影响急性脑卒中后吞咽障碍预后的因素

Analysis of the related factors influencing dysphagia prognosis after acute stroke

目的探讨影响脑卒中后吞咽障碍（dysphagiaafterstroke，DAS）预后的因素，为优化DAS的管理提供指导。方法选择经标准吞咽评估（StandardizedSwallowingAssessments，SSA）确诊的196例DAS患者，详细记录入院时的年龄、性别、是否有糖尿病史、高血压病史、卒中史、是否为脑干卒中、卒中病灶大小、卒中病灶是否多发、巴塞指数（Barthelindex，BI）、NIH卒中量表（NIHStrokeScale，NIHSS）评分、血糖、高敏C反应蛋白（high—sensitivity C—reactiveprotein，CRP）、血浆纤维蛋白原浓度（bloodplasmafibrinogendensity，Fib）、低密度脂蛋白（10W～densitylipoprotein，LDL）。6个月后，按洼田饮水试验量表评定标准将患者分为预后良好与预后不良两组。以上述因素为自变量，以预后是否良好为因变量进行多因素分析。结果年龄≥70岁、BI≤30、LDL≥3mg／L与DAS预后密切相关，差异具有统计学意义（P〈0．05）。结论DAS患者入院时的临床资料可以协助判断吞咽障碍的预后。年龄≥70岁、BI≤30、LDL≥3mg／L，是DAS患者吞咽功能预后不良的独立危险因素。

Objective To explore related factors influencing dysphagia prognosis after acute stroke in order to provide effective methods for management of dysphagia after stroke （DAS）. Methods 196 DAS patients diagnosed according to Standardized Swallowing Assessments （SSA） were enrolled in this study. The admission data of 196 DAS patients were registered in 14 items such as the age, sex, the previous positive/negative diabetes, stroke history, NIH Stroke Scale （NIHSS） Score and Barthel index （BI）, etc. After 6 months, the patients were divided into two groups （poor prognosis group and well prognosis group） by Wa Tian drinking water test scale. The correlations between the DAS prognosis and 14 factors were analyzed using multiple logistic regression analysis. Results Age≥70, LDL≥3 mg/L and BI≤30 were intimately related with DAS prognosis （P〈0. 05）. Conclusions Data gathered at admission from patients with DAS can help predict the prognosis of dysphagia. Age≥70, LDL≥3 mg/L and BI≤30 were independently risk factors for poor prognosis of DAS.