近期皮质下小梗死患者吞咽障碍的相关因素分析  

Related factors for dysphagia in patients with recent small subcortical infarction:an analysis of 188 cases

作　　者：崔明愚 刘欣 王丽娟 刘荧 魏欣 Cui Mingyu;Liu Xin;Wang Lijuan;Liu Ying;Wei Xin(Department of Neurology,Beijing Zhongguancun Hospital,Beijing 100190,China)

机构地区：[1]北京市中关村医院神经内科,100190

出　　处：《中华老年心脑血管病杂志》2025年第3期313-316,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市中关村医院科研培育专项项目(Y202211)。

摘　　要：目的探讨近期皮质下小梗死(resent small subcortical infarcts,RSSI)患者吞咽障碍的发生率及危险因素。方法选取2018年5月至2024年5月北京市中关村医院神经内科住院的RSSI患者188例,根据Gugging吞咽功能评估量表(Gugging swallowing screen,GUSS)评分分为吞咽障碍组51例(GUSS评分≤19分)及无吞咽障碍组137例(GUSS评分20分)。比较2组临床表现及影像学差异。结果吞咽障碍组年龄、构音障碍、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、改良的Rankin量表评分、病灶直径、脑桥梗死、侧脑室旁及深部脑白质高信号评分明显高于无吞咽障碍组,简易智能状态检查量表评分及蒙特利尔认知评估量表评分明显低于无吞咽障碍组,差异有统计学意义(P<0.05,P<0.01)。二元logistic回归分析显示,年龄、构音障碍、NIHSS评分、病灶直径及脑桥梗死是RSSI患者发生吞咽障碍的危险因素(OR=1.203,95%CI:1.070~1.352;OR=34.464,95%CI:5.013~236.942;OR=4.579,95%CI:2.180~9.617;OR=0.623,95%CI:0.463~0.838;OR=0.020,95%CI:0.002~0.191,P<0.01)。结论对年龄大、病灶直径大、伴有构音障碍、神经功能缺损严重、脑桥梗死的RSSI患者,应警惕吞咽障碍发生,避免严重并发症。Objective To investigate the incidence and risk factors of dysphagia in patients after recent small subcortical infarction(RSSI).Methods A total of 188 RSSI patients admitted to our department from May 2018 to May 2024 were enrolled,and according to Gugging swallowing screen(GUSS),they were divided into dysphagia group(GUSS score≤19,n=51)and nondysphagia group(the score=20,n=137).The clinical manifestations and imaging data were compared between the two groups.Results When compared with the non-dysphagia group,the dysphagia group had significantly older age,larger proportion of dysarthria,higher NIHSS and mRS scores,larger lesion diameter,higher incidence of pontine infarction,and higher scores of periventricular and deep white matter hyperintensities,but lower scores of mini-mental state examination and Montreal cognitive assessment(P<0.05,P<0.01).Binary logistic regression analysis showed that age,dysarthria,NIHSS score,lesion diameter,and pontine infarction were risk factors for dysphagia in RSSI patients(OR=1.203,95%CI:1.070-1.352;OR=34.464,95%CI:5.013-236.942;OR=4.579,95%CI:2.180-9.617;OR=0.623,95%CI:0.463-0.838;OR=0.020,95%CI:0.002-0.191,P<0.01).Conclusion For RSSI patients,especially those with older age,larger lesion diameter,dysarthria,severe neurological deficits,and pontine infarction,clinicians should be alert to the occurrence of dysphagia in order to avoid serious complications.

关 键 词：脑梗死 吞咽障碍 危险因素 脑血管障碍 

分 类 号：R743.33[医药卫生—神经病学与精神病学]