Szu Li-Yun, Hsieh Suh-Ing, Tseng Su-Mei, Huang Tzu-Hsin
Department of Nursing, Taoyuan Chang Gung Memorial Hospital, and Doctoral Student, School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan, ROC.
Department of Nursing, Chang Gung University of Science and Technology, and Associate Researcher, Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taiwan, ROC.
Hu Li Za Zhi. 2017 Jun;64(3):43-55. doi: 10.6224/JN.000039.
Stroke was the third leading cause of death in Taiwan in 2014. A study found that 53.61% of stroke patients suffered from dysphagia disorder during the rehabilitation phase, which may result in lung aspiration and death. The determinants of dysphagia among nationally hospitalized-rehabilitation stroke patients have not been explored comprehensively.
To explore the incidence of dysphagia among hospitalized-rehabilitation stroke patients and the related determinants of dysphagia.
This descriptive and correlational research design employed a convenience sample of 130 hospitalized stroke patients from rehabilitation wards at a northern regional hospital in Taiwan. A questionnaire and functional assessment were used to collect data. Instruments used included personal and clinical characteristics data questionnaire, the National Institute of Health Stroke Scale (NIHSS), Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Standardization Swallowing Assessment (SSA), and Acute Stroke Dysphagia Screening (ASDS). Data analyses contained descriptive statistics and logistic regression.
The incidence of stroke dysphagia was 63.8% (SSA) and 64.6% (ASDS), respectively. Age, marital status, stroke site, stroke severity (NIHSS), and cognitive status (MMSE) were identified as significant determinants of dysphagia in bivariate logistic regression, whereas stroke severity and cognitive status were identified as significant independent determinants of dysphagia in multivariate logistic regression.
CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Two-thirds of the participant sample were affected by dysphagia, for which NIHSS and cognitive status were identified as significant determinants. Thus, nurses may conduct early screening for high risk populations based on patients' clinical characteristics in order to reduce aspiration pneumonia problems and to improve the quality of clinical care for dysphagia patients.
2014年，中风是台湾地区第三大死因。一项研究发现，53.61%的中风患者在康复阶段患有吞咽障碍，这可能导致肺部误吸和死亡。全国范围内住院康复的中风患者吞咽困难的决定因素尚未得到全面探讨。
探讨住院康复中风患者吞咽困难的发生率及其相关决定因素。
本描述性和相关性研究设计采用便利抽样法，选取了台湾北部一家地区医院康复病房的130名住院中风患者。通过问卷调查和功能评估收集数据。使用的工具包括个人和临床特征数据问卷、美国国立卫生研究院卒中量表（NIHSS）、巴氏指数、简易精神状态检查表（MMSE）、老年抑郁量表（GDS）、标准化吞咽评估（SSA）和急性中风吞咽困难筛查（ASDS）。数据分析包括描述性统计和逻辑回归。
中风吞咽困难的发生率分别为63.8%（SSA）和64.6%（ASDS）。在二元逻辑回归中，年龄、婚姻状况、中风部位、中风严重程度（NIHSS）和认知状态（MMSE）被确定为吞咽困难的重要决定因素，而在多元逻辑回归中，中风严重程度和认知状态被确定为吞咽困难的重要独立决定因素。
结论/实践意义：三分之二的样本参与者受吞咽困难影响，其中NIHSS和认知状态被确定为重要决定因素。因此，护士可根据患者的临床特征对高危人群进行早期筛查，以减少误吸性肺炎问题，提高吞咽困难患者的临床护理质量。
