脑卒中后面瘫临床探讨

A clinical study on facial palsy after stroke

目的探讨卒中后面瘫(facial palsy after stroke,FPS)的临床特点,以提高对FPS的重视程度。方法选择2015年3月—6月住院的脑卒中患者,入院后48 h内完成改良House-Braekmann量表(Modified House-Braekmann,MHBN)面神经功能评定、Barthel指数(Barthel Index,BI)评分、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、标准吞咽评估量表评定以及患者健康抑郁问卷(Patient Health Questionnaire-9,PHQ-9)评定。根据MHBN评定结果将纳入患者分为FPS组和无FPS组,比较两组患者吞咽障碍、抑郁的发生率,以及BI、NIHSS和PHQ-9评分。在患者发病6个月后,采用改良Rankin量表比较两组患者的预后。结果共纳入129例卒中患者,FPS组81例(62.8%),无FPS组48例(37.2%)。FPS组吞咽障碍发生率(64.2%)和抑郁发生率(59.3%)高于无FPS组(22.9%、18.8%),BI评分[(41.79±14.19)分]低于无FPS组[(66.39±19.96)分],但NIHSS、PHQ-9评分[(11.23±4.62)、(11.54±3.43)分]高于无FPS组[(7.54±3.69)、(7.67±2.89)分],差异均有统计学意义(P<0.05)。6个月后,FPS组预后良好率(32.9%)低于无FPS组(67.4%),差异有统计学意义(P<0.001)。结论卒中患者FPS发生率较高,FPS患者吞咽障碍、抑郁的发生率高,FPS影响卒中患者预后,临床中应高度重视FPS的治疗。

Objective To investigate the clinical characteristics of facial palsy after stroke （FPS） in order to enhance the understanding of FPS. Methods Patients with stroke and admitted to hospital from March to June 2015 were selected in this study. They were evaluated by Modified House-Braekmann （MHBN）, Barthel Index （BI）, National Institute of Health Stroke Scale （NIHSS）, Standardized Swallowing Assessment and Patient Health Questionnaire-9 （PHQ-9） within 48 hours after admitting. According to the MHBN scores, the patients were divided into FPS group and non-FPS group, and the incidences of dysphagia and depression, and the scores of BI, NIHSS, and PHQ-9 were compared between the two group. Six months later, the patients＇ prognosis of stroke was assessed by the Modified Rankin Scale. Results A total of 129 patients were enrolled in this study, including 81 （62.8%） with FPS, and 48 （37.2%） without FPS. The incidences of dysphagia and depression in the FPS group （64.2%, 59.3%） were higher than those in the non-FPS group （22.9%, 18.8%）, and the differences were statistically significant （P〈0.05）. The BI, NIHSS, PHQ-9 scores in the FPS group were 41.79±14.19, 11.23±4.62, 11.54±3.43, respectively, while the scores in the non-FPS group were 66.39±19.96, 7.54±3.69, 7.67±2.89, respectively; the differences in the scores between the two groups were statistically significant （P〈0.05）. Six months later, the patients＇ prognosis in the non-FPS group was better than that in the FPS group （67.4%vs. 32.9%, P〈0.001）. Conclusions There is a high incidence of FPS, and there are high incidences of dysphagia and depression in the FPS patients with stroke. FPS influences the patients＇ prognosis, so the understanding and treatment of FPS should be enhanced.