脑卒中病灶与吞咽障碍严重程度的关联:回顾性队列研究  

Association between stroke-induced lesions and dysphagia severity:a retrospective cohort study

作　　者：蒋奕晨 沈沁 朱光跃 陈思韵 许东升 陈玲 顾琳 JIANGYichen;SHEN Qin;ZHU Guangyue(Shanghai Ruijin rehabilitation hospital,Shanghai,200023;不详)

机构地区：[1]上海市瑞金康复医院康复医学科,上海市200023 [2]上海中医药大学康复医学院 [3]中医智能康复教育部工程研究中心

出　　处：《中国康复医学杂志》2025年第4期528-533,共6页Chinese Journal of Rehabilitation Medicine

基　　金：上海市卫健委卫生行业临床研究专项面上项目(202240203)。

摘　　要：目的:探讨脑卒中病灶部位与脑卒中后吞咽障碍严重程度的相关性,寻找吞咽障碍早期预测指标。方法:回顾性收集2021年1月—2023年9月于上海市瑞金康复医院康复科住院治疗的脑卒中后吞咽障碍患者125例,根据患者病灶分为小脑幕上和幕下两组,并比较吞咽障碍严重程度及并发症严重程度的相关性。使用吞咽造影检查评估吞咽严重程度,并发症严重程度评估使用PAS量表和CTCAE 5.0,应用二元及多元Logistic回归分析确定吞咽障碍严重程度和并发症严重程度的独立影响因素。结果:吞咽障碍严重程度(全过程、口腔期、咽期)与病灶的相关性有显著性意义(P<0.01、P=0.014,P=0.02),小脑幕下受损和年龄的增加更容易引起较为严重的吞咽障碍。病灶与卒中后并发症严重程度的相关性具有显著性意义(P=0.005、P=0.001),病灶为小脑幕下更容易加重并发症的严重程度。结论:卒中后患者吞咽障碍严重程度与卒中病灶部位有相关性,且吞咽障碍的严重程度与误吸的严重程度和肺炎的发生有相关性。Objective:To investigate the correlation between the location of stroke lesions and the severity of post-stroke dysphagia(PSD),aiming to identify early predictors of dysphagia.Method:From January 2021 to September 2023,125 patients with PSD were divided into supratentorial and infratentorial groups according to their lesions.The correlation between the severity of dysphagia and the severity of complications was compared.VFSS was used to evaluate the severity of swallowing and PAS and CTCAE5.0 were used to evaluate the severity of complications.Binary and multivariate logistic regression analysis was used to determine the independent influencing factors of dysphagia and complications.Result:There was a significant correlation between the severity of dysphagia(whole process,oral stage,pharynx and larynx)and the lesion locations(P<0.01,P<0.014,P<0.02).Damage under the tentorium of the cerebellum and increase in age are more likely to cause more severe dysphagia.The correlation between the focus and the severity of complications after stroke was statistically significant.The correlation between the focus and the severity of complications after stroke was statistically significant(P=0.005,P=0.001).The focus under the tentorium of the cerebellum was more likely to aggravate the severity of complications.Conclusion:The severity of dysphagia after stroke is related to the location of stroke focus,and the severity of dysphagia is related to the severity of aspiration and the occurrence of pneumonia.

关 键 词：脑卒中后吞咽障碍 吞咽造影检查 卒中病灶部位 

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]