\u8111\u529f\u80fd\u6d3b\u52a8\u7684\u5174\u594b\u6027\uff0c\u800c\u9ad8\u9891rTMS\u5219\u53ef\u589e\u52a0\u5c40\u90e8\u8111\u529f\u80fd\u6d3b\u52a8\u7684\u5174\u594b\u6027\uff0c\u4f46\u5404\u7814\u7a76\u7684\u523a\u6fc0\u53c2\u6570\u4e0d\u7edf\u4e00\uff0c\u5f02\u8d28\u6027\u4e5f\u8f83\u9ad8\u3002Cheng\u7b49<sup>[43]<\/sup>\u7684Meta\u5206\u6790\u7eb3\u5165\u4e8613\u9879RCT\u7814\u7a76\uff0c\u5305\u62ec335\u4f8b\u8111\u5352\u4e2d\u541e\u54bd\u969c\u788d\u60a3\u8005\uff0c\u8fd9\u4e9bRCT\u7814\u7a76\u4e2drTMS\u7684\u6cbb\u7597\u65b9\u6848\u5305\u62ec\uff1a\u75c5\u7076\u540c\u4fa7\u9ad8\u9891\u523a\u6fc0\u3001\u75c5\u7076\u5bf9\u4fa7\u9ad8\u9891\u548c\u4f4e\u9891\u523a\u6fc0\u3001\u6216\u8005\u53cc\u4fa7\u523a\u6fc0\u3002\u9ad8\u9891\u523a\u6fc0\u53ef\u91c7\u75283 Hz\u30015 Hz\u621610 Hz\uff0c\u4f4e\u9891\u523a\u6fc0\u4ee51 Hz\u4e3a\u4e3b\u3002\u7ed3\u679c\u63d0\u793a\uff0c\u4e0e\u5bf9\u7167\u6cbb\u7597(\u5047\u523a\u6fc0\u6216\u5e38\u89c4\u541e\u54bd\u6cbb\u7597)\u76f8\u6bd4\uff0crTMS\u5177\u6709\u826f\u597d\u7684\u6cbb\u7597\u6548\u679c[SMD\uff1d0.73, 95% CI(0.49\uff0c0.98)]\uff0c\u80fd\u591f\u6709\u6548\u5730\u6539\u5584DOSS\u8bc4\u5206\u3001PAS\u7b49\u529f\u80fd\u8bc4\u5206\u3002\u8fdb\u4e00\u6b65\u7684\u4e9a\u7ec4\u5206\u6790\u663e\u793a\uff0c\u4f7f\u7528\u75c5\u7076\u540c\u4fa7\u9ad8\u9891\u523a\u6fc0\u6cbb\u7597\u6548\u679c\u6700\u4f73[SMD\uff1d0.83\uff0c95% CI(0.14\uff0c1.52)]\uff0c\u5176\u6b21\u4f4e\u9891\u523a\u6fc0\u5728\u5bf9\u4fa7\u534a\u7403[SMD\uff1d0.61, 95% CI(0.23\uff0c0.98)]\u548c\u9ad8\u9891\u523a\u6fc0\u5728\u5bf9\u4fa7\u534a\u7403[SMD\uff1d0.59, 95% CI(0.03\uff0c1.14)]\u7684\u6548\u5e94\u5927\u5c0f\u76f8\u8fd1\uff1b\u800c\u60a3\u4fa7\u534a\u7403\u9ad8\u9891\u523a\u6fc0\u65b9\u6cd5\u6cbb\u7597\u6548\u679c\u7684\u5f02\u8d28\u6027\u8f83\u5927\uff0c\u603b\u4f53\u6548\u5e94\u4e0d\u663e\u8457[SMD\uff1d0.57, 95% CI(\uff0d0.05\uff0c1.18)]\u3002Cheng\u7b49<sup>[43]<\/sup>\u4e5f\u5206\u6790\u4e86\u9488\u5bf9\u4e0d\u540c\u7814\u7a76\u5bf9\u8c61\u7684rTMS\u7814\u7a76\uff0c\u5373\u5305\u62ec\u6709\u534a\u7403\u540e\u5352\u4e2d\u3001\u5e55\u4e0b\u75c5\u53d8\u4ee5\u53ca\u5355\u7eaf\u8111\u5e72\u75c5\u53d8\uff0c\u60a3\u8005\u7684\u53d1\u75c5\u65f6\u95f4\u65e2\u67090~6\u4e2a\u6708\uff0c\u4e5f\u67096\u6708\u4ee5\u4e0a\uff1brTMS\u6cbb\u7597\u5f3a\u5ea6\u4ecb\u4e8e80~130%\u7684\u8fd0\u52a8\u9608\u503c(resting motor threshold\uff0cRMT)\uff0c\u6cbb\u7597\u65f6\u95f4\u4ecb\u4e8e5~18 d\uff0c\u5e72\u9884\u9776\u70b9\u5305\u62ec\u6709\u5065\u4fa7M1\u533a\u3001\u53cc\u4fa7M1\u533a\u3001\u60a3\u4fa7M1\u533a\u3001S1\u533a\u3001\u5c0f\u8111\u7b49\u90e8\u4f4d\u3002\u9664\u4e86\u5728\u8111\u5352\u4e2d\u53d1\u75c51\u5e74\u540e\u7684\u541e\u54bd\u969c\u788d\u60a3\u8005\u4e2d\u4f7f\u75285 Hz\u5de6\u4fa7\u5927\u8111\u534a\u7403rTMS\u6cbb\u7597\u540e\u672a\u53d1\u73b0\u660e\u663e\u529f\u80fd\u6539\u5584\u5916\uff0c\u5176\u4ed6\u5e72\u9884\u90e8\u4f4d\u3001\u75c5\u7076\u90e8\u4f4d\u7684rTMS\u7814\u7a76\u5747\u663e\u793a\u826f\u597d\u7684\u6cbb\u7597\u6548\u679c<sup>[44]<\/sup>\u3002\u8fd1\u5e74\u6765\uff0c\u9664\u4e86\u6700\u5e38\u89c1\u5e94\u7528\u4e8e\u5927\u8111\u534a\u7403\u540e\u5352\u4e2d\u541e\u54bd\u969c\u788d\u7684\u60a3\u8005\u4e2d\u7684\u7814\u7a76\uff0c\u6234\u840c\u7b49<sup>[45]<\/sup>\u53d1\u8868\u7684RCT\u7814\u7a76\u4e5f\u89c2\u5bdf\u4e86\u5c0f\u8111rTMS\u5728\u8111\u5e72\u5352\u4e2d\u3001\u5e55\u4e0b\u90e8\u4f4d\u8111\u5352\u4e2d\u4eba\u7fa4\u4e2d\u7684\u4f5c\u7528\u6548\u679c\uff0c\u603b\u4f53\u7ed3\u679c\u663e\u793a\uff0c\u53cc\u4fa7\u5c0f\u8111\u76ae\u8d28\u523a\u6fc0\u6216\u80fd\u66f4\u597d\u5730\u4f5c\u7528\u4e8e\u8be5\u7c7b\u4eba\u7fa4\u7684\u541e\u54bd\u969c\u788d\uff0c\u6709\u6548\u5730\u6539\u5584\u60a3\u8005\u7684PAS\u548cFOIS\u8bc4\u5206\uff0c\u540c\u65f6\u80fd\u591f\u8bf1\u5bfc\u4e00\u5b9a\u7684\u76ae\u8d28\u6838\u675f\u5174\u594b\u6027\u7684\u6539\u53d8\u3002\u9488\u5bf9\u4e0d\u540c\u90e8\u4f4d\u523a\u6fc0\u7684\u5dee\u5f02\uff0cZhong\u7b49<sup>[46]<\/sup>\u6bd4\u8f83\u4e86\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u4e0d\u540c\u8111\u533a(\u5305\u62ec\u5065\u4fa7\u548c\u60a3\u4fa7\u5927\u8111\u534a\u7403\u4ee5\u53ca\u5c0f\u8111)\u5e94\u75285 Hz\u7684rTMS\u7684\u60c5\u51b5\uff0c\u867d\u7136\u6240\u6709\u523a\u6fc0\u4f4d\u70b9\u7684\u8868\u73b0\u90fd\u4f18\u4e8e\u5047\u523a\u6fc0\uff0c\u4f46\u8fd9\u4e09\u4e2a\u533a\u57df\u8fdb\u884crTMS\u7684\u6cbb\u7597\u6548\u5e94\u5e76\u65e0\u7edf\u8ba1\u5b66\u5dee\u5f02\u3002<\/p>\n<p>\u7efc\u4e0a\uff0c\u9488\u5bf9\u8111\u5352\u4e2d\u60a3\u8005\uff0c\u6bd4\u8f83\u660e\u786e\u6709\u6548\u7684rTMS\u65b9\u6848\u5305\u62ec\u5bf9\u5065\u4fa7\u534a\u7403\u4f7f\u75281 Hz\u6291\u5236\u6027rTMS\u65b9\u6848\uff0c\u5bf9\u60a3\u4fa7\u4f7f\u75285 Hz\u5174\u594b\u6027rTMS\u548c\u53cc\u4fa7\u768410 Hz\u5174\u594b\u6027\u523a\u6fc0\uff1b\u5bf9\u4e8e\u5e55\u4e0b\u90e8\u4f4d\u8111\u5352\u4e2d\u7684\u60a3\u8005\u4eba\u7fa4\uff0c\u6709\u6548\u7684\u65b9\u6848\u5305\u62ec\u53cc\u4fa7\u541e\u54bd\u76ae\u8d28\u4ee3\u8868\u533a\u76843 Hz\u7684rTMS\uff0c\u53cc\u4fa7M1\u533a10 Hz\u7684rTMS\uff0c\u4ee5\u53ca\u53cc\u4fa7\u6216\u5355\u4fa7\u5c0f\u8111rTMS\u3002<\/p>\n<\/p>\n<p>\u95ee\u98986\uff1a\u8111\u5352\u4e2d\u540e\u53e3\u8154\u611f\u89c9\u523a\u6fc0\u662f\u5426\u53ef\u4ee5\u4fc3\u8fdb\u541e\u54bd\u542f\u52a8\uff0c\u6539\u5584\u541e\u54bd\u529f\u80fd\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c16\uff1a\u8bc1\u636e\u7b49\u7ea7\u4f4e(\uff0b\uff0b)\uff0c\u5f31\u63a8\u8350\u3002\u5bf9\u4e8e\u53e3\u54bd\u671f\u541e\u54bd\u969c\u788d\u60a3\u8005\u91c7\u7528\u53e3\u8154\u6e29\u5ea6\u89c9\u3001\u89e6\u89c9\u7b49\u611f\u89c9\u523a\u6fc0\u6cbb\u7597\uff0c\u5176\u6539\u5584\u541e\u54bd\u529f\u80fd\u548c\u9884\u9632\u5438\u5165\u6027\u80ba\u708e\u7684\u53d1\u751f\u83b7\u76ca\u6709\u9650\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u53e3\u8154\u5185\u611f\u89c9\u523a\u6fc0\u5728\u4e34\u5e8a\u4e0a\u4f7f\u7528\u5e7f\u6cdb\uff0c\u6e29\u5ea6\u89c9\u523a\u6fc0\u3001\u89e6\u89c9\u523a\u6fc0\u8fd9\u4e9b\u611f\u89c9\u523a\u6fc0\u88ab\u8ba4\u4e3a\u53ef\u80fd\u901a\u8fc7\u589e\u52a0\u611f\u89c9\u4f20\u5165\uff0c\u4fc3\u8fdb\u541e\u54bd\u53cd\u5c04\u3002\u5c3d\u7ba1\u4e00\u4e9b\u7814\u7a76\u8868\u660e\u611f\u89c9\u523a\u6fc0\u53ef\u80fd\u5bf9\u541e\u54bd\u969c\u788d\u6709\u4e00\u5b9a\u79ef\u6781\u5f71\u54cd\uff0c\u4f46\u611f\u89c9\u523a\u6fc0\u5bf9\u541e\u54bd\u969c\u788d\u7597\u6548\u7684\u8bc1\u636e\u4ecd\u7136\u6709\u9650\u4e14\u4e0d\u786e\u5b9a\u3002\u4e00\u4e9b\u7814\u7a76\u8868\u660e\u51b0\u6216\u70ed\u523a\u6fc0\u53ef\u80fd\u5bfc\u81f4\u541e\u54bd\u751f\u7406\u5b66\u4e0a\u7684\u6539\u53d8\uff0c\u4f46\u7ed3\u679c\u975e\u5e38\u4e0d\u4e00\u81f4\u3002\u5728Cheng\u7b49<sup>[47]<\/sup>\u7684Meta\u5206\u6790\u4e2d\uff0c\u7eb3\u5165\u4e868\u9879RCT\u7814\u7a76\uff0c\u6536\u96c6\u4e86285\u4f8b\u541e\u54bd\u969c\u788d\u60a3\u8005(\u5305\u62ec\u8111\u5352\u4e2d\u3001\u5e15\u91d1\u68ee\u75c5\u3001\u591a\u53d1\u6027\u786c\u5316\u3001\u8111\u80bf\u7624\u7b49)\u7684\u6570\u636e\uff0c\u7ed3\u679c\u663e\u793a\u53e3\u8154\u6e29\u5ea6\u89c9(\u70ed-\u89e6\u89c9\u3001\u70ed-\u5316\u5b66\u548c\u7535\u523a\u6fc0)\u7b49\u611f\u89c9\u523a\u6fc0\u5bf9\u4e8e\u795e\u7ecf\u6e90\u6027\u53e3\u54bd\u541e\u54bd\u969c\u788d\u60a3\u8005\u5e76\u6ca1\u6709\u83b7\u76ca[SMD\uff1d0.35, 