孤立性脑桥梗死合并吞咽障碍的临床影响因素分析

Analysis of clinical factors related to isolated pontine infarction patients with dysphagia

目的探讨孤立性脑桥梗死(IPD)合并吞咽障碍的影响因素和临床结局。方法去回顾性分析2021年1月至2022年6月在苏州市立医院神经内科住院的IPI患者128例,所有患者入院后24h内进行吞咽功能检查,并记录入院美国国立卫生研究院卒中量表(NIHSS)评分和出院改良Rankin量表(mRS)评分。将患者按是否有吞咽功能障碍分为吞咽障碍组与无吞咽障碍组,通过单因素分析(X^(2)检验、t检验和U检验)比较患者一般临床资料、IPI梗死侧别、临床结局的差异。通过多因素Logistic回归分析IPI患者吞咽障碍的影响因素。结果128例患者中吞咽障碍组患者42例(32.8%),无吞咽障碍组患者86例(67.2%)。吞咽障碍组与无吞咽障碍组的年龄[(72.95±9.91)岁vs(67.05±11.60)岁]、糖尿病比例(64.29%vs39.53%)、基线NIHSS评分[8.0(4.0,12.0)分vs1.0(0.0,2.0)分]、双侧IPI比例(30.95%vs 2.32%)相比,差异均具有统计学意义(f=-2.832,P=0.005;X^(2)=5.671,P=0.023;Z=-6.150,P<0.001;X^(2)=22.178,P<0.001)。吞咽障碍组患者出院不良结局(mRS评分≥3分)比例较无吞咽障碍组高(80.95%vs60.47%),差异具有统计学意义(X^(2)=5.373,P=0.015)。多因素Logistic回归分析显示,年龄(OR=1.059,95%CI:1.003~1.118,P=0.037)、基线高NIHSS评分(OR=1.487,95%CI:1.222~1.810,P<0.001)为吞咽障碍的独立危险因素。结论年龄、基线NIHSS评分高是IPI患者吞咽障碍的独立预测因子,吞咽障碍组患者出院不良结局比例高。

Objective To study the clinical data and imaging characteristics of isolated pontine infarction(IPI)complicated with neurogenic dysphagia,analyze the influencing factors,and compare the clinical outcomes.Methods A total of 128 patients with IPI hospitalized in the Department of Neurology of Suzhou Municipal Hospital from January 2021 to June 2022 were retrospectively analyzed.All patients underwent clinical testing for dysphagia after IPI within 24 hours of admission.Their initial National Institutes of Health stroke scale(NIHSS)score at admission and modified Rankin scale(mRS)score at discharge were recorded.All patients were divided into two groups:dysphagia group and non-dysphagia group.The diferences of general clinical data,bilateral IPI and clinical outcomes were compared by univariate analysis(chi-square test,t test and U test).The influencing factors of dysphagia in IPI patients were analyzed by multivariate Logistic regression.Results Among the 128 patients,42 cases(32.8%)were in the dysphagia group and 86 cases(67.2%)were in the non-dysphagia group.Compared the two groups,there were statistically significant differences in age[(72.95±9.91)years vs(67.05±11.60)years;t=-2.832,P=0.005],diabetes rate(64.29%vs 39.53%;X^(2)=5.671,P=0.023),baseline NIHSS score[8.0(4.0,12.0)score vs 1.0(0.0,2.0)score;Z=-6.150,P<0.001)on admission,and proportion of bilateral IPI(30.95%vs 2.32%;X^(2)=22.178,P<0.001).The proportion of adverse outcomes(mRS score≥3 points)in the dysphagia group was greater than that in the non-dysphagia group,and the difference was statistically significant(80.95%vs 60.47%,X^(2)=5.373,P=0.015).Multivariate logistic regression analysis showed that age(OR=1.059,95%CI:1.003-1.118,P=0.037)and baseline NIHSS score(OR=1.487,95%CI:1.222-1.810,P<0.001)were independent risk factors for dysphagia.ConclusionAge and high baseline NIHSS score were identified as predictors of dysphagia in patients with IPI.The dysphagia group had a higher proportion of adverse outcomes.