西安地区伴吞咽障碍老年急性脑梗死患者的临床特征及对住院结局的影响

Clinical characteristics of acute cerebral infarction complicated by dysphagia in elderly patients and the effect of dysphagia on in-patient outcome in Xi′an area

目的探讨西安地区伴吞咽障碍老年急性脑梗死患者的临床特征以及吞咽障碍对院内结局的影响。方法通过西安卒中登记研究,纳入西安市4所三级甲等医院收治的1116例老年急性脑梗死患者,根据入院24 h内洼田饮水试验评分分为吞咽良好组(1~2级)1004例和吞咽障碍组(3~5级)112例,比较分析2组的基线临床特征。采用多因素Logistic回归模型分析发生吞咽障碍对老年急性脑梗死患者院内结局(卒中相关性肺炎、肠外营养和预后不良)的影响。结果与吞咽良好组相比,吞咽障碍组患者的年龄较大,心房颤动比例、入院美国国立卫生研究院卒中量表评分、入院48 h不能行走比例较高,入院心率和空腹血糖、血尿素氮、白细胞计数水平较高(P<0.05)。吞咽障碍组院内卒中相关性肺炎发生率、肠外营养率以及预后不良率均高于吞咽良好组(26.8%vs.4.0%,11.6%vs.1.9%,46.4%vs.17.8%,P<0.001)。校正相关混杂因素后,多因素Logistic回归分析显示,发生吞咽障碍的老年急性脑梗死患者院内卒中相关性肺炎风险(OR=3.835,95%CI:2.005~7.335,P<0.001)及肠外营养概率(OR=4.909,95%CI:1.991~12.102,P<0.001)显著升高。结论西安地区伴吞咽障碍老年急性脑梗死患者院内卒中相关性肺炎风险和肠外营养概率显著升高,需引起临床医师关注和早期应对。

Objective To investigate the clinical characteristics of acute cerebral infarction(ACI)complicated by dysphagia in elderly patients and the effect of dysphagia on in-hospital outcome in Xi′an area.Methods By means of stroke registration study in Xi′an area,a total of 1116 elderly patients with ACI admitted to four first-class tertiary hospitals in Xi′an were included.According to the score of water swallowing test within 24 h after admission,they were divided into good swallowing group(grade 1-2)(n=1004)and dysphagia group(grade 3-5)(n=112).The baseline clinical characteristics of the two groups were compared.Multivariate Logistic regression model was used to analyze the impact of dysphagia on in-hospital outcomes[stroke-associated pneumonia(SAP),parenteral nutrition and poor prognosis]of elderly patients with ACI complicated by dysphagia.Results Compared with good swallowing group,patients in the dysphagia group were older,and had a higher proportion of atrial fibrillation,national institute of health stroke scale score on admission,and inability to walk within 48h after admission,as well as a higher admission heart rate,fasting blood glucose,blood urea nitrogen,and white blood cell levels(P<0.05).The rate of in-hospital SAP,parenteral nutrition and poor prognosis of dysphagia group were all higher than those of good swallowing group(26.8%vs.4.0%,11.6%vs.1.9%,46.4%vs.17.8%,P<0.001).After adjusting for related confusions,multivariate Logistic regression analysis showed that the risk of in-hospital SAP(OR=3.835,95%CI:2.005-7.335,P<0.001)and probability of parenteral nutrition(OR=4.909,95%CI:1.991-12.102,P<0.001)in elderly ACI patients with dysphagia were significantly increased.Conclusion The risk of in-hospital SAP and probability of parenteral nutrition of elderly ACI patients with dysphagia were significantly increased in Xi'an area.Therefore,it is necessary to arouse the attention and early response of clinicians.