95% CI(\uff0d0.03\uff0c0.72)]\u3002<\/p>\n<p>\u867d\u7136\u76ee\u524d\u6e29\u5ea6\u89c9\u3001\u89e6\u89c9\u7b49\u611f\u89c9\u523a\u6fc0\u7814\u7a76\u663e\u793a\u5e76\u672a\u83b7\u76ca\uff0c\u4f46\u4e34\u5e8a\u5b9e\u8df5\u4e2d\u4f7f\u7528\u5e7f\u6cdb\uff0c\u53ef\u80fd\u4e0e\u523a\u6fc0\u6a21\u5f0f\u3001\u5f3a\u5ea6\u7b49\u56e0\u7d20\u76f8\u5173\uff0c\u4e5f\u53ef\u8003\u8651\u4e0e\u5176\u4ed6\u6cbb\u7597\u8054\u5408\u4f7f\u7528\uff0c\u53ef\u80fd\u83b7\u5f97\u8f83\u5927\u7597\u6548\u3002<\/p>\n<\/p>\n<p>\u95ee\u98987\uff1a\u5934\u9888\u90e8\u80bf\u7624\u672f\u540e\u60a3\u8005\u53e3\u8154\u8fd0\u52a8\u8bad\u7ec3\u662f\u5426\u53ef\u4ee5\u6539\u5584\u541e\u54bd\u529f\u80fd\u3001\u63d0\u9ad8\u751f\u6d3b\u8d28\u91cf\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c17\uff1a\u8bc1\u636e\u7b49\u7ea7\u9ad8(\uff0b\uff0b\uff0b\uff0b)\uff0c\u5f3a\u63a8\u8350\u3002\u9488\u5bf9\u5934\u9888\u90e8\u80bf\u7624\u672f\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u8fdb\u884c\u820c\u808c\u8bad\u7ec3\uff0c\u53ef\u663e\u8457\u63d0\u9ad8\u5176\u541e\u54bd\u529f\u80fd\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u53e3\u8154\u8fd0\u52a8\u8bad\u7ec3\u5f62\u5f0f\u591a\u6837\uff0c\u5305\u62ec\u53e3\u5507\u4e3b\u88ab\u52a8\u8bad\u7ec3\u3001\u820c\u6297\u963b\u8bad\u7ec3\u3001\u820c\u808c\u7b49\u957f\/\u7b49\u5f20\u8bad\u7ec3\uff0c\u8fd0\u52a8\u65b9\u6cd5\u5305\u62ec\u4f7f\u7528\u538b\u820c\u677f\u3001\u7231\u8377\u534e\u53e3\u8154\u538b\u529b\u8bad\u7ec3\u4eea(Iowa oral pressure instrument\uff0cIOPI)\u3001\u6216\u8005\u8054\u5408\u808c\u7535\u751f\u7269\u53cd\u9988\u7597\u6cd5\u8fdb\u884c\u6297\u963b\u8bad\u7ec3\u7b49\u7b49\uff0c\u53ef\u4ee5\u81ea\u6211\u8bad\u7ec3\u6216\u8005\u7531\u6cbb\u7597\u5e08\u76d1\u7763\u4e0b\u8bad\u7ec3\uff0c\u65e8\u5728\u63d0\u9ad8\u53c2\u4e0e\u541e\u54bd\u7684\u808c\u8089(\u5982\u5507\u3001\u820c\u3001\u54bd)\u529b\u91cf\u3001\u8fd0\u52a8\u6027\u548c\u534f\u8c03\u6027\uff0c\u4ee5\u5b9e\u73b0\u5b89\u5168\u9ad8\u6548\u7684\u541e\u54bd\u3002<\/p>\n<p>\u5bf9\u4e8e\u5934\u9888\u90e8\u80bf\u7624\u672f\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u63a8\u8350\u91c7\u7528\u820c\u6297\u963b\u5f3a\u5316\u8bad\u7ec3\u3001Masako\u8bad\u7ec3\u7b49\u3002Banda\u7b49<sup>[48]<\/sup>\u7684\u4e00\u9879Meta\u5206\u6790\u7eb3\u516519\u9879RCT\u7814\u7a76\uff0c\u51711100\u540d\u53c2\u4e0e\u8005\uff0c\u6837\u672c\u91cf\u4ece20\u4f8b\u81f3168\u4f8b\u4e0d\u7b49\u3002\u5b9e\u9a8c\u7ec4\u8fdb\u884c\u4e86\u5305\u62ec\u820c\u4e3b\u52a8\u8bad\u7ec3\u3001\u62c9\u820c\u540e\u7f29\u541e\u54bd\u3001\u820c\u6297\u963b\u8bad\u7ec3\u3001\u820c\u6d3b\u52a8\u5ea6\u8bad\u7ec3\u548c\u820c\u7684\u5f3a\u5316\u7ec3\u4e60\uff1b\u5bf9\u7167\u7ec4\u4e3a\u4ec5\u63a5\u53d7\u5e38\u89c4\u62a4\u7406\u3001\u6ca1\u6709\u820c\u8bad\u7ec3\u7684\u60a3\u8005\u3002\u8be5\u7814\u7a76\u7ed3\u679c\u8868\u660e\uff0c\u591a\u6a21\u5f0f\u820c\u808c\u8bad\u7ec3\u5bf9\u5934\u9888\u90e8\u80bf\u7624\u672f\u540e\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\u548c\u5f20\u53e3\u5e45\u5ea6\u6709\u660e\u663e\u7684\u6539\u5584\u4f5c\u7528\uff0c\u540c\u65f6\u8fd8\u53ef\u6539\u5584\u5934\u9888\u90e8\u80bf\u7624\u672f\u540e\u60a3\u8005\u7684\u5e76\u53d1\u75c7\uff0c\u63d0\u9ad8\u5176\u751f\u6d3b\u8d28\u91cf\u3002\u8d75\u5983\u7b49<sup>[49]<\/sup>\u5bf914\u4f8b\u9f3b\u54bd\u764c\u653e\u7597\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u8fdb\u884c\u4e86\u4e3a\u671f\u4e24\u5468\u7684\u5f3a\u5316\u53e3\u54bd\u529f\u80fd\u8bad\u7ec3\uff0c\u5305\u62ec\u820c\u4e09\u660e\u6cbb\u8bad\u7ec3\u3001Masako\u8bad\u7ec3\u53ca\u820c\u4e2d\u90e8\u6297\u963b\u8bad\u7ec3\u7b49\uff0c\u7ed3\u679c\u8868\u660e\uff0c\u8bad\u7ec3\u540e\uff0c\u60a3\u8005\u7684FOIS\u3001\u6e17\u6f0f-\u8bef\u5438\u8bc4\u5206\u3001\u4f1a\u538c\u8c37\u68a8\u72b6\u7aa6\u6b8b\u7559\u6bd4\u4f8b\u3001VFSS\u7684\u65f6\u7a7a\u53c2\u6570\u5747\u8f83\u8bad\u7ec3\u524d\u660e\u663e\u6539\u5584\uff0c\u5373\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\u63d0\u9ad8\u3002<\/p>\n<p>\u7efc\u4e0a\u6240\u8ff0\uff0c\u53e3\u8154\u8fd0\u52a8\u8bad\u7ec3\u80fd\u63d0\u9ad8\u5934\u9888\u90e8\u80bf\u7624\u672f\u540e\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\uff0c\u64cd\u4f5c\u76f8\u5bf9\u7b80\u5355\uff0c\u53ef\u5f00\u5c55\u7684\u5f62\u5f0f\u591a\u6837\uff0c\u5efa\u8bae\u4e34\u5e8a\u4e0a\u6839\u636e\u60a3\u8005\u60c5\u51b5\u7684\u4e0d\u540c\u5236\u5b9a\u5408\u9002\u7684\u6cbb\u7597\u65b9\u6848\u3002<\/p>\n<\/p>\n<p>\u95ee\u98988\uff1a\u8fd0\u52a8\u884c\u4e3a\u7597\u6cd5\u662f\u5426\u80fd\u63d0\u9ad8\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u7ecf\u53e3\u6444\u98df\u529f\u80fd\u3001\u63d0\u9ad8\u541e\u54bd\u5b89\u5168\u6027\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c18\uff1a\u8bc1\u636e\u7b49\u7ea7\u9ad8(\uff0b\uff0b\uff0b\uff0b)\uff0c\u5f3a\u63a8\u8350\u3002\u8fd0\u52a8\u884c\u4e3a\u7597\u6cd5\u603b\u4f53\u4e0a\u53ef\u6539\u5584\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\uff0c\u5176\u4e2d\u7f29\u4e0b\u988c\u6297\u963b\u529b\u8bad\u7ec3(chin tuck against resistance\uff0cCTAR)\u3001Shaker\u8bad\u7ec3\u3001\u547c\u6c14\u808c\u8bad\u7ec3(expiratory muscle strength training\uff0cEMST)\u7b49\u7684\u7597\u6548\u66f4\u4e3a\u663e\u8457\uff0c\u5728\u5e38\u89c4\u541e\u54bd\u8bad\u7ec3\u7684\u57fa\u7840\u4e0a\u7ed3\u5408\u547c\u6c14\u808c\u8bad\u7ec3\u3001\u751f\u7269\u53cd\u9988\u8bad\u7ec3\uff0c\u53ef\u4ee5\u589e\u52a0\u541e\u54bd\u7684\u5b89\u5168\u6027\uff0c\u6539\u5584\u60a3\u8005\u7684\u5fc3\u7406\u72b6\u51b5\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u884c\u4e3a\u7597\u6cd5\u79cd\u7c7b\u591a\u6837\uff0c\u5305\u62ecCTAR\u3001EMST\u3001Shaker\u8bad\u7ec3\u3001\u751f\u7269\u53cd\u9988\u8bad\u7ec3\u7b49\uff0c\u5176\u4e2dShaker\u548cCTAR\u8bad\u7ec3\u5747\u53ef\u7528\u4e8e\u6539\u5584\u820c\u9aa8\u4e0a\u808c\u7fa4(suprahyoid