115例急性脑卒中患者标准吞咽功能评估

Standardized Swallowing Assessment of Acute Stroke Patients: an Analysis of 115 Cases

目的探讨急性脑卒中患者吞咽困难的发生率、危险因素及其对预后的影响.方法对115例急性脑卒中患者在入院24 h内进行标准吞咽功能评估,了解有无吞咽困难;在住院期间行头部CT或MRI检查判定病变部位,以发病3个月和6个月时改良Rankin量表（mRS）评分作为卒中预后指标,分别对影响脑卒中患者吞咽功能和预后的危险因素进行多元Logistic回归分析.结果卒中后吞咽困难发生率为62.6%,不同病变部位之间无显著性差异（P=0.212）;多因素Logistic回归分析显示,入院时NIH-SS评分是卒中后吞咽困难的独立危险因素（OR=5.841,95%CI：1.562～21.837）,吞咽困难是3个月时卒中预后不良（mRS 3～6分）的独立危险因素（OR=5.570,95%CI：1.052～29.496）,但未显示其对6个月预后有显著性意义.结论吞咽困难是脑卒中急性期的常见问题,也是3个月预后的独立预测指标;入院时NIHSS评分是卒中后吞咽困难的独立危险因素.

Objective To investigate the incidence and risk factors of dysphagia in acute stroke patients, and its influence on prognosis. Methods 115 patients with acute stroke reeelved Standardized Swallowing Assessment （SSA） within the first 24 hours af ter admission to find out whether they had dysphagia. During period being in hospital, the patients received CT scans or MRI examinations to diagnose the sites of lesions in brain. The risk factors related to dysphagia and prognosis were analyzed by multivariate logistic regression with modified Rankin scale （MRS） scores at 3 months and 6 months as prognosis criterion. Results The incidence of post-stroke dysphagia was 62.6%, and there was no significant difference among different brain lesion sites （ P = 0. 212）. The NIHSS score was the independent risk factor of post-stroke dysphagia （ OR = 5. 841, 95%CI： 1. 562-21. 837）, and post-stroke dysphagia was the independent risk factor of poor outcome at 3 months （ OR = 5. 570,95 % CI： 1. 052-29. 496） in the multivariate logistic regression analysis. But dysphagia was not correlated significantly with poor outcome at 6 months in multivariate logistic regression analysis, Conclusion Dysphagia is a common problem in acute stroke patients and an independent predictor for prognosis at 3 months. NIHSS score is an independent risk factor of post stroke dysphagia.