脑卒中吞咽障碍康复结局的影响因素

Factors Related with Outcome of Dysphagia after Stroke

目的探讨影响脑卒中后吞咽障碍康复的因素。方法回顾性分析脑卒中后吞咽障碍患者。将患者分为假性球麻痹组(n=296)和真性球麻痹组(n=82)。吞咽功能结局采用电视透视吞咽检查(VFSS)确定。采用Logistic回归分析发病年龄,性别,入院时体质量指数(BMI)、美国国立卫生研究院卒中量表(NIHSS)评分、简式Fug-Meyer运动评分(FMA)、改良Barthel指数(MBI),住院期间有无气管插管、有无误吸,住院时间,吞咽功能训练开始时间对吞咽功能结局的影响。结果发病年龄、NIHSS评分、有无气管插管、误吸、吞咽功能训练开始时间是两组患者吞咽功能不良的危险因素,MBI是假性球麻痹患者吞咽功能的保护因素。结论发病年龄越小、病情越轻、无气管插管、无误吸、吞咽功能训练开始时间越早,越有利于吞咽功能的恢复,MBI评分越高越有利于假性球麻痹患者的吞咽功能恢复。

Objective To investigate the factors related with swallowing function after stroke. Methods Stroke patients with dysphagia were reviewed, 296 cases with pseudobulbar paralysis, and 82 cases with bulbar paralysis. Swallowing function was evaluated with videoflu-oroscopic swallowing study （VFSS）. The variable of age, sex, Body Mass Index （BMI）, scores of National Institutes of Health Stroke Scale （NIHSS）, Simplified Fug-Meyer Assessment （FMA） and modified Barthel Index （MBI）, intubation, aspiration, length of hospitalization （LOH）, and initiation of rehabilitation intervention were analyzed with Logistic regression. Results Age, NIHSS score, intubation, aspira-tion, initiation of rehabilitation intervention were the risk factors for poor outcome of swallowing function in all the patients, while the score of MBI was the protective factor for the pseudobulbar paralysis ones. Conclusion The younger the patients, the less the NIHSS score, no in-tubation, no aspiration, and the earlier the rehabilitation intervened, the more independent the pseudobulbar paralysis patients, the better swallowing function recovered.