muscles\uff0cSHM)\u7684\u8fd0\u52a8<sup>[50]<\/sup>\u3002\u4e8c\u8005\u901a\u8fc7\u4fc3\u8fdb\u5589\u90e8\u3001\u820c\u9aa8\u548c\u4f1a\u538c\u7b49\u7684\u8fd0\u52a8\uff0c\u4fdd\u62a4\u6c14\u9053\uff0c\u63d0\u9ad8\u541e\u54bd\u5b89\u5168\u6027\u548c\u6709\u6548\u6027\u3002Shaker\u8bad\u7ec3\u5df2\u88ab\u8bc1\u5b9e\u53ef\u4ee5\u4fc3\u8fdb\u98df\u7ba1\u4e0a\u62ec\u7ea6\u808c\u5f00\u653e\u3002CTAR\u8bad\u7ec3\u662f\u5728Shaker\u8bad\u7ec3\u7684\u57fa\u7840\u4e0a\uff0c\u9009\u62e9\u6027\u6fc0\u6d3b\u820c\u9aa8\u4e0a\u808c\u548c\u820c\u9aa8\u4e0b\u808c\uff0c\u5176\u8bad\u7ec3\u4f53\u4f4d\u66f4\u81ea\u7531\uff0c\u53ef\u4ee5\u5750\u4f4d\u3001\u534a\u5367\u4f4d\uff0c\u901a\u8fc7\u6536\u7f29\u4e0b\u988c\u6324\u538b\u7f51\u7403\u3001\u62f3\u5934\u6216\u4f7f\u7528\u4e00\u79cd\u4e24\u7aef\u5206\u522b\u7f6e\u4e8e\u4e0b\u988c\u548c\u80f8\u9aa8\u67c4\u7684\u5f39\u529b\u652f\u6491\u6746(neckline slimmer)\u5b8c\u6210<sup>[50]<\/sup>\u3002<\/p>\n<p>Speyer\u7b49<sup>[51]<\/sup>\u7684Meta\u5206\u6790\u7eb3\u516521\u7bc7RCT\uff0c\u5176\u4e2d18\u9879\u7814\u7a76\u4e3a\u8111\u5352\u4e2d\u60a3\u8005\uff0c\u5176\u5b833\u9879\u7814\u7a76\u4e3a\u591a\u53d1\u6027\u786c\u5316\u3001\u6025\u6027\u8111\u5916\u4f24\u3001\u5934\u9888\u80bf\u7624\u653e\u5316\u7597\u540e\u60a3\u8005\u3002\u7ed3\u679c\u8868\u660e\uff0c\u4e0e\u5e38\u89c4\u541e\u54bd\u8bad\u7ec3\u6216\u8005\u65e0\u541e\u54bd\u6cbb\u7597\u76f8\u6bd4\uff0c\u884c\u4e3a\u7597\u6cd5\u53ef\u660e\u663e\u6539\u5584\u541e\u54bd\u529f\u80fd[SMD\uff1d1.139\uff0c95% CI(0.862\uff0c1.416)]\uff0c\u5176\u4e2dShaker\u8bad\u7ec3\u3001CTAR\u8bad\u7ec3\u3001EMST\u8f83\u5176\u4ed6\u8bad\u7ec3\u65b9\u6cd5\u5b58\u5728\u66f4\u663e\u8457\u7684\u6548\u5e94\u91cf\u3002Liu\u7b49<sup>[52]<\/sup>\u7684Meta\u5206\u6790\u5219\u7740\u91cd\u6bd4\u8f83CTAR\u8bad\u7ec3\u5bf9\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u4e25\u91cd\u7a0b\u5ea6\u7684\u6539\u5584\uff0c9\u7bc7RCT\u5171\u7eb3\u5165548\u4f8b\u8111\u5352\u4e2d\u60a3\u8005\uff0c\u63d0\u793a\u4e0e\u65e0\u5e72\u9884\u6216\u5e38\u89c4\u541e\u54bd\u8bad\u7ec3\u76f8\u6bd4\uff0cCTAR\u53ef\u6709\u6548\u5730\u6539\u5584\u541e\u54bd\u5b89\u5168\u6027[\u5e73\u5747\u5dee(mean difference\uff0cMD)\uff1d\uff0d1.43\uff0c95% CI(\uff0d1.81\uff0c\uff0d1.06)]\u3001\u7ecf\u53e3\u6444\u5165\u80fd\u529b[SMD\uff1d\uff0d1.82\uff0c95% CI(\uff0d3.28\uff0c\uff0d0.35)]\u3001\u5fc3\u7406\u72b6\u51b5[MD\uff1d\uff0d5.72\uff0c95% CI(\uff0d7.39\uff0c\uff0d4.05)\uff0cP&lt;0.00001]\uff1b\u4e0eShaker\u8bad\u7ec3\u76f8\u6bd4\uff0cCTAR\u8bad\u7ec3\u5728\u6539\u5584\u541e\u54bd\u5b89\u5168\u6027[MD\uff1d\uff0d0.49\uff0c95% CI(\uff0d0.83\uff0c\uff0d0.16)\uff0cP\uff1d0.004]\u3001\u5fc3\u7406\u72b6\u51b5[MD\uff1d\uff0d2.20\uff0c95% CI(\uff0d3.77\uff0c\uff0d0.64)\uff0cP\uff1d0.006]\u65b9\u9762\u66f4\u6709\u6548\u3002<\/p>\n<p>Shaker\u8bad\u7ec3\u3001EMST\u53ef\u63a7\u5236\u547c\u5438\u8282\u5f8b\u548c\u9891\u7387\uff0c\u6539\u5584\u547c\u5438\u4e0e\u541e\u54bd\u534f\u8c03\u6027\uff0c\u6539\u5584\u80ba\u901a\u6c14\uff0c\u63d0\u9ad8\u54b3\u55fd\u53cd\u5c04\u548c\u5ed3\u6e05\u80fd\u529b\uff0c\u540c\u65f6\u4e5f\u53ef\u4ee5\u6539\u5584\u820c\u9aa8\u4e0a\u808c\u7fa4\u7684\u6d3b\u52a8<sup>[53,54,55]<\/sup>\u3002\u9488\u5bf9\u53d1\u75c5\u65f6\u95f4\u4e3a0~6\u4e2a\u6708\u7684\u8111\u5352\u4e2d\u60a3\u8005\uff0c\u5171\u67093\u9879RCT\u8bc1\u660eEMST(\u6bcf\u54685 d\uff0c\u6bcf\u65e55\u6b21\uff0c70%\u6700\u5927\u547c\u6c14\u538b\u8bad\u7ec3\uff0c\u6301\u7eed4\u5468)\u53ef\u6709\u6548\u5730\u6539\u5584\u541e\u54bd\u529f\u80fd<sup>[54,55,56]<\/sup>\u3002\u5176\u4e2dEmo<sup>[55]<\/sup>\u548cMoon\u7b49<sup>[54]<\/sup>\u76842\u9879RCT\u8bc1\u5b9e\uff0c\u4e0e\u5e38\u89c4\u541e\u54bd\u8bad\u7ec3\u76f8\u6bd4\uff0cEMST\u8054\u5408\u5e38\u89c4\u541e\u54bd\u8bad\u7ec3\u53ef\u66f4\u597d\u5730\u6539\u5584\u60a3\u8005\u541e\u54bd\u969c\u788d\u4e25\u91cd\u7a0b\u5ea6\u3001PAS\u3001\u4f1a\u538c\u6b8b\u7559\u548cFDS\u3002Park\u7b49<sup>[56]<\/sup>\u7684RCT\u7eb3\u5165\u4e8627\u4f8b\u8111\u5352\u4e2d\u60a3\u8005\uff0c\u968f\u673a\u5206\u4e3aEMST\u7ec4\u548c\u5b89\u6170\u5242\u7ec4\uff0c\u7ed3\u679c\u663e\u793a\uff0c\u5e72\u9884\u540e\uff0cEMST\u7ec4\u7684\u820c\u9aa8\u4e0a\u808c\u6d3b\u52a8\u5e45\u5ea6\u3001\u6db2\u4f53PAS\u548cFOIS\u5747\u663e\u8457\u4f18\u4e8e\u5b89\u6170\u5242\u7ec4\u5584\uff0c\u7136\u800c\u9700\u6ce8\u610f\u8fc7\u5ea6\u7684\u547c\u6c14\u8bad\u7ec3\u53ef\u80fd\u5f15\u8d77\u5934\u6655\u3001\u8840\u538b\u6ce2\u52a8\u7b49\u4e0d\u826f\u53cd\u5e94\u3002<\/p>\n<p>\u751f\u7269\u53cd\u9988\u53ef\u4fc3\u8fdb\u6b63\u5e38\u7684\u541e\u54bd\u8fd0\u52a8\u6a21\u5f0f\u6216\u8bf1\u53d1\u8db3\u591f\u7684\u808c\u8089\u6536\u7f29\uff0c\u60a3\u8005\u80fd\u591f\u901a\u8fc7\u89c6\u542c\u89c9\u7b49\u770b\u5230\u81ea\u5df1\u7684\u541e\u54bd\u52a8\u4f5c\uff0c\u4ece\u800c\u6709\u52a9\u4e8e\u541e\u54bd\u8bad\u7ec3\u3002\u6b64\u5916\uff0c\u541e\u54bd\u808c\u7fa4\u7684\u808c\u7535\u4fe1\u53f7\u6216\u8005\u8d85\u58f0\u5f71\u50cf\u7b49\u4e5f\u53ef\u4ee5\u8f6c\u5316\u4e3a\u89c6\u542c\u89c9\u4fe1\u606f\u63d0\u4f9b\u7ed9\u60a3\u8005\u3002Benfield\u7b49<sup>[57]<\/sup>\u5173\u4e8e\u751f\u7269\u53cd\u9988\u7597\u6cd5\u5bf9\u5404\u79cd\u75c5\u56e0\u6240\u81f4\u541e\u54bd\u969c\u788d\u7684Meta\u5206\u6790\u663e\u793a\uff0c\u4e0e\u5bf9\u7167\u7ec4\u76f8\u6bd4\uff0c\u751f\u7269\u53cd\u9988\u7597\u6cd5\u5728\u6539\u5584\u7ecf\u53e3\u6444\u5165\u91cf[MD\uff1d1.1\uff0c95% CI(\uff0d1.69\uff0c3.89)\uff0cP\uff1d0.44]\u3001\u80c3\u7ba1\u62d4\u51fa\u7387[OR\uff1d3.19\uff0c95% CI(0.16\uff0c62.72)\uff0cP\uff1d0.45]\u65b9\u9762\u6ca1\u6709\u663e\u8457\u5dee\u5f02\uff0c\u5bf9\u820c\u9aa8\u4f4d\u79fb[MD\uff1d0.22\uff0c95% CI(0.04\uff0c0.40)\uff0cP\uff1d0.02]\u6709\u66f4\u79ef\u6781\u7684\u5f71\u54cd\u3002Shin\u7b49<sup>[58]<\/sup>\u7684RCT\u7814\u7a76\u53d1\u73b0\uff0c\u7ed9\u4e88\u8111\u5352\u4e2d\u60a3\u80054\u5468\u7684\u820c\u9aa8\u4e0a\u808c\u7fa4\u8868\u9762\u808c\u7535\u53cd\u9988\u8bad\u7ec3\u540e\uff0c\u5176\u541e\u54bd\u529f\u80fd\u663e\u8457\u6539\u5584\uff0c\u4e14\u89c6\u542c\u89c9\u53cd\u9988\u6bd4\u89c6\u89c9\u53cd\u9988\u548c\u5355\u7eaf\u541e\u54bd\u52a8\u4f5c\u8bad\u7ec3\u7684\u7597\u6548\u66f4\u597d\u3002Moon\u7b49<sup>[59]<\/sup>\u7684RCT\u7814\u7a76\u4e5f\u8868\u660e\uff0c\u7528\u529b\u541e\u54bd\u8bad\u7ec3\u8054\u5408\u8868\u9762\u808c\u7535\u53cd\u9988\u8bad\u7ec3\u7684\u7597\u6548\u4f18\u4e8e\u5355\u7eaf\u7684\u7528\u529b\u541e\u54bd\u8bad\u7ec3\u3002<\/p>\n<p>\u7efc\u4e0a\u6240\u8ff0\uff0c\u8fd0\u52a8\u884c\u4e3a\u7597\u6cd5\u4e2d\u63a8\u8350\u8fdb\u884cShaker\u8bad\u7ec3\u3001CTAR\u8bad\u7ec3\u3001EMST\u7b49\u8fd0\u52a8\u8bad\u7ec3\uff0c\u4f46\u9700\u9488\u5bf9\u541e\u54bd\u969c\u788d\u7684\u5177\u4f53\u95ee\u9898\u9009\u62e9\u6027\u4f7f\u7528\uff1b\u751f\u7269\u53cd\u9988\u8bad\u7ec3\u662f\u4e00\u79cd\u6709\u6548\u7684\u541e\u54bd\u65b9\u5f0f\uff0c\u5176\u4e2d\u8868\u9762\u808c\u7535\u53cd\u9988\u662f\u76ee\u524d\u4e34\u5e8a\u5e94\u7528\u6700\u4e3a\u5e7f\u6cdb\u7684\u4e00\u79cd\u65b9\u6cd5\uff0c\u7ed3\u5408\u541e\u54bd\u8fd0\u52a8\u8bad\u7ec3\u53ef\u53d6\u5f