影响脑卒中后吞咽障碍患者预后的相关因素分析

Analysis of the prognostic factors of post-stroke dysphagia

目的 探讨可影响脑卒中后吞咽障碍患者预后的相关因素 ,以便为是否需要对该类患者作进一步处理 (如使用静脉营养、鼻饲或手术治疗 )提供康复临床参考。方法 选择经过规范康复治疗的吞咽障碍患者 ,记录入院时年龄、性别、病变部位、症状、体征和吞咽障碍的评定项目 ,分别使用 2 检验和多元逐步回归方程进行单因素及多因素相关性分析。结果 单因素资料分析显示 ,下列因素为吞咽障碍预后不良的危险因素 ,如入院时年龄 >70岁 (P <0 .0 1 ) ,Barthel指数 <60 (P <0 .0 1 ) ,大面积脑卒中或多部位脑卒中、脑干卒中、双侧卒中 (P <0 .0 1 ) ,合并中枢性面瘫 (P >0 .0 5) ,咽反射减弱或消失 (P >0 .0 1 )。这些患者经治疗后症状改善不明显 ,预后较差 ;而性别 (P >0 .0 5)、文化程度 (P >0 .0 5)等与不良预后关系不大。多因素logistic回归分析显示 ,吞咽障碍预后与入院时年龄、Barthel指数、脑卒中部位及程度等密切相关。

Objective To explore factors that may influence prognosis of stroke patients with dysphagia. Methods Fifty six stroke inpatients with dysphagia who had received formal rehabilitation training were enrolled in this study. The data such as age, gender, lesion location, complications, symptoms and signs at admission were collected. These data were analyzed retrospectively by  2 test and multiple logistic regression method. Results The result showed that risk factors which might influence the prognosis of these patients were the older age (>70) ( P <0.01), Barthel index<60( P <0.01), facial paralysis ( P <0.05), poor pharyngeal reflex ( P <0.01), and diplegia ( P <0.01). Multiple logistic regression analysis demonstrated that the prognosis of the patient was closely related to age of the patient, location of lesions, and Barthel index score at admission. Conclusion Standardized retrospective study of outcome clearly demonstrated that information gathered at admission from patients with stroke can help predict the prognosis of the patient.