Falsetti Paolo, Acciai Caterina, Palilla Rosanna, Bosi Marco, Carpinteri Francesco, Zingarelli Alberto, Pedace Claudio, Lenzi Lucia
Neurorehabilitation, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy.
J Stroke Cerebrovasc Dis. 2009 Sep-Oct;18(5):329-35. doi: 10.1016/j.jstrokecerebrovasdis.2009.01.009.
We analyzed patients with stroke in a neurorehabilitation unit to define incidence of dysphagia, compare clinical bedside assessment and videofluoroscopy (VFS), and define any correlation between dysphagia and clinical characteristic of patients.
In all, 151 consecutive inpatients with recent ischemic or hemorrhagic stroke were enrolled.
Dysphagia was clinically diagnosed in 62 of 151 patients (41%). A total of 49 patients (79% of clinically dysphagic patients) underwent VFS. Six patients clinically suggested to be dysphagic had a normal VFS finding. The correlation between clinical and VFS diagnosis of dysphagia was significant (r = 0.6505). Penetrations and aspirations were observed, respectively, in 42.8% and 26.5% of patients with dysphagia, with 12.2% classified as silent. Lower respiratory tract infections were observed in 5.9%, more frequently in patients with dysphagia (30%). Dysphagia was not influenced by type of stroke. Cortical stroke of nondominant side was associated with dysphagia (P = .0322) and subcortical nondominant stroke showed a reduced frequency of dysphagia (P = .0008). Previous cerebrovascular disease resulted associated to dysphagia (P = .0399). Patients with dysphagia had significantly lower functional independence measurement (FIM) and level of cognitive functioning on admission and lower FIM on discharge, longer hospital stay, and more frequent malnutrition, and they were more frequently aphasic and dysarthric. Percutaneous endoscopic gastrostomy was used in 18 of 151 patients (11.9%) (41.8% of patients with VFS-proved dysphagia).
Dysphagia occurs in more than a third of patients with stroke admitted to rehabilitation. Clinical assessment demonstrates good correlation with VFS. The grade of dysphagia correlates with dysarthria, aphasia, low FIM, and level of cognitive functioning. Large cortical strokes of nondominant side are associated with dysphagia.
我们对神经康复科的中风患者进行分析，以确定吞咽困难的发生率，比较临床床旁评估和视频荧光吞咽造影检查（VFS），并确定吞咽困难与患者临床特征之间的相关性。
共纳入151例近期发生缺血性或出血性中风的连续住院患者。
151例患者中有62例（41%）临床诊断为吞咽困难。共有49例患者（占临床诊断为吞咽困难患者的79%）接受了视频荧光吞咽造影检查。6例临床提示吞咽困难的患者视频荧光吞咽造影检查结果正常。吞咽困难的临床诊断与视频荧光吞咽造影检查诊断之间存在显著相关性（r = 0.6505）。在吞咽困难患者中，分别有42.8%和26.5%的患者观察到食物误咽和误吸，其中12.2%为隐性误吸。5.9%的患者发生下呼吸道感染，吞咽困难患者中更常见（30%）。吞咽困难不受中风类型的影响。非优势侧皮质中风与吞咽困难相关（P = 0.0322），非优势侧皮质下中风吞咽困难发生率降低（P = 0.0008）。既往脑血管疾病与吞咽困难相关（P = 0.0399）。吞咽困难患者入院时的功能独立性测量（FIM）和认知功能水平显著较低，出院时FIM较低住院时间较长，营养不良更常见，且失语和构音障碍更频繁。151例患者中有18例（11.9%）使用了经皮内镜下胃造口术（占视频荧光吞咽造影检查证实为吞咽困难患者的41.8%）。
在康复科住院的中风患者中，超过三分之一的患者存在吞咽困难。临床评估与视频荧光吞咽造影检查显示出良好的相关性。吞咽困难的程度与构音障碍、失语、低FIM和认知功能水平相关。非优势侧大面积皮质中风与吞咽困难相关。