97\u66f4\u597d\u7684\u7597\u6548\u3002<\/p>\n<\/p>\n<p>\u95ee\u98989\uff1a\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u672f\u662f\u5426\u53ef\u4ee5\u6539\u5584\u795e\u7ecf\u6027\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c19\uff1a\u8bc1\u636e\u7b49\u7ea7\u4e2d\u7b49(\uff0b\uff0b\uff0b)\uff0c\u5f3a\u63a8\u8350\u3002\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u672f\u662f\u6cbb\u7597\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u75c7\u7684\u6709\u6548\u6cbb\u7597\u624b\u6bb5\uff0c\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u672f\u8054\u5408\u5176\u5b83\u5e38\u89c4\u5eb7\u590d\u8bad\u7ec3\u8f83\u5355\u7eaf\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u53ef\u66f4\u597d\u5730\u63d0\u9ad8\u541e\u54bd\u6cbb\u7597\u7684\u6709\u6548\u7387\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u75c7\u662f\u5bfc\u81f4\u795e\u7ecf\u6027\u541e\u54bd\u969c\u788d\u7684\u539f\u56e0\u4e4b\u4e00\uff0c\u7403\u56ca\u6269\u5f20\u88ab\u8ba4\u4e3a\u662f\u4e00\u79cd\u76f8\u5bf9\u5b89\u5168\u6709\u6548\u7684\u7f13\u89e3\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u7684\u65b9\u6cd5\uff0c\u53ef\u4ee5\u51cf\u5c11UES\u538b\u529b\uff0c\u589e\u52a0\u653e\u677e\u65f6\u95f4\u3002\u65e2\u5f80\u7403\u56ca\u6269\u5f20\u9700\u8981\u5185\u7aa5\u955c\u7b49\u5f15\u5bfc\uff0c\u4e14\u9700\u8981\u6839\u636e\u75c5\u60c5\u53d8\u5316\u968f\u65f6\u66f4\u6362\u4e0d\u540c\u76f4\u5f84\u7684\u5bfc\u7ba1\uff0c\u4e00\u822c\u7528\u4e8e\u539f\u53d1\u6027\u73af\u54bd\u808c\u529f\u80fd\u969c\u788d\u3002\u7aa6\u7956\u6797\u6559\u6388\u521b\u65b0\u6027\u5730\u5c06\u5bfc\u5c3f\u7ba1\u7403\u56ca\u6269\u5f20\u6280\u672f\u7528\u4e8e\u6cbb\u7597\u5404\u79cd\u75c5\u56e0\u5bfc\u81f4\u7684\u73af\u54bd\u808c\u529f\u80fd\u969c\u788d\u60a3\u8005\uff0c\u901a\u8fc7\u6ce8\u6c34\u91cf\u7684\u5927\u5c0f\u6539\u53d8\u7403\u56ca\u76f4\u5f84\uff0c\u5206\u7ea7\u6269\u5f20\u64cd\u4f5c\u66f4\u52a0\u65b9\u4fbf\uff0c\u5b89\u5168\u6027\u9ad8<sup>[60,61]<\/sup>\u3002\u6731\u6995\u7b49<sup>[62]<\/sup>\u7684Meta\u5206\u6790\u7eb3\u51658\u7bc7RCT\uff0c\u5171\u8ba1322\u4f8b\uff0c\u5176\u4e2d\u8bd5\u9a8c\u7ec4165\u4f8b\uff0c\u5bf9\u7167\u7ec4157\u4f8b\uff1b\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0c\u4e0e\u5e38\u89c4\u5eb7\u590d\u8bad\u7ec3\u76f8\u6bd4\uff0c\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u672f\u53ef\u6539\u5584\u8111\u5352\u4e2d\u540e\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u75c7\u60a3\u8005\u7684\u541e\u54bd\u901a\u8fc7\u65f6\u95f4\u3001\u57fa\u4e8eVFSS\u7684\u541e\u54bd\u969c\u788d\u7a0b\u5ea6\u8bc4\u5206\u548cFOIS\u8bc4\u5206\u3002\u536b\u5c0f\u6885\u7b49<sup>[63]<\/sup>\u5bf9\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u672f\u6cbb\u7597\u673a\u5236\u7684\u7814\u7a76\u8868\u660e\uff0c\u7403\u56ca\u6269\u5f20\u672f\u53ef\u63d0\u9ad8\u5355\u4fa7\u8111\u5e72\u5352\u4e2d\u60a3\u8005\u53d7\u7d2f\u4fa7\u8fd0\u52a8\u76ae\u8d28\u7684\u5174\u594b\u6027\uff0c\u540c\u65f6\u53ef\u6fc0\u6d3b\u4e0e\u541e\u54bd\u529f\u80fd\u76f8\u5173\u7684\u611f\u89c9\u8fd0\u52a8\u76ae\u8d28\u53ca\u76ae\u8d28\u4e0b\u7ed3\u6784\uff0c\u5bfc\u7ba1\u7403\u56ca\u6269\u5f203\u5468\u540e\uff0c\u8fd9\u4e9b\u60a3\u8005\u7684\u76ae\u8d28\u5174\u594b\u6027\u6539\u53d8\u4e0eFOIS\u8bc4\u5206\u76f8\u5173\u3002\u7aa6\u7956\u6797\u7b49<sup>[64]<\/sup>\u6bd4\u8f83\u4e86\u4e0d\u540c\u65b9\u5f0f\u7684\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u6cbb\u7597\u8111\u5352\u4e2d\u540e\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u60a3\u8005\uff0c\u7ed3\u679c\u8868\u660e\uff0c\u5bf9\u4e8e\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u91c7\u7528\u4e3b\u52a8\u6269\u5f20\u7684\u65b9\u5f0f\u7684\u7597\u6548\u6700\u660e\u663e\u3002Lan\u7b49<sup>[65]<\/sup>\u7684RCT\u7814\u7a76\u8fdb\u4e00\u6b65\u8868\u660e\uff0c\u4e0e\u5355\u7eaf\u7684\u5e38\u89c4\u541e\u54bd\u6cbb\u7597\u76f8\u6bd4\uff0c\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u6cbb\u7597\u53ef\u66f4\u5927\u7a0b\u5ea6\u5730\u6539\u5584\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684UES\u677e\u5f1b\uff0c\u589e\u5f3a\u54bd\u63a8\u8fdb\u529b\uff0c\u6062\u590dUES\u9759\u606f\u538b\u529b\u3002<\/p>\n<p>\u6539\u826f\u7684\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u6cbb\u7597\u4e5f\u53ef\u4ee5\u4e0e\u5176\u4ed6\u541e\u54bd\u6cbb\u7597\u8054\u5408\u4f7f\u7528\u3002\u738b\u7476\u7b49<sup>[66]<\/sup>\u7684Meta\u5206\u6790\u8868\u660e\uff0c\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u672f\u8054\u5408\u5e38\u89c4\u5eb7\u590d\u8bad\u7ec3\u8f83\u5355\u7eaf\u5e38\u89c4\u5eb7\u590d\u8bad\u7ec3\uff0c\u53ef\u63d0\u9ad8\u541e\u54bd\u969c\u788d\u6cbb\u7597\u6709\u6548\u7387\uff0c\u6539\u5584\u541e\u54bd\u901a\u8fc7\u65f6\u95f4\u3001\u57fa\u4e8eVFSS\u7684\u541e\u54bd\u969c\u788d\u7a0b\u5ea6\u8bc4\u5206\u3001FOIS\u8bc4\u5206\uff0c\u51cf\u5c11\u5438\u5165\u6027\u80ba\u708e\u53d1\u751f\u7387\u3002\u5728\u8054\u5408\u6cbb\u7597\u65b9\u6848\u4e2d\uff0cLuo\u7b49<sup>[67]<\/sup>\u7684\u7814\u7a76\u53d1\u73b0\uff0c\u5c06\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u672f\u8054\u5408\u9488\u7078\u3001\u4e2d\u836f\u6cbb\u7597\u3001\u795e\u7ecf\u808c\u8089\u7535\u523a\u6fc0\u3001rTMS\u7b49\u7528\u4e8e\u8111\u5352\u4e2d\u540e\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u75c7\u7684\u5eb7\u590d\uff0c\u53ef\u663e\u8457\u6539\u5584\u60a3\u8005\u7684SSA\u8bc4\u5206\u548c\u57fa\u4e8eVFSS\u7684\u541e\u54bd\u969c\u788d\u7a0b\u5ea6\u8bc4\u5206\uff0c\u4e14\u6bd4\u5355\u7eaf\u7684\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u6cbb\u7597\u66f4\u6709\u6548\u3002<\/p>\n<p>\u7efc\u4e0a\u6240\u8ff0\uff0c\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u6cbb\u7597\u4f5c\u4e3a\u73af\u54bd\u808c\u529f\u80fd\u969c\u788d\u60a3\u8005\u7684\u5b89\u5168\u3001\u6709\u6548\u7684\u6cbb\u7597\u65b9\u6cd5\uff0c\u4e34\u5e8a\u4e0a\u5f3a\u70c8\u63a8\u8350\u5e94\u7528\uff0c\u4f46\u4f7f\u7528\u65f6\u9700\u8981\u6ce8\u610f\u9002\u5e94\u7684\u4eba\u7fa4\uff0c\u9700\u7ecf\u8be6\u7ec6\u7684\u541e\u54bd\u529f\u80fd\u8bc4\u4f30\u3002\u76ee\u524d\u5bf9\u4e8e\u8054\u5408\u5176\u5b83\u541e\u54bd\u5eb7\u590d\u6cbb\u7597\u7684\u65b9\u6848\u4e0d\u7edf\u4e00\uff0c\u8bc1\u636e\u5f02\u8d28\u6027\u8f83\u9ad8\uff0c\u5efa\u8bae\u5728\u5b8c\u5584\u541e\u54bd\u529f\u80fd\u8bc4\u4f30\u7684\u57fa\u7840\u4e0a\u8c28\u614e\u9009\u62e9\u4f7f\u7528\u3002<\/p>\n<\/p>\n<p>\u95ee\u989810\uff1a\u8089\u6bd2\u6bd2\u7d20\u6ce8\u5c04\u80fd\u5426\u6cbb\u7597\u6d41\u6d8e\u75c7\/\u73af\u54bd\u808c\u529f\u80fd\u969c\u788d\uff0c\u6709\u5229\u4e8e\u6539\u5584\u541e\u54bd\u529f\u80fd\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c110\uff0d1\uff1a\u8bc1\u636e\u7b49\u7ea7\u4e2d\u7b49(\uff0b\uff0b\uff0b)\uff0c\u63