老年卒中后吞咽障碍病人自我管理能力、吞咽训练依从性、心理负担与营养不良的相关性研究  

Correlation of self-management ability,swallowing training compliance,psychological burden with malnutrition in elderly patients with post-stroke dysphagia

作　　者：赵天雪 聂婷婷 赵乐妍 ZHAO Tianxue;NIE Tingting;ZHAO Leyan(Department of Internal Medicine,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院医保内科,北京市100050

出　　处：《实用老年医学》2025年第1期41-45,共5页Practical Geriatrics

基　　金：北京市卫生科技发展专项基金资助项目(2020-4-249)。

摘　　要：目的调查老年卒中后吞咽障碍(PSD)病人营养不良的发生情况以及影响因素,为老年PSD病人的营养干预提供有效的参考依据。方法选取2022年1月至2023年6月北京友谊医院收治的102例老年PSD病人,根据其患病后是否存在营养不良分为营养不良组(n=54)和非营养不良组(n=48),比较2组病人的基本信息、日常生活活动能力(ADL)、吞咽训练依从性、自我管理能力以及心理负担等资料,分析老年PSD病人发生营养不良的危险因素,并构建预测模型。结果102例老年PSD病人中54例出现营养不良,营养不良发生率为52.94%。营养不良组和非营养不良组年龄、自我感受负担量表(SPBS)评分、ADL评分、脑卒中史、吞咽训练依从性评分、自我护理能力量表(ESCA)评分、饮食习惯、合并其他并发症比例差异均有统计学意义(P<0.05)。将上述因素纳入多因素Logistic回归分析,结果显示年龄(OR=2.565,95%CI:1.394~4.719)、吞咽训练依从性评分(OR=0.830,95%CI:0.715~0.964)、SPBS评分(OR=1.283,95%CI:1.022~1.610)、ESCA评分(OR=0.839,95%CI:0.748~0.942)、合并其他并发症(OR=3.080,95%CI:1.270~7.470)是老年PSD病人发生营养不良的独立影响因素。Logistic回归模型预测老年PSD病人营养不良的ROC曲线下面积为0.946。结论老年PSD病人营养不良发生率较高,年龄、自我管理能力、心理负担、吞咽训练依从性以及合并其他并发症是老年PSD病人发生营养不良的影响因素,基于Logistic回归构建的预测模型对老年PSD病人营养不良的发生有一定预测价值。Objective To investigate the prevalence and influencing factors of malnutrition in the elderly patients with post-stroke dysphagia(PSD),and to provide effective reference for nutritional intervention.Methods A total of 102 elderly PSD patients admitted to Beijing Friendship Hospital from January 2022 to June 2023 were selected and divided into malnutrition group(n=54)and non-malnutrition group(n=48)based on whether they presented with malnutrition after PSD.The self-made general information questionnaire,activities of daily living(ADL)scale,exercise of self-care agency scale(ESCA),self-made swallowing training compliance scale,self-perceived burden scale(SPBS)were used to analyze the basic information,ADL,swallowing training compliance,self-management ability and psychological burden.The influencing factors of malnutrition in the elderly PSD patients were analyzed by multivariate Logistic regression model,and a prediction model of malnutrition was constructed.Results The incidence rate of malnutrition was 52.94%(54/102)in the PSD patients.There were statistically significant differences in age,SPBS score,ADL score,history of stroke,swallowing training compliance score,ESCA score,eating habits and the incidence of other complications between the two groups(P<0.05).Logistic regression analysis showed that age(OR=2.565,95%CI:1.394-4.719),swallowing training compliance score(OR=0.830,95%CI:0.715-0.964),SPBS score(OR=1.283,95%CI:1.022-1.610),ESCA score(OR=0.839,95%CI:0.748-0.942)and other complications(OR=3.080,95%CI:1.270-7.470)were the influencing factors of malnutrition in the elderly PSD patients.The area under the receiver operator characteristic curve of the Logistic regression model in predicting malnutrition was 0.946.Conclusions The prevalence of malnutrition in the elderly PSD patients is high,and age,self-management ability,psychological burden,swallowing training compliance and complications are the influencing factors of malnutrition in the elderly PSD patients,and the prediction model based on Logistic r

关 键 词：脑卒中 吞咽障碍 自我管理能力 吞咽训练依从性 营养不良 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]