脑卒中后吞咽障碍患者进食不同稠度食物时发生误吸的影响因素分析  

Analysis of Factors Influencing Aspiration in Post-Stroke Patients with Dysphagia When Consuming Foods

作　　者：徐婷 曹瀚元 卢容 崔晓阳 张伟 郑婵娟 吴美玲 Xu Ting;Cao Hanyuan;Lu Rong(Rehabilitation Medicine Center,Hubei Hospital of Integrated Traditional Chinese and Western Medicine,Wuhan 430015,China)

机构地区：[1]湖北省中西医结合医院康复医学中心,武汉437000

出　　处：《中国康复》2024年第10期589-593,共5页Chinese Journal of Rehabilitation

基　　金：湖北省自然科学基金项目(2024AFD254)。

摘　　要：目的:采用吞咽X线荧光透视造影检查(VFSS)分析脑卒中后吞咽障碍患者进食不同稠度食物时发生误吸的相关影响因素,旨在为卒中后吞咽障碍患者临床预防误吸和进一步治疗提供参考。方法:分析123例脑卒中后吞咽障碍患者进食3种不同稠度(稀流质,浓流质,糊状)食物时的VFSS动态录像数据,进食不同稠度食物以是否误吸为因变量,将年龄、性别、临床诊断、发病部位(脑干和非脑干)、吞咽启动延迟、口腔推送困难、会厌残留、梨状窦残留、环咽肌功能障碍等作为自变量,进行单因素分析。对其中有统计差异的变量,进行多因素logistic回归分析,探讨进食3种不同稠度食物时发生误吸的影响因素,为卒中后吞咽障碍治疗提供可靠的依据。结果:Logistic回归分析显示在进食稀流质食物患者中发病部位位于脑干及吞咽启动延迟2项有显著性差异(OR=4.618、OR=2.323,均P<0.05);进食浓流质食物患者中口腔推送困难1项有显著性差异(OR=3.840,P<0.05),是发生误吸的独立危险因素;进食糊状食物时发病部位位于脑干、口腔推送困难2项均有显著性差异(OR=2.683、OR=3.463,均P<0.05),是发生误吸的危险因素。结论:脑卒中后吞咽障碍患者在进食稀流质及糊状食物时,病变位于脑干、吞咽启动延迟及口腔推送困难时易发生误吸;进食浓流质食物时,病变位于非脑干及口腔推送困难时易发生误吸。Objective:This study aims to investigate the factors influencing aspiration in stroke patients with dysphagia when consuming foods of varying consistencies using video fluoroscopic swallowing study(VFSS).The findings are intended to provide clinical guidance for the prevention and treatment of aspiration in post-stroke patients.Methods:A retrospective analysis was performed on VFSS recordings from 123 stroke patients with dysphagia while consuming three different consistencies of foods:thin liquids,thick liquids,and puree.Aspiration served as the dependent variable,while independent variables included age,gender,clinical diagnosis,lesion location(brainstem vs.non-brainstem),delayed swallow initiation,oral propulsion difficulties,epiglottic residue,pyriform sinus residue,and cricopharyngeal dysfunction.Univariate analysis was conducted,followed by multivariate logistic regression for variables showing statistical significance.Results:Logistic regression analysis revealed that for thin liquids,brainstem lesions and delayed swallow initiation were significantly associated with aspiration risk(OR=4.618,OR=2.323,both P<0.05).For thick liquids,oral propulsion difficulties were identified as an independent risk factor(OR=3.840,P<0.05).In patients consuming puree,both brainstem lesions and oral propulsion difficulties were significantly associated with aspiration(OR=2.683,OR=3.463,both P<0.05).Conclusion:Stroke patients with brainstem lesions,delayed swallow initiation,or oral propulsion difficulties are at higher risk of aspiration when consuming thin liquids and puree.Additionally,patients with oral propulsion difficulties and non-brainstem lesions are more likely to aspirate when consuming thick liquids.

关 键 词：吞咽障碍 吞咽荧光透视造影检查 误吸 脑卒中 

分 类 号：R49[医药卫生—康复医学] R743.3[医药卫生—临床医学]