a8\u8350\u5f3a\u5ea6\u4e3a\u5f3a\u63a8\u8350\u3002\u553e\u6db2\u817a\u8089\u6bd2\u6bd2\u7d20\u6ce8\u5c04\u53ef\u4ee5\u6539\u5584\u795e\u7ecf\u6e90\u6027\u75be\u75c5\u60a3\u8005\u7684\u6d41\u6d8e\u75c7\u72b6\uff0c\u4e0e\u5b89\u6170\u5242\u76f8\u6bd4\uff0c\u672a\u89c1\u660e\u663e\u5e76\u53d1\u75c7\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u5065\u5eb7\u4eba\u6bcf\u5929\u4ea7\u751f\u7684\u553e\u6db2\u53ef\u901a\u8fc7\u541e\u54bd\u52a8\u4f5c\u6e05\u9664\uff0c\u6d41\u6d8e\u75c7\u4e0e\u541e\u54bd\u969c\u788d\u5bc6\u5207\u76f8\u5173\u3002\u76ee\u524d\u6cbb\u7597\u6d41\u6d8e\u75c7\u901a\u5e38\u4ee5\u51cf\u5c11\u553e\u6db2\u5206\u6ccc\u4e3a\u76ee\u6807\uff0c\u8089\u6bd2\u6bd2\u7d20\u4f5c\u4e3a\u4e00\u79cd\u6709\u6548\u6cbb\u7597\u6d41\u6d8e\u75c7\u7684\u65b9\u6cd5\uff0c\u53ef\u6291\u5236\u795e\u7ecf\u672b\u68a2\u4e59\u9170\u80c6\u78b1\u7684\u91ca\u653e\uff0c\u51cf\u5c11\u553e\u6db2\u7684\u4ea7\u751f\u3002\u76ee\u524d\u4f7f\u7528\u7684\u8089\u6bd2\u6bd2\u7d20\u67094\u79cd(3\u79cdA\u578b\u8089\u6bd2\u6bd2\u7d20\u2014Botox\u3001Dysport\u3001Xeomin\u548c1\u79cdB\u578b\u8089\u6bd2\u6bd2\u7d20\u2014Myobloc\/Neurobloc)\uff0c\u56fd\u5185\u666e\u904d\u4f7f\u7528\u7684\u4e3b\u8981\u662fA\u578b\u8089\u6bd2\u6bd2\u7d20\uff0c\u5e38\u7528\u6ce8\u5c04\u5242\u91cf\u662f100 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U\u51cf\u5c11\u6700\u660e\u663e\uff0c\u4e14\u7597\u6548\u53ef\u6301\u7eed\u81f3\u6ce8\u5c04\u540e16\u5468\u3002<\/p>\n<p>\u9648\u4e3d\u5a1f\u7b49<sup>[69]<\/sup>\u5bf9\u8089\u6bd2\u6bd2\u7d20\u6cbb\u7597\u6210\u4eba\u6d41\u6d8e\u75c7\u7684\u6709\u6548\u6027\u548c\u5b89\u5168\u6027\u7684Meta\u5206\u6790\u5171\u7eb3\u5165\u4e868\u9879\u7814\u7a76\uff0c\u603b\u6837\u672c\u91cf532\u4f8b\uff0c\u5176\u4e2d\u8089\u6bd2\u6bd2\u7d20\u7ec4369\u4f8b\uff0c\u5b89\u6170\u5242\u7ec4163\u4f8b\uff0c\u9488\u5bf9\u4e0d\u540c\u75be\u75c5(\u5305\u62ec\u5e15\u91d1\u68ee\u75c5\u3001\u8111\u5352\u4e2d\u3001\u8111\u5916\u4f24\u3001\u8fd0\u52a8\u795e\u7ecf\u5143\u75c5\u7b49)\uff0c\u91c7\u7528\u5ba2\u89c2\u6d4b\u91cf\u65b9\u5f0f(\u553e\u6db2\u91cd\u91cf\u3001\u553e\u6db2\u6d41\u7387\u548c\u553e\u6db2\u4f53\u79ef)\u548c\u4e3b\u89c2\u6d4b\u91cf\u65b9\u5f0f\u5982\u6d41\u6d8e\u4e25\u91cd\u7a0b\u5ea6\u548c\u9891\u7387\u91cf\u8868(drooling frequency and severity scale\uff0cDFSS)\u3001\u6d41\u6d8e\u8bc4\u5b9a\u91cf\u8868(drooling rating scale, DRS)\uff0c\u7ed3\u679c\u663e\u793a\uff0c\u5bf9\u6bd4\u5b89\u6170\u5242\u7ec4\uff0c\u8089\u6bd2\u6bd2\u7d20\u7ec4\u5728\u6cbb\u7597\u540e\u7b2c4\u5468\u3001\u7b2c8\u5468\u3001\u7b2c11~15\u5468\u5bf9\u6d41\u6d8e\u7684\u51cf\u5c11\u5747\u5177\u6709\u4f18\u52bf\uff1b\u8089\u6bd2\u6bd2\u7d20\u7ec4\u7684\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u9ad8\u4e8e\u5b89\u6170\u5242\u7ec4\uff0c\u5e38\u89c1\u4e0d\u826f\u53cd\u5e94\u5305\u62ec\u53e3\u5e72\u548c\u4e00\u8fc7\u6027\u541e\u54bd\u56f0\u96be\uff0c\u5176\u4f59\u4e0d\u826f\u53cd\u5e94\u53ef\u89c1\u53e3\u8154\u5f02\u5473\u3001\u9f8b\u9f7f\u3001\u4e00\u8fc7\u6027\u5480\u56bc\u65e0\u529b\u7b49\uff0c\u4f46\u4e24\u8005\u5728\u4e25\u91cd\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u4e0a\u65e0\u660e\u663e\u5dee\u522b\u3002<\/p>\n<p>\u7efc\u4e0a\u6240\u8ff0\uff0c\u553e\u6db2\u817a\u8089\u6bd2\u6bd2\u7d20\u6ce8\u5c04\u53ef\u660e\u663e\u51cf\u5c11\u553e\u6db2\u5206\u6ccc\uff0c\u5b89\u5168\u6027\u9ad8\uff0c\u63a8\u8350\u4f7f\u7528\u53cc\u4fa7\u553e\u6db2\u817a\u4e88\u4ee5A\u578b\u8089\u6bd2\u6bd2\u7d20\u6ce8\u5c04100 U\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c110\uff0d2\uff1a\u8bc1\u636e\u7b49\u7ea7\u4f4e(\uff0b\uff0b)\uff0c\u63a8\u8350\u5f3a\u5ea6\u4e3a\u5f3a\u63a8\u8350\u3002\u9488\u5bf9\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u75c7\u60a3\u8005\uff0c\u8089\u6bd2\u6bd2\u7d20\u6ce8\u5c04\u662f\u6709\u6548\u7684\uff0c\u4e14\u8054\u5408\u4f7f\u7528\u591a\u79cd\u5b9a\u4f4d\u6280\u672f\u53ef\u63d0\u9ad8\u5176\u6709\u6548\u7387\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u73af\u54bd\u808c\u529f\u80fd\u969c\u788d\u6216\u5931\u8fdf\u7f13\u75c7\u5e38\u89c1\u4e8e\u795e\u7ecf\u6027\u75be\u75c5\u3001\u5934\u9888\u90e8\u80bf\u7624\u4ee5\u53caZenker\u2032s\u61a9\u5ba4\uff0c\u8868\u73b0\u4e3a\u73af\u54bd\u808c\u4e0d\u80fd\u5f00\u653e\u6216\u8005\u5f00\u653e\u4e0d\u5b8c\u5168\uff0c\u53ef\u5bfc\u81f4\u98df\u7269\u96be\u4ee5\u901a\u8fc7\u98df\u7ba1\u5165\u53e3\uff0c\u589e\u52a0\u98df\u7269\u5728\u54bd\u90e8\u68a8\u72b6\u7aa6\u6b8b\u7559\u3001\u8fdb\u5165\u5589\u524d\u5ead\u6e17\u6f0f\u548c\u8bef\u5438\u7684\u98ce\u9669\u3002\u8089\u6bd2\u6bd2\u7d20\u6ce8\u5c04\u662f\u6700\u4e3a\u5e38\u7528\u7684\u6cbb\u7597\u73af\u54bd\u808c\u529f\u80fd\u969c\u788d\u6216\u5931\u8fdf\u7f13\u75c7\u7684\u65b9\u6cd5\u4e4b\u4e00\uff0c\u5171\u67094\u7bc7\u4e34\u5e8a\u7814\u7a76\u63d0\u51fa\uff0c\u8089\u6bd2\u6bd2\u7d20\u7684\u73af\u54bd\u808c\u6ce8\u5c04\u53ef\u6539\u5584\u541e\u54bd\u529f\u80fd\u548cDOSS\u8bc4\u5206\uff0c\u5176\u6709\u6548\u7387\u4e3a63~78%<sup>[70]<\/sup>\u3002\u8089\u6bd2\u6bd2\u7d20\u6ce8\u5c04\u7684\u76f8\u5bf9\u98ce\u9669\u4f3c\u4e4e\u8f83\u4f4e\uff0c\u800c\u4e14\u5229\u5927\u4e8e\u5f0a\uff0c\u5e76\u53d1\u75c7\u53d1\u751f\u7387\u975e\u5e38\u4f4e\uff0c\u53ea\u67091\u4f8b\u60a3\u8005\u51fa\u73b0\u6682\u65f6\u6027\u5355\u4fa7\u58f0\u5e26\u9ebb\u75f9<sup>[70]<\/sup>\u3002\u73af\u54bd\u808c\u8089\u6bd2\u6bd2\u7d20\u7684\u6ce8\u5c04\u5242\u91cf\u63a8\u8350\u4e3a50~100 U\uff0c\u5e38\u7528\u7684\u73af\u54bd\u808c\u5b9a\u4f4d\u6ce8\u5c04\u65b9\u5f0f\u6709\u5185\u955c\u5f15\u5bfc\u3001\u808c\u7535\u56fe\u3001\u7403\u56ca\u3001CT\u5f71\u50cf\u7b49\u3002Xie\u7b49<sup>[71]<\/sup>\u7684\u7814\u7a76\u7eb3\u5165\u7ecf\u5e38\u89c4\u541e\u54bd\u6cbb\u7597\u540e\u75c7\u72b6\u672a\u51cf\u8f7b\u7684\u795e\u7ecf\u6e90\u6027\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u75c7\u60a3\u800521\u4f8b\uff0c\u91c7\u7528\u8d85\u58f0\u3001\u808c\u7535\u56fe\u4ee5\u53ca\u7403\u56ca\u7ed3\u5408\u5b9a\u4f4d\u6ce8\u5c04\uff0c\u6ce8\u5c04\u5242\u91cf\u4e3a30~100 U\uff0c\u670917\u4f8b\u60a3\u8005(80.9%)\u7684FOIS\u8bc4\u5206\u589e\u52a0\uff0c\u8303\u56f4\u4e3a1~3(P&lt;0.001)\uff0c\u968f\u8bbf6\u4e2a\u6708\u540e\u53d1\u73b0\uff0c\u4e4b\u524dFOIS\u8bc4\u5206\u6539\u5584\u768417\u4f8b\u60a3\u8005\u5176FOIS\u8bc4\u5206\u6301\u7eed\u589e\u52a0(\u5373FOIS\u8bc4\u5206\u4e3a5~7\u5206)\u3002\u73af\u54bd\u808c\u8089\u6bd2\u6bd2\u7d20\u7684\u6ce8\u5c04\u5242\u91cf\u63a8\u8350\u4e3a50~100 