Oropharyngeal Dysphagia after Stroke: Incidence, Diagnosis, and Clinical Predictors in Patients Admitted to a Neurorehabilitation Unit
Oropharyngeal Dysphagia after Stroke: Incidence, Diagnosis, and Clinical Predictors in Patients Admitted to a Neurorehabilitation Unit
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DOI：
10.1016/j.jstrokecerebrovasdis.2009.01.009
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发表时间：
2009-09-01
影响因子：
2.5
通讯作者：
Lenzi, Lucia
中科院分区：
文献类型：
--
作者：
Falsetti, Paolo;Acciai, Caterina;Lenzi, Lucia
目的：我们分析了神经康复科的卒中患者，以确定吞咽困难的发生率，比较临床床边评估和视频透视（VFS），并确定吞咽困难与患者临床特征之间的任何相关性。方法：共纳入151例近期缺血性或出血性卒中的连续住院患者。结果：151例患者中有62例（41%）临床诊断为吞咽困难。共有49例患者（79%的临床吞咽困难患者）接受了VFS。6例临床提示吞咽困难的患者VFS结果正常。吞咽困难的临床诊断与VFS诊断有显著相关性（r = 0.6505）。分别在42.8%和26.5%的吞咽困难患者中观察到穿透和吸入，其中12.2%被归类为无症状。5.9%的患者观察到下呼吸道感染，吞咽困难患者更常见（30%）。吞咽困难不受卒中类型的影响。非优势侧皮质卒中与吞咽困难相关（P = 0.0322），皮质下非优势侧卒中显示吞咽困难的频率降低（P = 0.0008）。既往脑血管疾病导致吞咽困难（P = .0399）。吞咽困难患者入院时功能独立性和认知功能水平显著降低，出院时功能独立性和认知功能水平显著降低，住院时间较长，营养不良发生率较高，失语和构音障碍发生率较高。151例患者中有18例（11.9%）（41.8%的VFS证实的吞咽困难患者）使用了经皮内镜胃造口术。结论：吞咽困难发生在超过三分之一的脑卒中康复患者中。临床评估显示与VFS具有良好的相关性。吞咽困难的程度与构音障碍、失语症、低吞咽能力和认知功能水平相关。非优势侧的大面积皮质卒中与吞咽困难相关。
Objective: We analyzed patients with stroke in a neurorehabilitation unit to define incidence of dysphagia, compare clinical bedside assessment and videofluoroscopy (VFS), and define any correlation between dysphagia and clinical characteristic of patients. Methods: In all, 151 consecutive inpatients with recent ischemic or hemorrhagic stroke were enrolled. Results: Dysphagia was clinically diagnosed in 62 of 151 patients (41%). A total of 49 patients (79% of clinically dysphagic patients) underwent VFS. Six patients clinically suggested to be dysphagic had a normal VFS finding. The correlation between clinical and VFS diagnosis of dysphagia was significant (r = 0.6505). Penetrations and aspirations were observed, respectively, in 42.8% and 26.5%, of patients with dysphagia, with 12.2% classified as silent. Lower respiratory tract infections were observed in 5.9%, more frequently in patients with dysphagia (30%). Dysphagia was not influenced by type of stroke. Cortical stroke of nondominant side was associated with dysphagia (P = .0322) and subcortical nondominant stroke showed a reduced frequency of dysphagia (P = .0008). Previous cerebrovascular disease resulted associated to dysphagia (P = .0399). Patients with dysphagia had significantly lower functional independence measurement (FIM) and level of cognitive functioning on admission and lower FIM on discharge, longer hospital stay, and more frequent malnutrition, and they were more frequently aphasic and dysarthric. Percutaneous endoscopic gastrostomy was used in 18 of 151 patients (11.9%) (41.8% of patients with VFS-proved dysphagia). Conclusions: Dysphagia occurs in more than a third of patients with stroke admitted to rehabilitation. Clinical assessment demonstrates good correlation with VFS. The grade of dysphagia correlates with dysarthria, aphasia, low FIM, and level of cognitive functioning. Large cortical strokes of nondominant side are associated with dysphagia.