缺血性脑卒中后吞咽障碍患者经口摄食功能发展轨迹及影响因素分析

Development trajectory of oral intake function in patients with post-stroke dysphagia and its influencing factors

目的探讨脑卒中后吞咽障碍患者经口摄食功能的潜在类别,并分析其影响因素,为个性化康复护理措施提供参考。方法便利选取广东省4所三级医院神经内科的缺血性脑卒中后吞咽障碍患者393例,采用一般资料调查表、经口摄食功能评估量表进行调查。潜类别增长分析模型识别经口摄食功能变化轨迹的潜在类别后,采用无序多分类Logistic回归分析其影响因素。结果患者的经口摄食功能变化轨迹可分为低风险稳定组(25.6%)、高风险下降组(51.1%)、高风险稳定组(23.3%)。多分类Logistic回归分析结果显示,不同经口摄食功能类别的患者在年龄、美国国立卫生院卒中量表评分、管饲时长、院外照护机构上差异具有统计学意义(P<0.05)。结论脑卒中后吞咽障碍患者经口摄食功能分为3种变化轨迹,存在群体异质性,应根据患者经口摄食功能的变化轨迹采取针对性的康复护理干预。

Objective To explore the latent categories and influencing factors of oral intake function in patients with post-stroke dysphagia,and to provide reference for individualized rehabilitation nursing intervention.Methods Convenience sampling was used to select 393 patients with post-stroke dysphagia in four tertiary grade-A hospitals,and the patients were surveyed by using general information questionnaire and National Institutes of Health Stroke Scale.The latent category growth analysis model was used to identify the potential categories of oral intake function,and its influencing factors were analyzed by multinomial logistic regression.Results Three distinct trajectories were identified as“low risk of stable group”(25.6%),“high risk of stable group”(51.1%),and“high risk of decreasing group”(23.3%).Multinomial logistic regression analysis showed that there were significant differences in age,National Institutes of Health Stroke Scale score,length of tube feeding,and out-of-hospital care institutions among different categories(P<0.05).Conclusion There are 3 trajectories of oral intake function in patients with post-stroke dysphagia,and there is group heterogeneity in their oral intake function.Individualized rehabilitation nursing intervention should be taken according to the trajectory of patients’oral intake function.