U\uff0c\u4e0a\u8ff0\u591a\u9879\u9488\u5bf9\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u75c7\u60a3\u8005\u8089\u6bd2\u6bd2\u7d20\u6ce8\u5c04\u7684\u7814\u7a76\u5747\u672a\u51fa\u73b0\u660e\u663e\u7684\u4e0d\u826f\u53cd\u5e94\u3002<\/p>\n<p>\u7efc\u4e0a\u6240\u8ff0\uff0c\u8089\u6bd2\u6bd2\u7d20\u6ce8\u5c04\u53ef\u6539\u5584\u541e\u54bd\u969c\u788d\u76f8\u5173\u7684\u6d41\u6d8e\u75c7\u548c\u73af\u54bd\u808c\u5931\u5f1b\u7f13\u75c7\uff0c\u867d\u5b58\u5728\u4e00\u5b9a\u7684\u4e0d\u826f\u4e8b\u4ef6\uff0c\u4f46\u90fd\u4e0d\u662f\u4e25\u91cd\u4e8b\u4ef6\uff0c\u6ce8\u5c04\u65f6\u5982\u4ed4\u7ec6\u8003\u8651\u6bcf\u4f8b\u60a3\u8005\u541e\u54bd\u56f0\u96be\u7684\u7279\u70b9\u548c\u5b9a\u4f4d\u6ce8\u5c04\u7684\u65b9\u6cd5\uff0c\u53ef\u51cf\u5c11\u4e0d\u826f\u53cd\u5e94\uff0c\u800c\u8d85\u58f0\u3001\u808c\u7535\u56fe\u6216\u80052\u8005\u8054\u5408\u4f7f\u7528\u7684\u65b9\u5f0f\uff0c\u5747\u503c\u5f97\u63a8\u8350\u4e34\u5e8a\u4f7f\u7528\u3002<\/p>\n<\/p>\n<p>\u95ee\u989811\uff1a\u9488\u523a\u662f\u5426\u80fd\u6539\u5584\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c111\uff1a\u8bc1\u636e\u7b49\u7ea7\u9ad8(\uff0b\uff0b\uff0b\uff0b)\uff0c\u63a8\u8350\u7b49\u7ea7\u4e3a\u5f3a\u63a8\u8350\u3002\u9488\u523a\u8054\u5408\u541e\u54bd\u5eb7\u590d\u8bad\u7ec3\u53ef\u4ee5\u6539\u5584\u8111\u5352\u4e2d\u3001\u5e15\u91d1\u68ee\u75c5\u5f15\u8d77\u7684\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\u548c\u541e\u54bd\u76f8\u5173\u7684\u751f\u6d3b\u8d28\u91cf\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u9488\u523a\u53ef\u4ee5\u6539\u5584\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u7684\u60a3\u8005\u7684\u541e\u54bd\u969c\u788d\u7a0b\u5ea6\u8bc4\u5206\u3001\u751f\u6d3b\u8d28\u91cf\u548c\u541e\u54bd\u529f\u80fd\uff0c\u964d\u4f4e\u5176SSA\u8bc4\u5206\uff0c\u80ba\u708e\u53d1\u751f\u7387\u548c\u6b7b\u4ea1\u7387\uff0c\u4e14\u91c7\u7528\u7684\u9488\u523a\u65b9\u6cd5\u6709\u666e\u901a\u9488\u523a\u3001\u7535\u9488\u3001\u5934\u9488\u3001\u820c\u9488\u3001\u9879\u9488\u3001\u54bd\u9488\u7b49\u3002\u591a\u9879\u7814\u7a76\u7ed3\u679c\u63d0\u793a\uff0c\u9488\u523a\u5bf9\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u6709\u6539\u5584\u4f5c\u7528\uff0c\u9488\u7078\u8054\u5408\u5176\u5b83\u5eb7\u590d\u6cbb\u7597\u7684\u7597\u6548\u8f83\u597d\uff0c\u53ef\u63d0\u9ad8\u60a3\u8005\u7684\u751f\u6d3b\u8d28\u91cf[SMD\uff1d1.51\uff0c95% CI(1.30\uff0c1.75)]<sup>[72,73]<\/sup>\u300212\u4e2aMeta\u5206\u6790\u5171\u7eb3\u5165279\u9879\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u548c32\u9879\u975e\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u3002\u5176\u4e2d\u670916\u9879\u7814\u7a76\u91c7\u53d6\u4e86\u5355\u72ec\u7684\u9488\u523a\u5e72\u9884\uff0c\u5176\u5b83\u7814\u7a76\u91c7\u53d6\u9488\u523a\u8054\u5408\u5eb7\u590d\u8bad\u7ec3\u5e72\u9884\u3002\u8054\u5408\u5eb7\u590d\u8bad\u7ec3\u5305\u62ec\uff1a\u4f53\u8868\u795e\u7ecf\u808c\u8089\u7535\u523a\u6fc0(neuromuscular electrical stimulation, NMES)\u3001\u53e3\u8154\u611f\u89c9\u523a\u6fc0\u6216\u8fd0\u52a8\u8bad\u7ec3\u3001\u5bfc\u7ba1\u7403\u56ca\u6269\u5f20\u7b49\u3002<\/p>\n<p>\u5bf9\u4e8e\u5e15\u91d1\u68ee\u75c5\u6240\u5f15\u8d77\u7684\u541e\u54bd\u969c\u788d\uff0cWu\u7b49<sup>[74]<\/sup>\u7684Meta\u5206\u6790\u7eb3\u516510\u9879\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\uff0c\u5171724\u4f8b\u60a3\u8005\uff0c\u7ed3\u679c\u63d0\u793a\uff0c\u9488\u523a\u8054\u5408\u5eb7\u590d\u8bad\u7ec3\u53ef\u63d0\u9ad8\u541e\u54bd\u969c\u788d\u7684\u4e34\u5e8a\u7597\u6548[RR\uff1d1.40, 95% CI(1.25\uff0c1.58)]\u548cVFSS\u8bc4\u5206[MD\uff1d1.48, 95% CI(1.16\uff0c1.81)]\uff0c\u964d\u4f4eSSA\u8bc4\u5206[MD\uff1d\uff0d3.08\uff0c95% CI(\uff0d4.01\uff0c\uff0d2.15)]\uff0c\u6539\u5584\u60a3\u8005\u7684\u8425\u517b\u72b6\u6001\u548c\u80ba\u90e8\u611f\u67d3\u7387[RR\uff1d0.29, 95% CI(0.14\uff0c0.63)]\u3002\u8be5\u7ed3\u679c\u63d0\u793a\uff0c\u9488\u523a\u53ef\u4f5c\u4e3a\u5e15\u91d1\u68ee\u75c5\u541e\u54bd\u969c\u788d\u7684\u8f85\u52a9\u6cbb\u7597\u65b9\u6cd5\uff0c\u4f46\u7a74\u4f4d\u7684\u9009\u62e9\u548c\u6cbb\u7597\u65f6\u95f4\u5c1a\u65e0\u7edf\u4e00\u7684\u6807\u51c6\u3002<\/p>\n<p>\u6574\u4f53\u800c\u8a00\uff0c\u9488\u523a\u6cbb\u7597\u795e\u7ecf\u6027\u541e\u54bd\u969c\u788d\u6709\u4e00\u5b9a\u7684\u7597\u6548\uff0c\u4f46\u76ee\u524d\u7684\u5e72\u9884\u65b9\u6848\u5f02\u8d28\u6027\u8f83\u5927\uff0c\u63a8\u8350\u7684\u6709\u666e\u901a\u9488\u523a\u3001\u820c\u9488\u3001\u9879\u9488\uff0c\u4ecd\u9700\u8fdb\u4e00\u6b65\u9ad8\u8d28\u91cf\u3001\u591a\u4e2d\u5fc3\u7684\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u9a8c\u8bc1\uff1b\u5176\u6b21\uff0c\u7531\u4e8e\u9488\u523a\u53d7\u64cd\u4f5c\u8005\u7406\u8bba\u548c\u7ecf\u9a8c\u7684\u5f71\u54cd\uff0c\u5176\u6240\u91c7\u7528\u7684\u9488\u523a\u7a74\u4f4d\u548c\u6cbb\u7597\u65f6\u95f4\u7684\u5dee\u5f02\u4e5f\u8f83\u5927\uff0c\u76ee\u524d\u5c1a\u65e0\u7edf\u4e00\u7684\u9488\u7078\u6cbb\u7597\u65b9\u6848\uff0c\u800c\u73b0\u6709\u7684\u8bc1\u636e\u672a\u660e\u786e\u54ea\u4e00\u79cd\u9488\u7078\u65b9\u6cd5\u6700\u4f73\u3002<\/p>\n<\/p>\n<p>\u95ee\u989812\uff1a\u59ff\u52bf\u4ee3\u507f\u662f\u5426\u80fd\u6709\u6548\u6539\u5584\u541e\u54bd\u529f\u80fd\u3001\u964d\u4f4e\u8bef\u5438\u53d1\u751f\u7387\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c112\uff1a\u8bc1\u636e\u7b49\u7ea7\u4e2d\u7b49(\uff0b\uff0b\uff0b)\uff0c\u63a8\u8350\u7b49\u7ea7\u4e3a\u5f3a\u63a8\u8350\u3002\u91c7\u7528\u59ff\u52bf\u4ee3\u507f\u6027\u541e\u54bd\u6280\u672f\u53ef\u6539\u5584\u541e\u54bd\u529f\u80fd\u3001\u964d\u4f4e\u8bef\u5438\u53d1\u751f\u7387\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u541e\u54bd\u7684\u59ff\u52bf\u4ee3\u507f\u662f\u7ba1\u7406\u541e\u54bd\u969c\u788d\u60a3\u8005\u8fdb\u98df\u65f6\u7684\u8865\u507f\u6027\u7b56\u7565\u4e4b\u4e00\uff0c\u5305\u62ec\u5934\u9888\u90e8\u4ee3\u507f\u5982\u5934\u9888\u90e8\u4f38\u5c55\u3001\u5934\u9888\u90e8\u5c48\u66f2\u3001\u4ef0\u5934\u541e\u54bd\u3001\u9888\u90e8\u65cb\u8f6c\u3001\u4fa7\u65b9\u541e\u54bd\uff0c\u8eaf\u5e72\u4ee3\u507f\u5982\u534a\u5367\u4f4d\u548c\u8eaf\u5e72\u5782\u76f4\u4f53\u4f4d\u7b49\u3002\u7531\u4e8e\u541e\u54bd\u969c\u788d\u7684\u7c7b\u578b\u3001\u4e25\u91cd\u7a0b\u5ea6\u4e0d\u540c\uff0c\u5e94\u5148\u5728\u541e\u54bd\u9020\u5f71\u68c0\u67e5\u65f6\u89c2\u5bdf\u6709\u6548\u7684\u541e\u54bd\u59ff\u52bf\uff0c\u518d\u9009\u62e9\u9488\u5bf9\u6027\u7684\u59ff\u52bf\u8fdb\u884c\u8fdb\u98df\u8bad\u7ec3<sup>[75]<\/sup>\u3002<\/p>\n<p>Park\u7b49<sup>[76]<\/sup>\u5bf937\u4f8b\u8111\u5352\u4e2d\u541e\u54bd\u969c\u788d\u60a3\u8005\u91c7\u7528\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\uff0c\u6bd4\u8f83\u4e86\u57fa\u4e8eCTAR\u8bad\u7ec3\u4e0e\u4f20\u7edf\u7684\u4ef0\u5934\u8fd0\u52a8\u5bf9\u541e\u54bd\u529f\u80fd\u548c\u4f9d\u4ece\u6027\u7684\u5f71\u54cd\uff0c\u5e72\u9884\u65f6\u95f4\u6bcf\u54685\u6b21\uff0c\u8fde\u7eed\u5e72\u98844\u5468\uff1b\u7ed3\u679c\u663e\u793a\uff0c\u5e72\u98844\u5468\u540e\uff0c2\u7ec4\u60a3\u8005VDS\u8bc4\u5206\u3001PAS\u8bc4\u5206\u3001FOIS\u8bc4