ASPIRATION AND RELATIVE RISK OF MEDICAL COMPLICATIONS FOLLOWING STROKE
ASPIRATION AND RELATIVE RISK OF MEDICAL COMPLICATIONS FOLLOWING STROKE
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DOI：
10.1001/archneur.1994.00540220099020
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发表时间：
1994-10-01
影响因子：
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通讯作者：
REDING, MJ
中科院分区：
文献类型：
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作者：
HOLAS, MA;DEPIPPO, KL;REDING, MJ
目的：确定在脑卒中亚急性期吸入性吸痰、无声吸痰、一次或多次钡剂试验时吸痰量大于或大于10%、吸入性浓稠液体或较多固体稠度的显像证据与肺炎、脱水和死亡相关的相对风险。设计：前瞻性、纵向队列研究。环境：住院中风康复病房。患者：连续114例患者符合以下标准：(1)通过临床病史和神经学检查（兼容计算机断层扫描或磁共振成像扫描）确定卒中；(2)年龄20至90岁（含）；(3)无明显口咽异常病史；(4)有吞咽困难的显像。在122名符合条件的患者中，有8人拒绝参与。主要结局指标：发生肺炎、脱水和死亡。结果：有吸痰的患者发生肺炎的相对风险是没有吸痰的患者的6.95倍（P= 0.027），无声吸痰的患者发生肺炎的相对风险是吸痰时咳嗽或不吸痰的患者的5.57倍（P= 0.012），一次或多次吞钡试验吸痰10%或以上的患者发生肺炎的相对风险是不吸痰的患者的8.36倍（P= 0.002）。结论：在脑卒中后亚急性期，吸入性、无声吸入性以及一次或多次钡剂吸入量大于或大于10%与肺炎风险增加有关，但与脱水或死亡无关。
Objective: To determine the relative risk of pneumonia, dehydration, and death associated with videofluoroscopic evidence of aspiration, silent aspiration, aspiration of 10% or greater on one or more barium test swallows, and aspiration of thick liquid or more solid consistencies in the subacute phase after stroke.Design: Prospective, longitudinal cohort study.Setting: Inpatient stroke rehabilitation unit.Patients: There were 114 consecutive patients who met the following criteria: (1) stroke as defined by clinical history and neurological examination with compatible computed tomographic or magnetic resonance imaging scan; (2) age 20 to 90 years, inclusive; (3) no known history of significant oropharyngeal anomaly, and (4) videofluoroscopic evidence of dysphagia. Of 122 eligible patients, eight refused participation.Main Outcome Measures: Development of pneumonia, dehydration, and death.Results: The relative risk for developing pneumonia was 6.95 times greater (P=.027) for those patients who aspirated compared with those who did not, 5.57 times greater (P=.012) for those who aspirated silently compared with those who coughed when aspirating or who did not aspirate, and 8.36 times greater (P=.002) for those who aspirated 10% or greater on one or more barium test swallows compared with those who aspirated less than 10% or did not aspirate.Conclusion: Aspiration, silent aspiration, and aspiration of 10% or greater on one or more barium test swallows during videofluoroscopic evaluation are associated with an increased risk of pneumonia, but not dehydration or death, during the subacute phase after stroke.