蛛网膜下腔出血后发生吞咽困难的危险因素研究

Risk factors of dysphagia after spontaneous subarachnoid hemorrhage and its relationship with neurological outcomes

目的探究自发性蛛网膜下腔出血(SAH)患者吞咽困难的发生率及其早期预测因素。方法以2015年2月~2019年10月华北理工大学附属医院神经外科收治的250例自发性SAH患者为研究对象,入院后收集患者人口学等临床资料,评估Hunt-Hess分级、脑部CT的Fisher分级。发病7 d时采用洼田饮水试验评估患者的吞咽功能,分析研究吞咽困难的危险因素。结果250例SAH患者中86例(34.4%)患者发生吞咽困难,其中62例(72%)为重度吞咽困难。多因素Logistic回归分析显示,入院时Hunt-HessⅣ和Ⅴ级[OR(95%CI):2.02(1.03~3.96),P=0.040]、有动脉瘤[OR(95%CI):3.48(1.22~9.92),P=0.019]、脑实质性出血[OR(95%CI):2.55(1.17~5.53),P=0.018]、插管时间>48 h[OR(95%CI):19.2(6.18~59.8),P<0.001]是SAH患者发生吞咽困难的独立危险因素。结论自发性SAH患者具有较高的吞咽困难发生率。对于Hunt-HessⅣ和Ⅴ级、入院CT显示脑上有实质血肿、因脑积水行脑室外引流、有动脉瘤和插管时间>24 h的患者,应给予早期的预防性干预。

Objective To investigate the incidence of dysphagia and its early predictors in patients with spontaneous subarachnoid hemorrhage(SAH)and to assess the correlation between dysphagia and neurological outcome.Methods A total of 250 patients with spontaneous SAH admitted to our hospital from February 2015 to October 2019 were included.The swallowing function of the patients was assessed using the Wada drinking test,and the functional outcome 3 months after SAH was assessed by the modified Rankin Scale(mRS score).Results In the 250 patients with SAH,86(34.4%)were dysphagia,and 62(72%)were severe dysphagia.Multivariate logistic regression analysis showed that Hunt-Hess grade IV and V[OR(95%CI):2.02(1.03-3.96),P=0.040],presence of aneurysm[OR(95%CI):3.48(1.22-9.92),P=0.019],parenchymal hemorrhage[OR(95%CI):2.55(1.17-5.53),P=0.018],and intubation time>48 hours[OR(95%CI):19.2(6.18-59.8),P<0.001]at admission were independent risk factors for dysphagia in the SAH patients.There was an association between the dysphagia and poor function(univariate OR(95%CI):3.10(1.49-6.39),P<0.002).Conclusion The patients with spontaneous SAH have a high incidence of dysphagia,which correlates with neurological outcome.Early preventive intervention should be given to the patients with Hunt Hess grade IV and V,parenchymal hematoma on admission CT,external ventricular drainage for hydrocephalus,aneurysm,and intubation time>24 hours.