\u5206\u4e0e\u7ec4\u5185\u6cbb\u7597\u524d\u6bd4\u8f83\uff0c\u5747\u663e\u8457\u6539\u5584(P&lt;0.001)\uff0c\u4f462\u7ec4\u95f4\u5dee\u5f02\u5374\u65e0\u7edf\u8ba1\u5b66\u610f\u4e49(P&gt;0.05)\uff0c\u8be5\u7ed3\u679c\u8868\u660e\uff0c\u4e24\u7ec4\u7684\u6cbb\u7597\u65b9\u6cd5\u5747\u5177\u6709\u663e\u8457\u7684\u6cbb\u7597\u6548\u679c\u3002Ko\u7b49<sup>[77]<\/sup>\u7684\u7814\u7a76\u53d1\u73b0\uff0c\u4f4e\u5934\u541e\u54bd\u964d\u4f4e\u541e\u54bd\u969c\u788d\u60a3\u8005\u8bef\u5438\u7684\u6bd4\u4f8b\uff0c\u4e14\u663e\u8457\u4f18\u4e8e\u8eaf\u5e72\u5782\u76f4\u4f53\u4f4d\u4e0b\u541e\u54bd(P\uff1d0.001)\uff0c\u4e14\u4f4e\u5934\u541e\u54bd\u4f1a\u538c\u8c37\u548c\u68a8\u72b6\u9690\u7a9d\u7684\u6b8b\u7559\u7a0b\u5ea6\u4e5f\u8f7b\u4e8e\u8eaf\u5e72\u5782\u76f4\u4f53\u4f4d\u4e0b\u541e\u54bd\u3002Woisard\u7b49<sup>[78]<\/sup>\u91c7\u7528\u53ef\u79fb\u52a8\u6298\u53e0\u5ea7\u6905\u88c5\u7f6e\uff0c\u6bd4\u8f83\u4e86\u4e0d\u540c\u541e\u54bd\u59ff\u52bf\u5bf9\u60a3\u8005\u7684\u5f71\u54cd\uff0c\u8be5\u7814\u7a76\u5c0656\u4f8b\u541e\u54bd\u969c\u788d\u60a3\u8005\u968f\u673a\u5206\u4e3a\u88c5\u7f6e\u7ec430\u4f8b\u548c\u65e0\u88c5\u7f6e\u7ec426\u4f8b\uff0c\u88c5\u7f6e\u7ec4\u5728\u7528\u9910\u65f6\u91c7\u7528\u8be5\u88c5\u7f6e\u6765\u6539\u53d8\u60a3\u8005\u7684\u5750\u59ff\uff0c\u5e72\u98842\u4e2a\u6708\u540e\uff0c\u88c5\u7f6e\u7ec4\u60a3\u8005\u7684\u7528\u9910\u59ff\u52bf\u3001\u5589\u548c\u820c\u9aa8\u7684\u8fd0\u52a8\u5e45\u5ea6\u5747\u4f18\u4e8e\u65e0\u88c5\u7f6e\u7ec4(P&lt;0.05)\u3002\u6731\u7f8e\u7ea2\u7b49<sup>[79]<\/sup>\u5c06\u8111\u5352\u4e2d\u540e\u541e\u54bd\u969c\u788d\u60a3\u8005100\u4f8b\u968f\u673a\u5206\u4e3a\u89c2\u5bdf\u7ec4\u53ca\u548c\u5bf9\u7167\u7ec4\uff0c\u5bf9\u7167\u7ec4\u91c7\u7528\u5e38\u89c4\u541e\u54bd\u6cbb\u7597\uff0c\u89c2\u5bdf\u7ec4\u6839\u636e\u60a3\u8005\u7684\u60c5\u51b5\u8fdb\u884c\u4e2a\u6027\u5316\u7684\u59ff\u52bf\u4ee3\u507f\u6cbb\u7597\uff0c\u5305\u62ec\u8eaf\u5e72\u63a7\u5236\u3001\u5934\u90e8\u65cb\u8f6c\u3001\u4fa7\u65b9\u541e\u54bd\u3001\u4f4e\u5934\u541e\u54bd\u548c\u4ef0\u5934\u541e\u54bd\u7b49\uff0c\u6cbb\u75971\u4e2a\u6708\u540e\uff0c2\u7ec4\u60a3\u8005\u7684\u541e\u54bd\u529f\u80fd\u8f83\u7ec4\u5185\u6cbb\u7597\u524d\u5747\u663e\u8457\u6539\u5584(P&lt;0.05)\uff0c\u4e14\u89c2\u5bdf\u7ec4\u60a3\u8005\u6cbb\u75971\u4e2a\u6708\u540e\u7684FOIS\u5206\u7ea7\u3001PAS\u8bc4\u5206\u548c\u80ba\u90e8\u611f\u67d3\u60c5\u51b5\u5747\u663e\u8457\u4f18\u4e8e\u5bf9\u7167\u7ec4\u6cbb\u75971\u4e2a\u6708\u540e\u7684\u60c5\u51b5(P&lt;0.05)\u3002Park\u7b49<sup>[80]<\/sup>\u5bf934\u4f8b\u541e\u54bd\u56f0\u96be\u60a3\u8005\u5206\u522b\u8fdb\u884c90\u00b0\u8eaf\u5e72\u5782\u76f4\u5750\u59ff\u548c45\u00b0\u534a\u5367\u4f4d\u4e0b\u7684VFSS\u5bf9\u7167\u7814\u7a76\uff0c\u7ed3\u679c\u663e\u793a\uff0c45\u00b0\u534a\u5367\u4f4d\u4e0b\uff0c\u60a3\u8005\u541e\u54bd2 mL\u7a00\u6db2\u4f53\u65f6\u7684\u6e17\u900f-\u8bef\u5438\u91cf\u8868\u8bc4\u5206\u3001\u53e3\u8154\u901a\u8fc7\u65f6\u95f4\u3001\u54bd\u90e8\u5ef6\u8fdf\u65f6\u95f4\u3001\u54bd\u90e8\u901a\u8fc7\u65f6\u95f4\u3001\u4f1a\u538c\u8c37\u548c\u68a8\u72b6\u9690\u7a9d\u6b8b\u7559\u7b49\uff0c\u5747\u4f18\u4e8e90\u00b0\u8eaf\u5e72\u5782\u76f4\u5750\u59ff(P\uff1d0.007)\u3002<\/p>\n<p>\u7efc\u4e0a\u6240\u8ff0\uff0c\u541e\u54bd\u65f6\u901a\u8fc7\u59ff\u52bf\u4ee3\u507f\u53ef\u4f7f\u541e\u54bd\u901a\u9053\u7684\u8d70\u5411\u3001\u8154\u5f84\u7684\u5927\u5c0f\u548c\u67d0\u4e9b\u541e\u54bd\u5668\u5b98\u7ec4\u6210\u7ed3\u6784(\u5982\u5589\u3001\u820c\u3001\u6753\u72b6\u8f6f\u9aa8)\u7684\u4f4d\u7f6e\u53d1\u751f\u6539\u53d8\u548c\u79fb\u52a8\uff0c\u53ef\u589e\u52a0\u541e\u54bd\u56f0\u96be\u60a3\u8005\u7684\u611f\u89c9\u8f93\u5165\u523a\u6fc0\uff0c\u907f\u514d\u8bef\u5438\u548c\u6b8b\u7559\uff0c\u6539\u5584\u545b\u54b3\u7b49\u75c7\u72b6\u7684\u53d1\u751f\u3002<\/p>\n<\/p>\n<p>\u95ee\u989813\uff1a\u8bf4\u8bdd\u74e3\u819c\u5e72\u9884\u80fd\u5426\u6709\u6548\u51cf\u5c11\u6c14\u7ba1\u5207\u5f00\u4f34\u541e\u54bd\u969c\u788d\u60a3\u8005\u8bef\u5438\u7684\u53d1\u751f\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c113\uff1a\u8bc1\u636e\u7b49\u7ea7\u4f4e(\uff0b\uff0b)\uff0c\u63a8\u8350\u5f3a\u5ea6\u4e3a\u5f3a\u63a8\u8350\u3002\u6c14\u7ba1\u5207\u5f00\u4f34\u541e\u54bd\u969c\u788d\u60a3\u8005\u5728\u4e13\u4e1a\u4eba\u5458\u6307\u5bfc\u4e0b\u901a\u8fc7\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c\u53ef\u51cf\u5c11\u60a3\u8005\u8bef\u5438\u3001\u6e17\u6f0f\u7387\uff0c\u4ece\u800c\u6709\u52a9\u4e8e\u541e\u54bd\u529f\u80fd\u7684\u6062\u590d\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u8bf4\u8bdd\u74e3\u819c(\u53c8\u79f0\u8bed\u97f3\u9600)\u662f\u7531David Muir\u4e8e1985\u5e74\u53d1\u660e\uff0c\u6700\u521d\u8bbe\u8ba1\u76ee\u7684\u662f\u4f7f\u6c14\u7ba1\u5207\u5f00\u7684\u60a3\u8005\u80fd\u591f\u8bf4\u8bdd\uff0c\u76ee\u524d\u5df2\u8bc1\u5b9e\u5176\u53ef\u4ee5\u901a\u8fc7\u91cd\u65b0\u5efa\u7acb\u751f\u7406\u547c\u6c14\u672b\u6b63\u538b\u3001\u6062\u590d\u6b63\u5e38\u7684\u58f0\u95e8\u4e0b\u6c14\u538b\uff0c\u4f7f\u60a3\u8005\u9002\u5e94\u6b63\u5e38\u7684\u547c\u6c14\u6c14\u6d41\u6a21\u5f0f\uff0c\u5408\u7406\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c\u6709\u5229\u4e8e\u6539\u5584\u541e\u54bd\u529f\u80fd\u3002O\u2032Connor\u7b49<sup>[81]<\/sup>\u4e8e2018\u5e74\u7684\u4e00\u7bc7\u7cfb\u7edf\u56de\u987e\u7eb3\u5165\u65e2\u5f80\u517168\u4f8b\u76845\u9879\u968f\u673a\u5bf9\u7167\u5b9e\u9a8c\uff0c\u7ed3\u679c\u7efc\u5408\u5206\u6790\u663e\u793a\uff0c\u6c14\u7ba1\u5207\u5f00\u60a3\u8005\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c\u540e\u53ef\u51cf\u5c11\u60a3\u8005\u8bef\u5438\u7684\u98ce\u9669[OR\uff1d0.122\uff0c95% CI(0.031\uff0c0.479)]\u3002\u503c\u5f97\u4e00\u63d0\u7684\u662f\uff0c\u4e0a\u8ff0\u7eb3\u5165\u5c0f\u6837\u672c\u7684\u7814\u7a76\u91cc\uff0cLeder\u7b49<sup>[82]<\/sup>\u7684\u4e00\u9879\u7eb3\u516520\u4f8b\u60a3\u8005\u7684\u7814\u7a76\u8ba4\u4e3a\uff0c\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c(3~7 d)\u5e76\u4e0d\u80fd\u964d\u4f4e\u6c14\u5207\u60a3\u8005\u7684\u8bef\u5438\u98ce\u9669\u3002<\/p>\n<p>Han\u7b49<sup>[83]<\/sup>\u4e8e2012\u5e74\u5bf9\u75c5\u7a0b&gt;2\u4e2a\u6708\u7684\u8111\u5352\u4e2d\u548c\u9ad8\u4f4d\u622a\u762b\u540e\u7684\u6c14\u7ba1\u5207\u5f00\u4f34\u541e\u54bd\u969c\u788d\u60a3\u8005\u8fdb\u884c\u4e86\u81f3\u5c111\u5468\u3001\u5355\u6b21\u8010\u53d730 min\u4ee5\u4e0a\u7684\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c\u7684\u8bad\u7ec3\uff0c\u901a\u8fc7\u60a3\u8005\u4f69\u6234\u524d\u3001\u540e\u7684\u541e\u54bd\u9020\u5f71\u68c0\u67e5\u53d1\u73b0\uff0c\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c\u540e\u60a3\u8005\u7684\u8bef\u5438\u7387\u51cf\u5c11(81.25% vs 