Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward
Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward
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DOI：
10.1016/j.jstrokecerebrovasdis.2016.12.005
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发表时间：
2017-05-01
影响因子：
2.5
通讯作者：
Katsuki, Yasuo
中科院分区：
文献类型：
--
作者：
Ikenaga, Yasunori;Nakayama, Sayaka;Katsuki, Yasuo
背景：经皮内窥镜胃造口术可用于吞咽困难的中风患者。然而，一些患者无需胃造口术即可恢复完全口服摄入。本研究旨在调查摄入量的预测因素，从而确定胃造口术的适应症。方法：2009年至2015年入住我们康复康复病房并接受胃造口术或鼻胃管置入术的中风幸存者根据出院时的摄入情况分为两组。对入院时的人口统计数据和功能独立测量（FIM）、吞咽困难严重程度（DSS）、美国国立卫生研究院卒中量表和格拉斯哥昏迷量表（GCS）评分进行比较。我们使用逐步逻辑回归分析评估了预测摄入量的因素。结果：34 名患者恢复摄入，而 38 名患者摄入不完全。完全摄入组的平均年龄较低，平均体重指数（BMI）较高，并且从卒中发病到入院的平均时间较短。完全摄入组在 GCS、FIM 和 DSS 评分方面的损害较小。在逐步逻辑回归分析中，BMI、FIM 认知评分和 DSS 评分是预测摄入量的显着独立因素。 BMI x.26 + FIM 认知评分 x.19 + DSS 评分 x 1.60 的公式预测完全摄入恢复，敏感性为 88.2%，特异性为 84.2%。结论：患有吞咽困难的中风幸存者，BMI、FIM 认知和 DSS 评分较高，倾向于恢复口腔摄入量。
Background: Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. Method: Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. Results: Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI x.26 + FIM cognitive score x.19 + DSS score x 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. Conclusions: Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake.