The Multidisciplinary Swallowing Team Approach Decreases Pneumonia Onset in Acute Stroke Patients.
The Multidisciplinary Swallowing Team Approach Decreases Pneumonia Onset in Acute Stroke Patients.
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DOI：
10.1371/journal.pone.0154608
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Hiroshima University Hospital Stroke Swallowing Team
中科院分区：
文献类型：
--
作者：
Aoki S;Hosomi N;Hirayama J;Nakamori M;Yoshikawa M;Nezu T;Kubo S;Nagano Y;Nagao A;Yamane N;Nishikawa Y;Takamoto M;Ueno H;Ochi K;Maruyama H;Yamamoto H;Matsumoto M;Hiroshima University Hospital Stroke Swallowing Team
吞咽困难在急性脑卒中患者中发生率很高，其中许多人发展为吸入性肺炎。利用各专业人员的专业知识和技能，团队合作的方法有能力提高医疗保健的质量。我院组织了多学科参与式吞咽小组。本研究的目的是通过比较组队前后急性脑卒中患者的肺炎发生率，阐明组队治疗对吞咽困难的影响。对2009年4月至2014年3月在我院连续住院的急性脑卒中患者进行登记。我们分析了组队前（前期）和组队后（后期）肺炎发病率的差异。采用Cox比例风险模型进行单因素和多因素分析，以确定肺炎的预测因素。我们招募了132名急性脑卒中患者和173名急性脑卒中后患者。术后肺炎发生率较术前低（6.9% vs. 15.9%, p = 0.01）。基于Cox比例风险模型的多变量分析，确定吞咽小组方法与入院时美国国立卫生研究院卒中量表评分无关的肺炎发病相关（校正风险比0.41,95%置信区间0.19-0.84,p = 0.02）。多学科参与吞咽小组有效降低急性脑卒中患者肺炎发病。
Dysphagia occurs in acute stroke patients at high rates, and many of them develop aspiration pneumonia. Team approaches with the cooperation of various professionals have the power to improve the quality of medical care, utilizing the specialized knowledge and skills of each professional. In our hospital, a multidisciplinary participatory swallowing team was organized. The aim of this study was to clarify the influence of a team approach on dysphagia by comparing the rates of pneumonia in acute stroke patients prior to and post team organization. All consecutive acute stroke patients who were admitted to our hospital between April 2009 and March 2014 were registered. We analyzed the difference in the rate of pneumonia onset between the periods before team organization (prior period) and after team organization (post period). Univariate and multivariate analyses were performed using a Cox proportional hazards model to determine the predictors of pneumonia. We recruited 132 acute stroke patients from the prior period and 173 patients from the post period. Pneumonia onset was less frequent in the post period compared with the prior period (6.9% vs. 15.9%, respectively; p = 0.01). Based on a multivariate analysis using a Cox proportional hazards model, it was determined that a swallowing team approach was related to pneumonia onset independent from the National Institutes of Health Stroke Scale score on admission (adjusted hazard ratio 0.41, 95% confidence interval 0.19–0.84, p = 0.02). The multidisciplinary participatory swallowing team effectively decreased the pneumonia onset in acute stroke patients.