56.25%)\uff1b\u8be5\u56e2\u961f\u968f\u540e\u4e8e2022\u5e74\u505a\u7684\u4e00\u9879\u7eb3\u516520\u4f8b\u6c14\u7ba1\u5207\u5f00\u7684\u9885\u8111\u635f\u4f24\u60a3\u8005\u7684\u5355\u76f2\u3001\u968f\u673a\u5bf9\u7167\u7814\u7a76\u663e\u793a\uff0c\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c\u540e\u60a3\u8005\u7684\u6e17\u6f0f-\u8bef\u5438\u8bc4\u5206\u6539\u5584\uff0c\u8fd9\u53ef\u80fd\u4e0e\u60a3\u8005\u58f0\u95e8\u4e0b\u538b\u529b\u589e\u52a0\u3001\u816d\u54bd\u90e8\u6700\u5927\u538b\u529b\u589e\u52a0\u4ee5\u53ca\u98df\u7ba1\u4e0a\u62ec\u7ea6\u808c\u677e\u5f1b\u65f6\u95f4\u589e\u52a0\u7b49\u56e0\u7d20\u76f8\u5173\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c\u5fc5\u987b\u7531\u4e13\u4e1a\u4eba\u5458\u8fdb\u884c\u8bc4\u4f30\uff0c\u5728\u4f69\u6234\u8fc7\u7a0b\u4e2d\u5e94\u5173\u6ce8\u60a3\u8005\u7684\u8868\u60c5\u3001\u8840\u6c27\u9971\u548c\u5ea6\u3001\u8109\u640f\u3001\u547c\u5438\u9891\u7387\u3001\u53e3\u54bd\u8154\u5206\u6ccc\u7269\u3001\u54b3\u55fd\u53cd\u5e94\u7b49\u591a\u65b9\u9762\u60c5\u51b5\uff0c\u4ece\u800c\u534f\u52a9\u5224\u65ad\u60a3\u8005\u662f\u5426\u80fd\u5b89\u5168\u5730\u8010\u53d7\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c\u3002<\/p>\n<p>\u6574\u4f53\u800c\u8a00\uff0c\u6c14\u7ba1\u5207\u5f00\u4f34\u541e\u54bd\u969c\u788d\u60a3\u8005\u901a\u8fc7\u5408\u7406\u4f69\u6234\u8bf4\u8bdd\u74e3\u819c\uff0c\u53ef\u51cf\u5c11\u60a3\u8005\u8bef\u5438\u548c\u6e17\u6f0f\u7387\u3002\u4f46\u76ee\u524d\u591a\u6570\u7814\u7a76\u4ecd\u7136\u662f\u5355\u4e2d\u5fc3\u3001\u5c0f\u6837\u672c\uff0c\u4ecd\u9700\u8fdb\u4e00\u6b65\u9ad8\u8d28\u91cf\u3001\u591a\u4e2d\u5fc3\u7684\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u8fdb\u884c\u9a8c\u8bc1\u3002<\/p>\n<\/p>\n<p>\u7b2c\u56db\u90e8\u5206\u3000\u8425\u517b\u7ba1\u7406\u4e0e\u53e3\u8154\u62a4\u7406\u7684\u95ee\u9898\u548c\u610f\u89c1<\/p>\n<p>\u95ee\u989814\uff1a\u7ba1\u9972\u8425\u517b\u662f\u541e\u54bd\u969c\u788d\u5e72\u9884\u7684\u9996\u9009\uff0c\u54ea\u79cd\u7ba1\u9972\u5582\u517b\u6709\u5229\u4e8e\u6539\u5584\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u4e34\u5e8a\u7ed3\u5c40\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c114\uff1a\u8bc1\u636e\u7b49\u7ea7\u9ad8(\uff0b\uff0b\uff0b\uff0b)\uff0c\u63a8\u8350\u5f3a\u5ea6\u4e3a\u5f3a\u63a8\u8350\u3002\u5bf9\u4e8e\u54bd\u8154\u53cd\u5c04\u5f31\u6216\u8005\u6d88\u5931\u7684\u541e\u54bd\u969c\u788d\u60a3\u8005\uff0c\u4e0e\u6301\u7eed\u7f6e\u7ba1\u7ba1\u9972\u76f8\u6bd4\uff0c\u4f7f\u7528\u95f4\u6b47\u7ecf\u53e3\u81f3\u98df\u9053\u7ba1\u9972\u65e2\u80fd\u4fdd\u8bc1\u8425\u517b\u4f9b\u5e94\uff0c\u53c8\u80fd\u4fc3\u8fdb\u541e\u54bd\u529f\u80fd\u7684\u6062\u590d\uff0c\u51cf\u5c11\u5438\u5165\u6027\u80ba\u708e\u7684\u53d1\u751f\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c1\u8bf4\u660e\uff1a\u4fdd\u8bc1\u541e\u54bd\u969c\u788d\u60a3\u8005\u8425\u517b\u4f9b\u5e94\u548c\u9009\u62e9\u5408\u9002\u7684\u8425\u517b\u652f\u6301\u65b9\u5f0f\u5bf9\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u9884\u540e\u5341\u5206\u91cd\u8981\u3002\u6b64\u524d\u5e38\u9009\u62e9\u6301\u7eed\u7f6e\u7ba1\u9f3b\u9972\u6216\u80c3\u9020\u7618\u7ba1\u9972\uff0c\u6301\u7eed\u7f6e\u7ba1\u7ba1\u9972\u901a\u8fc7\u7f6e\u9f3b\u80c3\u7ba1\u6216\u9f3b\u80a0\u7ba1\u8f93\u9001\u8425\u517b\u6db2\u5230\u60a3\u8005\u80c3\u80a0\u9053\u5185\uff0c\u9700\u8981\u60a3\u800524 h\u4f69\u6234\u9f3b\u9972\u7ba1\uff0c\u6bcf30 d\u66f4\u6362\u7ba1\u8def\uff1b\u80c3\u9020\u7618\u7ba1\u9972\u9700\u8981\u60a3\u8005\u63a5\u53d7\u624b\u672f\u5f62\u6210\u80c3\u9020\u7618\uff0c\u901a\u8fc7\u80c3\u9020\u7618\u8f93\u5165\u8425\u517b\u7269\u8d28\u81f3\u80c3\u5185\u3002\u8fd1\u5e74\u6765\u53d1\u73b0\uff0c\u957f\u671f\u7559\u7f6e\u9f3b\u9972\u7ba1\u6613\u5f15\u53d1\u80c3\u5185\u5bb9\u7269\u53cd\u6d41\uff0c\u53e6\u4e00\u65b9\u9762\uff0c\u80c3\u9020\u7618\u7684\u62a4\u7406\u56f0\u96be\u3001\u6613\u53d1\u751f\u611f\u67d3\u7b49\u5e76\u53d1\u75c7\uff0c\u95f4\u6b47\u7ecf\u53e3\u81f3\u98df\u7ba1\u6216\u80c3\u7ba1\u9972\u6210\u4e3a\u8d8a\u6765\u8d8a\u591a\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u9009\u62e9<sup>[84]<\/sup>\u3002\u95f4\u6b47\u7ecf\u53e3\u81f3\u98df\u7ba1\u7ba1\u9972\u662f\u6307\uff0c\u5728\u6bcf\u6b21\u7ba1\u9972\u524d\uff0c\u7ecf\u53e3\u81f3\u98df\u7ba1\u7f6e\u7ba1\u540e\u7ed9\u4e88\u8425\u517b\u6db2\uff0c\u5582\u517b\u7ed3\u675f\u540e\u7acb\u5373\u53d6\u51fa\u9f3b\u9972\u7ba1\uff0c\u95f4\u6b47\u7ecf\u53e3\u81f3\u80c3\u7ba1\u9972\u5373\u628a\u7ba1\u63d2\u5230\u80c3\u91cc\uff0c\u5582\u517b\u7ed3\u675f\u540e\u7acb\u5373\u53d6\u51fa\u80c3\u7ba1\u3002\u95f4\u6b47\u7ecf\u53e3\u7ba1\u9972\u4e0e\u7559\u7f6e\u9f3b\u9972\u7684\u4e0d\u540c\u70b9\uff0c\u662f\u6bcf\u6b21\u5728\u9700\u8981\u8fdb\u98df\u65f6\u7f6e\u7ba1\uff0c\u65e2\u65e0\u9700\u624b\u672f\uff0c\u53c8\u65e0\u970024 h\u653e\u7f6e\u9f3b\u9972\u7ba1\uff0c\u65e2\u53ef\u7ef4\u62a4\u60a3\u8005\u7684\u5f62\u8c61\uff0c\u8fd8\u53ef\u6539\u5584\u5176\u541e\u54bd\u529f\u80fd(\u6bcf\u6b21\u7f6e\u7ba1\u65f6\u9700\u8981\u60a3\u8005\u505a\u541e\u54bd\u52a8\u4f5c\uff0c\u4ece\u800c\u8fdb\u884c\u4e86\u541e\u54bd\u8bad\u7ec3)\u548c\u751f\u6d3b\u8d28\u91cf<sup>[84]<\/sup>\u3002<\/p>\n<p>4\u9879\u7814\u7a76\u91c7\u7528\u6d3c\u7530\u996e\u6c34\u8bd5\u9a8c\uff0c2\u9879\u91c7\u7528\u541e\u54bd\u969c\u788d\u7a0b\u5ea6\u8bc4\u5206(degree score of dysphagia\uff0cVGF)\u8bc4\u4f30\u4e86\u95f4\u6b47\u7f6e\u7ba1\u7ba1\u9972\u5bf9\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u5f71\u54cd\u3002\u5f20\u57f9\u5b87\u7b49<sup>[85]<\/sup>\u7684\u7814\u7a76\u53d1\u73b0\uff0c\u95f4\u6b47\u7ba1\u9972\u80fd\u591f\u4fdd\u8bc1\u541e\u54bd\u969c\u788d\u60a3\u8005\u7684\u8425\u517b\u4f9b\u5e94\uff0c\u8be5\u7814\u7a76\u7684\u7684\u8425\u517b\u6307\u6807\u5305\u62ec\u8840\u7ea2\u86cb\u767d\u3001\u8840\u6e05\u767d\u86cb\u767d\u3001\u8840\u6e05\u524d\u767d\u86cb\u767d\u3001\u8840\u6e05\u603b\u86cb\u767d\u3001\u80b1\u4e09\u5934\u808c\u76ae\u8936\u539a\u5ea6\u3001\u5065\u4fa7\u4e0a\u81c2\u4e2d\u90e8\u808c\u56f4\u7b49\u3002\u8881\u68a6\u7433\u7b49<sup>[86]<\/sup>\u5bf92\u9879\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u8fdb\u884c\u4e86Meta\u5206\u6790\uff0c\u7ed3\u679c\u53d1\u73b0\uff0c\u95f4\u6b47\u7f6e\u7ba1\u7ba1\u9972\u7ec4\u7684\u8bef\u5438\u53d1\u751f\u7387\u663e\u8457\u4f4e\u4e8e\u6301\u7eed\u7f6e\u7ba1\u7ec4[RR\uff1d0.27\uff0c95% CI(0.08\uff0c0.93)]\u3002Wu\u7b49<sup>[87]<\/sup>\u5bf95\u9879\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u8fdb\u884c\u4e86Meta\u5206\u6790\uff0c\u7ed3\u679c\u53d1\u73b0\uff0c\u95f4\u6b47\u7f6e\u7ba1\u7ba1\u9972\u7ec4\u5438\u5165\u6027\u80ba\u708e\u53d1\u751f\u7387\u663e\u8457\u4f4e\u4e8e\u6301\u7eed\u7f6e\u7ba1\u7ec4[OR\uff1d0.28, 95% 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