The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke
The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke
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DOI：
10.1016/j.jcomdis.2013.04.001
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发表时间：
2013-05-01
影响因子：
1.7
通讯作者：
Martino, Rosemary
中科院分区：
文献类型：
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作者：
Flowers, Heather L.;Silver, Frank L.;Martino, Rosemary
中风后经常出现吞咽困难、构音障碍和失语症。我们的目的是确定首次缺血性中风后这些损伤的发生率、同时发生和预测因素。我们使用来自一个中风中心的加拿大中风网络数据库登记处（2003-2008 年）随机抽取了 250 名经 MR 成像证实的急性缺血性中风患者样本。我们进一步进行了回顾性病历审查。我们建立了可靠的数据采集并确定了三种缺陷的存在。我们得出了吞咽困难、构音障碍和失语症的发病率和共现估计值以及 95% 置信区间 (Cl)。然后，我们通过逻辑回归计算优势比 (OR) 来识别预测变量。二十九名患者病历无法供审查。吞咽困难、构音障碍和失语的发生率估计分别为 44% (95% CI, 38-51)、42% (95% CI, 35-48) 和 30% (95% CI, 25-37)。对于同时存在吞咽困难和构音障碍的任何两种损伤，同时发生率最高为 28%（95% Cl，23-34）。所有 221 名患者中的 10% 都存在这三种损伤。最高的预测因子是吞咽困难的非警戒意识水平（OR 2.6，CI 1.03-6.5）、构音障碍的虚弱症状（OR 5.3，CI 2.4-12.0）和失语的右侧症状（OR 7.1，CI 3.1-16.6）。这些发现是确定同质中风样本中多种并发损伤的发生率和预测因素的第一步。 学习成果： 学习成果：读者将能够 (1) 认识到中风研究的必要性，根据中风病因和复发模式报告结果，(2) 确定首次急性缺血性中风后吞咽困难、构音障碍和失语症的发生率和同时发生，以及 (3) 描述临床这些损伤是中风急性期的先兆。 (C) 2013 Elsevier Inc. 保留所有权利。
Dysphagia, dysarthria and aphasia occur frequently following stroke. Our purpose was to identify the incidence, co-occurrence, and predictors of these impairments after first-ever ischemic stroke. We used the Registry of the Canadian Stroke Network's database (2003-2008) from one stroke center to identify a random sample of 250 patients with acute ischemic stroke confirmed by MR imaging. We further conducted a retrospective medical chart review. We established reliable data capture and identified the presence of the three impairments. We derived incidence and co-occurrence estimates along with 95% confidence intervals (Cl) for dysphagia, dysarthria, and aphasia. We then computed odds ratios (OR) through logistic regression to identify predictors. Twenty-nine patient charts were not available for review. Estimates of the incidence of dysphagia, dysarthria, and aphasia were 44% (95% CI, 38-51), 42% (95% CI, 35-48) and 30% (95% CI, 25-37), respectively. The highest co-occurrence of any two impairments was 28% (95% Cl, 23-34) for the presence of both dysphagia and dysarthria. Ten percent of all 221 patients had all three impairments. The highest predictors were non-alert level of consciousness for dysphagia (OR 2.6, CI 1.03-6.5), symptoms of weakness for dysarthria (OR 5.3, CI 2.4-12.0), and right-sided symptoms for aphasia (OR 7.1, CI 3.1-16.6). These findings are a first step toward identifying the incidence and predictors of multiple co-occurring impairments in a homogenous stroke sample.Learning outcomes: Learning outcomes: Readers will be able to (1) RECOGNIZE the need for research in stroke, whereby outcomes are reported according to stroke etiology and recurrence patterns, (2) identify the incidence and co-occurrence of dysphagia, dysarthria, and aphasia after a first-ever acute ischemic stroke, and (3) describe clinical precursors of these impairments in the acute stage of stroke. (C) 2013 Elsevier Inc. All rights reserved.