摘要
目的研究老年脑卒中后吞咽障碍与卒中相关性肺炎(SAP)的相关性。方法前瞻性纳入邯郸市中心医院神经内一科自2020年3月至2021年1月收治的161例老年脑卒中患者作为研究对象,根据入院24 h行洼田饮水试验的结果分为2组,49例无吞咽障碍的患者为无吞咽困难组,112例伴有吞咽障碍的患者为吞咽障碍组。再根据吞咽障碍严重程度将吞咽障碍组分为3个亚组,其中轻度组43例、中度组38例、重度组31例。比较各组患者的SAP发生率、发生时间及预后,采用Pearson分析吞咽障碍程度与SAP的发生及发生时间的相关性,采用Logistic回归分析吞咽障碍对SAP发生的影响。结果吞咽障碍组与无吞咽困难组患者假性球麻痹、糖尿病、既往肺部疾病史、脑卒中部位构成比较,差异均无统计学意义(P>0.05)。重度组、中度组、轻度组和无吞咽困难组的SAP发生率、发生时间以及SAP发生时的APACHEⅡ评分、平均治疗时间、受累肺叶数、死亡率比较,差异均有统计学意义(P<0.05)。吞咽障碍程度与SAP的发生时间呈负相关(r=-0.407,P=0.038),与SAP的发生呈正相关(r=0.328,P=0.043)。Logistic回归分析显示,吞咽障碍是SAP发生的危险因素(OR=2.719,95%CI:1.152~7.483,P<0.05)。结论吞咽障碍是老年脑卒中患者SAP发生的危险因素,且吞咽障碍严重程度与SAP的发生呈正相关,与SAP的发生时间呈负相关。SAP会显著影响患者的预后,建议应重视老年脑卒中患者吞咽障碍的防治,以降低SAP的发生率。
Objective To investigate the association between dysphagia and stroke-associated pneumonia(SAP)after stroke in the elderly.Methods A prospective study was conducted on 161 elderly stroke patients admitted to the First Neurology Department of Handan Central Hospital from March 2020 to January 2021.They were divided into two groups based on the results of water swallow test after 24 h of admission,with 49 patients without dysphagia as the non-dysphagia group and 112 patients with dysphagia as the dysphagia group.According to the severity of dysphagia,the dysphagia group were divided into three subgroups,with 43 cases in the mild group,38 cases in the moderate group,and 31 cases in the severe group.The incidence,occurrence time and prognosis of SAP were compared among three subgroups.Pearson analysis was used to analyze the correlation between the degree of dysphagia and the occurrence and occurrence time of SAP.Logistic regression was used to analyze the influence of dysphagia on the occurrence of SAP.Results There were no significant differences in pseudobulbar palsy,diabetes,history of pulmonary disease and stroke site composition between the dysphagia group and the non-dysphagia group(P>0.05).There were significant differences in incidence,occurrence time,APACHEⅡscore,mean treatment time,number of affected lung lobes and mortality of SAP among severe,moderate,mild and non-dysphagia groups(all P<0.05).The degree of dysphagia was negatively correlated with the occurrence time of SAP(r=-0.407,P=0.038),it was positively correlated with SAP occurrence(r=0.328,P=0.043).Logistic regression analysis showed that dysphagia was a risk factor for SAP(OR=2.719,95%CI:1.152-7.483,P<0.05).Conclusion Dysphagia is a high risk factor for the occurrence of SAP in stroke patients,and the severity of dysphagia is positively correlated with the incidence of SAP,and negatively correlated with the occurrence time of SAP.SAP will significantly affect the prognosis of patients.It is suggested that attention should be paid to the prevent
作者
尤素伟
You Suwei(First Department of Neurology,Handan Central Hospital,Handan 056001,China)
出处
《中华脑科疾病与康复杂志（电子版）》
2023年第3期150-155,共6页
Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）
基金
河北省卫生厅科研计划项目(20171143)。
