老年脑梗死患者吞咽功能与呼吸肌肌力及吸入性肺炎的发生关系研究

Study on the relationship between swallowing function,respiratory muscle strength and aspiration pneumonia in elderly patients with cerebral infarction

目的 研究老年脑梗死患者吞咽功能与呼吸肌力及吸入性肺炎发生的相关性。方法 选取华中科技大学同济医学院附属同济医院2019年4月—2021年4月收治的142例老年脑梗死患者为研究对象(研究组),另选取95例同时期来本院进行体检的健康志愿者为对照组。采用视频吞咽造影功能障碍量表(VDS)和标准吞咽功能评价量表(SSA)评估受试者吞咽功能,检测受试者患者呼吸肌肌力,并比较对照组与研究组吞咽功能与呼吸肌肌力情况。研究组患者根据住院期间是否发生吸入性肺炎分为发生组和未发生组,比较发生组与未发生组吞咽功能、呼吸肌肌力指标及其他因素。采用Logistic回归分析影响老年脑梗死患者发生吸入性肺炎的危险因素,绘制受试者工作特征(ROC)曲线分析吞咽功能指标对老年脑梗死患者发生吸入性肺炎的预测价值。采用spearman相关性分析分析患者吞咽功能与呼吸肌肌力指标及吸入性肺炎发生的相关性。结果 研究组VDS、SSA评分水平高于对照组(P<0.05),最大呼气压(MEP)、最大吸气压(MIP)水平低于对照组(P<0.05)。发生组VDS、SSA、入院NIHSS评分水平高于未发生组(P<0.05),MEP、MIP水平低于未发生组(P<0.05)。Logistic回归分析显示VDS、SSA、MEP、MIP、入院NIHSS评分均是影响老年脑梗死患者发生吸入性肺炎的危险因素(P<0.05)。ROC曲线分析显示,VDS、SSA评分联合预测老年脑梗死患者发生吸入性肺炎的灵敏度、AUC分别为92.16%、0.836均高于VDS、SSA评分单独预测(P<0.05)。Spearman相关性分析显示VDS评分与MEP、MIP水平成呈负相关(r=-0.537、-0.546,P<0.05);SSA评分与MEP、MIP水平成呈负相关(r=-0.558、-0.569,P<0.05)。VDS评分与老年脑梗死患者吸入性肺炎的发生率呈正相关(r=0.572,P<0.05);SSA评分与老年脑梗死患者吸入性肺炎的发生率呈正相关(r=0.586,P<0.05)。结论 老年脑梗死患者吞咽功能较差,VDS、SSA评分与呼吸肌力关系密切,因此可通过改善患者呼吸肌力情况改善患者吞咽功能。另外VDS、SSA评分是导致老年脑梗死发生吸入性肺炎的危险因素,对老年脑梗死发生吸入性肺炎的发生率具有较高的预测价值,且二者联合检测预测价值更高。

Objective To study the correlation between swallowing function and respiratory muscle strength and occurrence of aspiration pneumonia in elderly patients with cerebral infarction.Methods A total of 142 elderly patients with cerebral infarction admitted to our hospital from April 2019 to April 2021 were selected as the research objects(study group),and 95 healthy volunteers who came to our hospital for physical examination during the same period were selected as the control group.The swallowing function of the subjects was evaluated by video swallowing angiography dysfunction scale(VDS)and standard swallowing function evaluation scale(SSA),the respiratory muscle strength of the subjects was detected,and the swallowing function and respiratory muscle strength of the control group and the study group were compared.Patients in the study group were divided into the occurrence group and the non occurrence group according to whether inhalation pneumonia occurred during hospitalization.The swallowing function,respiratory muscle strength and other factors were compared between the occurrence group and the non occurrence group.Logistic regression analysis was used to analyze the risk factors of aspiration pneumonia in elderly patients with cerebral infarction,draw the receiver operating characteristic(ROC)curve,and analyze the predictive value of swallowing function index on aspiration pneumonia in elderly patients with cerebral infarction.Spearman correlation analysis was used to analyze the correlation between swallowing function and respiratory muscle strength indexes and the occurrence of aspiration pneumonia.Results The levels of VDS and SSA in the study group were higher than those in the control group(P<0.05),and the levels of maximum expiratory pressure(MEP)and maximum inspiratory pressure(MIP)were lower than those in the control group(P<0.05).The scores of VDS,SSA and NIHSS in the occurrence group were higher than those in the non occurrence group(P<0.05),and the levels of MEP and MIP were lower than those in the non occurrence group(P<0.05).Logistic regression analysis showed that VDS,SSA,MEP,MIP and NIHSS scores were the risk factors of aspiration pneumonia in elderly patients with cerebral infarction(P<0.05).ROC curve analysis showed that the sensitivity and AUC of VDS and SSA scores combined in predicting aspiration pneumonia in elderly patients with cerebral infarction were 92.16%and 0.836 respectively,which were higher than those predicted by VDS and SSA scores alone(P<0.05).Spearman correlation analysis showed that VDS score was negatively correlated with MEP and MIP levels(r=-0.537,-0.546,P<0.05).SSA score was negatively correlated with MEP and MIP levels(r=-0.558,-0.569,P<0.05).VDS score was positively correlated with the incidence of aspiration pneumonia in elderly patients with cerebral infarction(r=0.572,P<0.05).SSA score was positively correlated with the incidence of aspiration pneumonia in elderly patients with cerebral infarction(r=0.586,P<0.05).Conclusion Elderly patients with cerebral infarction have poor swallowing function,and VDS and SSA scores are closely related to respiratory muscle strength.Therefore,the swallowing function of patients can be improved by improving the respiratory muscle strength of patients.In addition,VDS and SSA scores are risk factors for the occurrence of aspiration pneumonia in elderly cerebral infarction,and have higher predictive value for the incidence of aspiration pneumonia in elderly cerebral infarction,and the combined detection of the two has higher predictive value.