老年脑梗死隐性误吸的高危因素临床研究

Clinical Research on the Risk Factors of Hidden Aspiration in Elderly Cerebral Infarction

【目的】探讨老年脑梗死隐性误吸的高危因素与发生机制，为卒中相关性肺炎的风险评估与早期干预提供参考。【方法】2011年8月至2012年10月入选在本院神经内科住院的急性老年脑梗死患者72例，入院后24 h内完成临床吞咽功能评估，并在7 d内完成吞咽电视荧光透视检查（VFSS），通过VFSS确定患者有无误吸，记录隐性误吸发生率，分析隐性误吸与年龄、病变部位、临床吞咽异常表现的关系，分析老年脑梗死隐性误吸的高危因素。【结果】完成VFSS检查的72例患者中，误吸者32例，误吸发生率为44．4％（32/72），其中隐性误吸占13例，占误诊的40．6％（13/32）。60～65岁，66～70岁，71～75岁，76～80岁，＞80岁这五个年龄段的隐性误吸发生率分别为7．7％（1/31），15．4％（2/13），23．1％（3/13），23．1％（3/13），30．7％（4/13），年龄越大隐性误吸的发生率就越高。＞80岁患者较60～65岁患者的隐性误吸发生率有统计学差异（ P ＜0．05）。其余各年龄段无统计学差异（ P ＞0．05）。双侧多发性梗死者隐性误吸率46．6％（7/15），脑干＋小脑梗死者为40％（2/5），大脑半球＋基底节区梗死者为9．5％，前两组与大脑半球＋基底节区梗死组比较均有统计学差异（ P ＜0．01）。但前两组间的比较无统计学差异（ P ＞0．05）。【结论】急性老年脑梗死患者较容易发生隐性误吸，年龄越大的患者，双侧多发性脑梗死的老年患者发生的几率更高。

[Objective]To explore the risk factors and occurrence mechanism of hidden aspiration after elderly cerebral in-farction in order to provide the reference for risk assessment and early intervention of stroke associated pneumonia .[Methods]A total of 72 elderly inpatients with acute cerebral infarction in neurological department of our hospital from Aug .2011 to Oct . 2012 were enrolled .Clinical evaluation of swallowing function was completed within 24h after admission ,and the swallowing TV fluoroscopy（VFSS） was completed within 7d after admission .VFSS was used to confirm patients with or without aspira-tion .The incidence of hidden aspiration was recorded .The correlation of hidden aspiration with age ,lesion site and clinical swallowing abnormal appearance was analyzed .The risk factors and occurrence mechanism of hidden aspiration in senile cere-bral infarction were also analyzed .[Results] Among 72 patients completing VFSS ,32 patients were aspiration in which 13 pa-tients（40 .6% ） were hidden aspiration .The incidence of hidden aspiration was 44 .4% （32/72） .The incidence rates of hidden aspiration in patients aged 60~65 ,66~70 ,71~75 ,76~80 and over 80 years old were 7 .7% ,15 .4% ,23 .1% ,23 .1% and 30 .7% ,respectively .The incidence of hidden aspiration in patients with older age was higher .There was significant difference in incidence of aspiration between the patients aged over 80 years old groups and the patients aged 60~ 65 years old （ P 〈0 .05） .There was no significant difference among other age groups （ P〉0 .05） .The hidden aspiration rate of patients with bi-lateral multiple infarction was 46 .6% （7/15） ,and that of patients with brain stem and small cerebral infarction was 40% ,and that of patients with cerebral hemisphere and basal ganglia infarction was 9 .5% .There was significant difference in hidden as-piration rate between the first two groups and cerebral hemisphere infarction combined with basal ganglia infarction group （ P〈0 .01） ,but there was no significant difference between the first two groups （ P〉0 .05） .[Conclusion]Senile patients with acute cerebral infarction are prone to have implicit aspiration .The incidence of hidden aspiration in patients with bilateral multiple cerebral infarction and older age is higher .