| 王芳.出血性脑卒中患者吞咽困难筛查失败的危险因素分析[J].中国康复,2020,35(1):27-30 |
| 出血性脑卒中患者吞咽困难筛查失败的危险因素分析 |
| Risk factors of failure of dysphagia screening in patients with hemorrhagic stroke |
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| DOI： |
| 中文关键词: 出血性脑卒中 吞咽困难筛查 卒中后遗症 危险因素 |
| 英文关键词: hemorrhagic stroke dysphagia screening stroke sequelae risk factors |
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| 中文摘要: |
| 目的：评估出血性脑卒中患者的吞咽困难未通过率，寻找与未通过筛查的相关预测因素，以及筛查未通过后的预后情况。方法：回顾性分析2016年7月~2018年7月期间收治我科的出血性脑卒中患者，选用多伦多床旁吞咽筛查试验（TOR-BSST）进行吞咽困筛查，收集入组患者的年龄、性别、体重指数（BMI）、合并症、急性生理学和慢性健康评估分（APACHEII）和格拉斯哥昏迷评分（GSC）等相关临床参数，运用改良Rankin量表评估患者脑卒中后身体功能恢复情况。根据加拿大神经功能评分量表（CNS）和美国国立卫生研究院卒中量表（NIHSS），评估患者临床症状的严重程度。评估接受吞咽困难筛查失败的预测因素和筛查失败后的相关预后。结果：单因素分析中，年龄、语言障碍、GCS评分在2组之间差异有统计学意义（P<0.01，0.05）。此外，轻度和重度脑卒中、姑息治疗的患者吞咽困难筛查未通过率较高（P<0.01）。多因素分析中，与吞咽困难筛查成功与否有关的危险因素包括：年龄、语言障碍、GCS评分、卒中严重程度、姑息治疗（ P<0.05，0.01）。吞咽困难筛查未通过组的患者更容易发生吸入性肺炎，留量胃管和放置经皮喂养管明显增加，其严重残疾比例更高及住院时间和30d死亡率更高（均P<0.01）。结论：高龄、语言障碍、GCS评分、卒中严重程度、姑息治疗是出血性脑卒中患者吞咽困难筛查失败的危险因素，并且与不良预后密切相关。需进一步加强和完善出血性脑卒中患者的吞咽困难筛查。 |
| 英文摘要: |
| Objective: To evaluate the rate of unsuccessful dysphagia screening in patients with hemorrhagic stroke, and find the relative predictors and prognosis. Methods: A retrospective analysis was done on patients with hemorrhagic stroke admitted to our department from July 2016 to July 2018, and screening for swallowing was performed using the Toronto Bedside Swallow Screening Test (TOR BSST). The relevant clinical parameters such as age, gender, body mass index (BMI), comorbidities, acute physiology and chronic health assessment (APACHE II) and Glasgow Coma Scale (GSC) were collected. The modified Rankin scale was used to assess the recovery of physical function in stroke patients. The severity of clinical symptoms was assessed according to the Canadian Neurological Function Rating Scale (CNS) and the National Institutes of Health Stroke Scale (NIHSS). The risk factors for dysphagia screening failure and the associated prognosis after screening failure were assessed. All data were analyzed using statistical software. Results: There were 49 cases of hemorrhagic stroke that met the inclusion and exclusion criteria, 37 cases in the success group and 57 cases in the un success group. The univariate analysis showed that there were significant differences between the two groups in age, language barrier, and GCS score (P<0.01, 0.05). In addition, the failure rate of screening for dysphagia was significantly higher in patients with mild and severe stroke, palliative care (P<0.05). The multivariate analysis revealed that the risk factors associated with the success of dysphagia included: age, language disorder, GCS score, stroke severity, palliative treatment regimen (P<0.05, 0.01). Conclusion: Old age, language barrier, GCS score, stroke severity and palliative care were risk factors for failure of dysphagia screening in patients with hemorrhagic stroke and were closely associated with poor prognosis. Further screening and improvement of dysphagia screening in patients with hemorrhagic stroke are needed. |
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