急性缺血性脑卒中后吞咽障碍发病率及影响因素分析  

Prevalence and risk factors of dysphagia among acute ischemic stroke patients

作　　者：曹猛 宋学梅 梁丽[1] 麦静慧 吴亚男 朱丽娜 张晓梅[1] Cao Meng;Song Xuemei;Liang Li;Mai Jinghui;Wu Yanan;Zhu Lina;Zhang Xiaomei(Department of Neurology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院神经内科,广东广州510515

出　　处：《护理学杂志》2021年第2期24-27,共4页Journal of Nursing Science

基　　金：广东省省级科技计划项目(2014A020212542)。

摘　　要：目的探讨急性缺血性脑卒中后吞咽障碍发病率、危险因素及预后,为采取干预措施提供参考。方法对急性缺血性脑卒中患者在入院48h内,采用洼田饮水试验结合容积-黏度吞咽测试完成吞咽功能评估,收集年龄、性别、既往史、卒中部位、肌力、Barthel指数、美国国立卫生研究院脑卒中量表(NIHSS)评分等资料,并随访患者出院后1、3个月的预后情况。结果共纳入542例患者,吞咽障碍发病率为37.3%;Logistic回归分析显示,NIHSS评分、年龄、肌力及Barthel指数是吞咽障碍的影响因素(P<0.05,P<0.01);吞咽障碍患者与吞咽正常患者出院后死亡率、肺部感染率及改良Rankin评分比较,差异有统计学意义(均P<0.01)。结论急性缺血性脑卒中后吞咽障碍发病率较高,日常生活自理能力、神经功能、年龄及肌力是影响因素,吞咽障碍的发生显著影响患者预后;需系统和针对性开展吞咽障碍筛查,早期进行护理干预,以改善预后。Objective To study the incidence,risk factors and prognosis of dysphagia after acute ischemic stroke,and to provide reference for targeted interventions.Methods Patients with acute ischemic stroke were consecutively enrolled and assessed for swallowing function by Water-Swallow Test and Volume-Viscosity Swallow Test within 48 h of hospitalization.Age,gender,medical history,location of the stroke lesion,muscle strength,Barthel Index(BI),and National Institute of Health Stroke Scale(NIHSS)score were collected and follow-ups were performed at 1 and 3 months after discharge.Results A total of 542 patients were enrolled in this study.The incidence of dysphagia was 37.3%.Logistic regression analysis showed that NIHSS score,age,muscle strength and BI were independent risk factors for dysphagia(P<0.05,P<0.01).There were significant differences in mortality,incidence of pulmonary infection and the Modified Rankin Scale(mRS)score between the dysphagia and non-dysphagia patients after discharge(P<0.01 for all).Conclusion Dysphagia after acute ischemic stroke is prevalent,and is affected by performance in activities of daily living,neurological function,age and muscle strength.Dysphagia would impede the recovery after acute ischemic stroke,so systematic and targeted screening and early intervention should be conducted to improve the prognosis.

关 键 词：脑卒中 吞咽障碍 吞咽功能 洼田饮水试验 容积-黏度吞咽测试 肌力 自理能力 预后 

分 类 号：R473.74[医药卫生—护理学] R743.3[医药卫生—临床医学]