Swallowing function after stroke - Prognosis and prognostic factors at 6 months
Swallowing function after stroke - Prognosis and prognostic factors at 6 months
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DOI：
10.1161/01.str.30.4.744
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发表时间：
1999-04-01
期刊：
影响因子：
8.3
通讯作者：
Cameron, D
中科院分区：
文献类型：
--
作者：
Mann, G;Hankey, GJ;Cameron, D
背景和目的：吞咽功能障碍（吞咽困难）是急性卒中后常见的致残性疾病，但其对潜在并发症的长期预后和吞咽功能障碍的恢复的影响仍不确定。我们的目的是前瞻性研究吞咽功能的预后在第一个6个月后急性中风，并确定重要的独立的临床和视频透视预后因素在基线与吞咽功能障碍和complications. Methods的风险增加，我们前瞻性地组装了一个初始队列的128名医院转诊的急性首次中风患者。我们采用标准化方法和诊断标准，分别在卒中发作后3天和10天内通过临床和视频透视评估吞咽功能。所有患者前瞻性随访6个月的死亡，复发性中风，胸部感染，吞咽功能的恢复，并返回到正常diet.Results-At介绍，吞咽异常检测临床65例（51%; 95%CI，42%至60%）和videofluoroscopically 82例（64%; 95%CI，55%至72%）。在随后的6个月内，26例患者（20%; 95% CI，14%-28%）发生胸部感染。在中风后6个月，112名幸存者中有97名（87%; 95%CI，79%至92%）恢复了中风前的饮食。56例患者存在吞咽异常的临床证据（50%-95% CI，40%-60%）。在6个月时，对67名基线时有吞咽异常的患者进行了视频透视检查;结果显示34名患者的假索穿透，另外17名患者出现误吸。在6个月随访期间，胸部感染的单一独立基线预测因子是吞咽反射延迟或缺失（通过视频荧光透视检测）。无法恢复正常饮食的唯一独立预测因素是延迟的口腔运输（通过视频透视检测）。吞咽功能障碍，胸部感染，或在6个月的误吸的联合结果事件的独立预测因素是videofluoroscopic证据延迟的口腔运输和渗透的对比剂进入喉vestibule. Conclusions，吞咽功能应评估所有急性中风患者，因为吞咽功能障碍是常见的，它持续在许多患者，并发症经常出现。吞咽功能的评估应该是临床和视频荧光镜。临床和视频荧光镜特征是随后吞咽异常和并发症的重要预测因素，是延迟口腔传输、延迟或缺乏吞咽反射和渗透的视频荧光镜证据。这些发现需要在其他研究中验证。
Background and Purpose-Swallowing dysfunction (dysphagia) is common and disabling after acute stroke, but its impact on long-term prognosis for potential complications and the recovery from swallowing dysfunction remain uncertain. We aimed to prospectively study the prognosis of swallowing function over the first 6 months after acute stroke and to identify the important independent clinical and videofluoroscopic prognostic factors at baseline that are associated with an increased risk of swallowing dysfunction and complications.Methods-We prospectively assembled an inception cohort of 128 hospital-referred patients with acute first stroke. We assessed swallowing function clinically and videofluoroscopically, within a median of 3 and 10 days, respectively, of stroke onset, using standardized methods and diagnostic criteria. Ail patients were followed up prospectively for 6 months for the occurrence of death, recurrent stroke, chest infection, recovery of swallowing function, and return to normal diet.Results-At presentation, a swallowing abnormality was detected clinically in 65 patients (51%; 95% CI, 42% to 60%) and videofluoroscopically in 82 patients (64%; 95% CI, 55% to 72%). During the subsequent 6 months, 26 patients (20%; 95% CI, 14% to 28%) suffered a chest infection. At 6 months after stroke, 97 of the 112 survivors (87%; 95% CI, 79% to 92%) had returned to their prestroke diet. Clinical evidence of a swallowing abnormality was present in 56 patients (50% 95% CI, 40% to 60%). Videofluoroscopy was performed at 6 months in 67 patients who had a swallowing abnormality at baseline; it showed penetration of the false cords in 34 patients and aspiration in another 17. The single independent baseline predictor of chest infection during the 6-month follow-up period was a delayed or absent swallowing reflex (detected by videofluoroscopy). The single independent predictor of failure to return to normal diet was delayed oral transit (detected by videofluoroscopy). Independent predictors of the combined outcome event of swallowing impairment, chest infection, or aspiration at 6 months were videofluoroscopic evidence of delayed oral transit and penetration of contrast into the Iaryngeal vestibule, age >70 years, and male sex.Conclusions-Swollowing function should be assessed in all acute stroke patients because swallowing dysfunction is common, it persists in many patients, and complications frequently arise. The assessment of swallowing function should be both clinical and videofluoroscopic. The clinical and videofluoroscopic features at presentation that are important predictors of subsequent swallowing abnormalities and complications are videofiuoroscopic evidence of delayed oral transit, a delayed or absent swallow reflex, and penetration. These findings require validation in other studies.