Masiero Stefano, Pierobon Roberta, Previato Chiara, Gomiero Elisa
Department of Rehabilitation, University of Padova, Padova, Italy.
Neurol Sci. 2008 Jun;29(3):139-45. doi: 10.1007/s10072-008-0925-2. Epub 2008 Jul 9.
The aim of the study was to estimate the frequency of pneumonia and to determine the risk factors for this complication in poststroke patients with oropharyngeal dysphagia (OD). We prospectively followed up 67 patients (mean age 72.9+/-12.2 years) in the first 6 months after stroke, during which time we recorded gender, stroke side, type of lesion, diabetes, history of chronic obstructive pulmonary disease (COPD), smoking, level of consciousness, functional outcome, dietary history, occurrence of chest infection, and death. Degree of OD and presence/absence of reflex cough was assessed by Fiberoptic Endoscopic Evaluation of Swallowing. Sixty patients showed complete recovery of prestroke swallowing; 9 (13.4% IC 95%=5-20%) developed pneumonia, two of whom died. The first episode of pneumonia occurred in all nine patients within the first month after stroke onset. The pneumonia was associated with absence of reflex cough after swallow, COPD, and severe impairment of consciousness and poor functional outcome.
本研究的目的是评估肺炎的发生率，并确定伴有口咽吞咽困难（OD）的中风后患者发生这种并发症的危险因素。我们对67例中风后前6个月的患者（平均年龄72.9±12.2岁）进行了前瞻性随访，在此期间记录了性别、中风部位、病变类型、糖尿病、慢性阻塞性肺疾病（COPD）病史、吸烟情况、意识水平、功能结局、饮食史、胸部感染的发生情况和死亡情况。通过纤维内镜吞咽功能评估来评估OD的程度以及是否存在反射性咳嗽。60例患者中风前吞咽功能完全恢复；9例（13.4%，95%置信区间=5-20%）发生肺炎，其中2例死亡。所有9例患者的首次肺炎发作均发生在中风发作后的第一个月内。肺炎与吞咽后无反射性咳嗽、COPD以及意识严重障碍和功能结局差有关。
