Stroke Unit, Department of Medicine for the Elderly, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norfolk NR4 7TJ, United Kingdom.
J Am Geriatr Soc. 2009 Nov;57(11):2101-6. doi: 10.1111/j.1532-5415.2009.02526.x.
To examine the effect of dysphasia and dysphagia on stroke outcome.
Retrospective database study.
Norfolk, United Kingdom.
Two thousand nine hundred eighty-three men and women with stroke admitted to the hospital between 1997 and 2001.
Inpatient mortality and likelihood of longer length of hospital stay, defined as longer than median length of stay (LOS). Dysphagia was defined as difficulty swallowing any liquid (including saliva) or solid material. Dysphasia was defined as speech disorders in which there was impairment of the power of expression by speech, writing, or signs or impairment of the power of comprehension of spoken or written language. An experienced team assessed dysphagia and dysphasia using explicit criteria.
Two thousand nine hundred eighty-three patients (1,330 (44.6%) male), median age 78 (range 17-105), were included, of whom 77.7% had ischemic, 10.5% had hemorrhagic, and 11.8% had undetermined stroke types. Dysphasia was present in 41.2% (1,230) and dysphagia in 50.5% (1,506), and 27.7% (827) had both conditions. Having either or both conditions was associated with greater mortality and longer LOS (P<.001 for all). Using multiple logistic regression models controlling for age, sex, premorbid Rankin score, previous disabling stroke, and stroke type, corresponding odds ratios for death and longer LOS were 2.2 (95% confidence interval (CI)=1.8-2.7) and 1.4 (95% CI=1.2-1.6) for dysphasia; 12.5 (95% CI=8.9-17.3) and 3.9 (95% CI=3.3-4.6) for dysphagia, 5.5 (95% CI=3.7-8.2), 1.9 (95% CI=1.6-2.3) for either, and 13.8 (95% CI=9.4-20.4) and 3.7 (95% CI=3.1-4.6) if they had both, versus having no dysphasia, no dysphagia, or none of these conditions, respectively.
Patients with dysphagia have worse outcome in terms of inpatient mortality and length of hospital stay than those with dysphasia. When both conditions are present, the presence of dysphagia appears to determine the likelihood of poor outcome. Whether this effect is related just to stroke severity or results from problems related directly to dysphagia is unclear.
探讨构音障碍和吞咽困难对卒中结局的影响。
回顾性数据库研究。
英国诺福克。
1997 年至 2001 年间住院的 2983 名男性和女性卒中患者。
住院死亡率和较长住院时间（定义为长于中位数住院时间（ LOS ））的可能性。吞咽困难定义为吞咽任何液体（包括唾液）或固体物质有困难。构音障碍定义为言语障碍，表现为言语、书写或手势表达能力受损，或理解口语或书面语言的能力受损。一个经验丰富的团队使用明确的标准评估吞咽困难和构音障碍。
共纳入 2983 例患者（1330 例男性（44.6%），中位年龄 78 岁（范围 17-105 岁）），其中 77.7%为缺血性卒中，10.5%为出血性卒中，11.8%为未确定类型的卒中。41.2%（1230 例）存在构音障碍，50.5%（1506 例）存在吞咽困难，27.7%（827 例）同时存在两种情况。存在一种或两种情况与死亡率和 LOS 延长相关（所有 P<.001）。使用多变量逻辑回归模型，控制年龄、性别、发病前 Rankin 评分、既往致残性卒中以及卒中类型，构音障碍的死亡和 LOS 延长的相应比值比为 2.2（95%置信区间（CI）=1.8-2.7）和 1.4（95% CI=1.2-1.6）；吞咽困难为 12.5（95% CI=8.9-17.3）和 3.9（95% CI=3.3-4.6），两者兼有为 5.5（95% CI=3.7-8.2）和 1.9（95% CI=1.6-2.3），两种情况均有则为 13.8（95% CI=9.4-20.4）和 3.7（95% CI=3.1-4.6），而无构音障碍、无吞咽困难或无上述任何情况的患者分别作为对照。
与存在构音障碍、吞咽困难或无上述任何情况的患者相比，存在吞咽困难的患者住院死亡率和住院时间均较差。当两种情况同时存在时，吞咽困难的存在似乎决定了不良预后的可能性。这种影响是否仅与卒中严重程度有关，还是与直接与吞咽困难相关的问题有关尚不清楚。
