Long-term outcome after stroke: does dysphagia matter?
Long-term outcome after stroke: does dysphagia matter?
复制标题
DOI：
10.1093/ageing/afl149
复制
发表时间：
2007-01-01
期刊：
影响因子：
6.7
通讯作者：
Wolfe, C. D. A.
中科院分区：
文献类型：
--
作者：
Smithard, D. G.;Smeeton, N. C.;Wolfe, C. D. A.
背景：吞咽问题（吞咽困难）在急性中风后很常见，并且是短期结果的独立预测因素。目前还不确定这些吞咽问题是否与长期结果相关。目的：插入以确定急性中风第一周出现的吞咽困难是否与长期结果相关。方法：对一生中首次中风的人进行基于人群的长期随访。中风后 1 周内对吞咽困难进行评估，并在 3 个月时和每年通过面对面访谈对患者进行随访，持续 5 年。使用多项逻辑回归根据生存率和居住地来定义结果。 Barthel评分分为15-20和0-14两组，并使用多元逻辑回归建模。结果：有567名吞咽困难患者（平均年龄74.3岁）和621名安全吞咽患者（平均年龄69.6岁）。经过多项逻辑回归分析，那些在中风第一周吞咽测试失败的人更有可能住在疗养院；然而，这仅在第 3 个月（相对风险比 (RRR) = 1.73；95% 置信区间 (CI) 1.02 至 2.95）、第 4 年（RRR 3.35、1.37-8.19）和第 5 年（RRR 3.06、1.06-8.83）时达到统计显着性。仅在前三个月内，死亡率增加也存在显着相关性（RRR 2.03、1.12 至 3.67）。 结论：本研究证实，中风急性期出现吞咽困难与随后一年（尤其是 3 个月）的不良结局相关，并且与长期住院率增加相关。
Background: swallowing problems (dysphagia) are common following acute stroke and are independent predictors of short-term outcome. It is uncertain as to whether these swallowing problems are associated with outcome in the longer-term.Aim: insert to determine whether dysphagia present in the first week of acute stroke is associated with long-term outcome.Methods: a population-based long-term follow-up of people with first in a life-time stroke. Dysphagia was assessed within 1 week of stroke and patients were followed up at 3 months and yearly for 5 years by face-to-face interview. Outcome was defined by survival and place of residence, using multinomial logistic regression. Barthel Scores were divided into the two groups 15-20 and 0-14, and modelled using multiple logistic regression.Results: there were 567 patients with dysphagia (mean age 74.3 years) and 621 with a safe swallow (mean age 69.6 years). Following multinomial logistic regression, residence in a nursing home was more likely to occur in those who failed the swallow test during the first week of their stroke; however, this only reached statistical significance at 3 months (relative risk ratio (RRR) = 1.73; 95% confidence interval (CI) 1.02 to 2.95), and years 4 (RRR 3.35,1.37-8.19) and 5 (RRR 3.06,1.06-8.83). There was also a significant association with increased mortality only during the first three months (RRR 2.03, 1.12 to 3.67).Conclusion: this study confirms that the presence of dysphagia during the acute phase of stroke is associated with poor outcome during the subsequent year, particularly at 3 months, and is associated with increased institutionalisation rate in the long term.