Kirshblum S, Johnston M V, Brown J, O'Connor K C, Jarosz P
Spinal Cord Injury Services, Kessler Institute for Rehabilitation, and Outcomes Research, West Orange, NJ, USA.
Arch Phys Med Rehabil. 1999 Sep;80(9):1101-5. doi: 10.1016/s0003-9993(99)90068-0.
To quantify the incidence of swallowing deficits (dysphagia) and to identify factors that predict risk for dysphagia in the rehabilitation setting following acute traumatic spinal cord injury.
Retrospective case-control study.
Freestanding rehabilitation hospital.
Data were collected on 187 patients with acute traumatic spinal cord injury admitted for rehabilitation over a 4-year period who underwent a swallowing screen, in which 42 underwent a videofluoroscopic swallowing study (VFSS).
VFSS was performed on patients with suspected swallowing problems. Possible antecedents of dysphagia were recorded from the medical record including previous history of spine surgery, surgical approach and technique, tracheostomy and ventilator status, neurologic level of injury, ASIA Impairment Classification, orthosis, etiology of injury, age, and gender.
On admission to rehabilitation 22.5% (n = 42) of spinal cord injury patients had symptoms suggesting dysphagia. In 73.8% (n = 31) of these cases, testing confirmed dysphagia (aspiration or requiring a modified diet), while VFSS ruled out dysphagia in 26.2% (n = 11) cases. Logistic regression and other analyses revealed three significant predictors of risk for dysphagia: age (p < .028), tracheostomy and mechanical ventilation (p < .001), and spinal surgery via an anterior cervical approach (p < .016). Other variables analyzed had no relation or at best a slight relation to dysphagia. Tracheostomy at admission was the strongest predictor of dysphagia. The combination of tracheostomy at rehabilitation admission and anterior surgical approach had an extremely high rate of dysphagia (48%).
Swallowing abnormalities are present in a significant percentage of patients presenting to rehabilitation with acute traumatic cervical spinal cord injury. Patients with a tracheostomy appear to have a substantially increased risk of development of dysphagia, although other factors are also relevant. Risk of dysphagia should be evaluated to decrease the potential for morbidity related to swallowing abnormalities.
量化吞咽功能障碍（吞咽困难）的发生率，并确定急性创伤性脊髓损伤后康复环境中吞咽困难风险的预测因素。
回顾性病例对照研究。
独立康复医院。
收集了187例急性创伤性脊髓损伤患者的数据，这些患者在4年期间入院接受康复治疗，并进行了吞咽筛查，其中42例接受了视频荧光吞咽造影检查（VFSS）。
对疑似吞咽问题的患者进行VFSS检查。从病历中记录吞咽困难的可能诱因，包括既往脊柱手术史、手术入路和技术、气管切开术和呼吸机状态、神经损伤平面、美国脊髓损伤协会（ASIA）损伤分级、矫形器、损伤病因、年龄和性别。
在康复入院时，22.5%（n = 42）的脊髓损伤患者有提示吞咽困难的症状。在这些病例中，73.8%（n = 31）经检查确诊为吞咽困难（有误吸或需要调整饮食），而VFSS排除了26.2%（n = 11）病例的吞咽困难。逻辑回归和其他分析揭示了吞咽困难风险的三个重要预测因素：年龄（p < .028）、气管切开术和机械通气（p < .001）以及经颈前路的脊柱手术（p < .016）。分析的其他变量与吞咽困难无关或至多有轻微关联。入院时气管切开术是吞咽困难最强的预测因素。康复入院时气管切开术和前路手术相结合的患者吞咽困难发生率极高（48%）。
在因急性创伤性颈脊髓损伤而接受康复治疗的患者中，相当比例存在吞咽异常。气管切开术患者发生吞咽困难的风险似乎大幅增加，尽管其他因素也与之相关。应评估吞咽困难风险，以降低与吞咽异常相关的发病可能性。
