Saito Tsukasa, Hayashi Keisuke, Nakazawa Hajime, Yagihashi Fumika, Oikawa Leo O, Ota Tetsuo
Department of Physical Medicine and Rehabilitation, Asahikawa Medical University Hospital, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
Department of Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Asahikawa, Japan.
Dysphagia. 2018 Apr;33(2):258-265. doi: 10.1007/s00455-017-9855-6. Epub 2017 Oct 11.
Dysphagia and malnutrition seem to be associated, but little research in detail has been reported. We aimed to clarify the association between dysphagia and malnutrition by adopting accurate diagnosis and mathematical evaluation of dysphagia using videofluorography and nutritional assessment calculated by a well-established nutritional risk index. We conducted a retrospective analysis of 165 enrolled patients who were admitted to our hospital for acute diseases and underwent videofluorography on suspicion of dysphagia in the year 2016. We diagnosed high-risk dysphagia in patients with 8-point penetration-aspiration scale (PAS) score over 4. We used the geriatric nutritional risk index (GNRI) as a nutritional assessment tool. A GNRI score less than 91.2 corresponds to malnutrition. The median age of 165 enrolled patients was 76.0, and the number of female patients was 53. The mean GNRI was 81.2, and 134 patients (81.2%) had malnutrition. The number of the patients with a diagnosis of high-risk dysphagia was 54 (32.7%). The GNRI of patients with high-risk dysphagia was significantly less than that of patients without (mean value 77.7 ± 10.5 vs. 83.0 ± 10.5, P = 0.003). GNRI < 91.2 was independently and significantly associated with high-risk dysphagia (OR 3.094; CI 1.057-9.058; P = 0.039). Based on the current study, the authors propose evaluating nutritional status to predict dysphagia risk of patients in the acute phase.
吞咽困难与营养不良似乎有关联,但详细的研究报道较少。我们旨在通过采用视频荧光造影对吞咽困难进行准确诊断和数学评估,以及通过成熟的营养风险指数计算进行营养评估,来阐明吞咽困难与营养不良之间的关联。我们对2016年因急性疾病入院且因疑似吞咽困难接受视频荧光造影的165例登记患者进行了回顾性分析。我们将穿透 - 误吸量表(PAS)评分超过4分的患者诊断为高危吞咽困难。我们使用老年营养风险指数(GNRI)作为营养评估工具。GNRI评分低于91.2对应营养不良。165例登记患者的中位年龄为76.0岁,女性患者有53例。平均GNRI为81.2,134例患者(81.2%)存在营养不良。诊断为高危吞咽困难的患者有54例(32.7%)。高危吞咽困难患者的GNRI显著低于无高危吞咽困难的患者(平均值77.7±10.5 vs. 83.0±10.5,P = 0.003)。GNRI < 91.2与高危吞咽困难独立且显著相关(OR 3.094;CI 1.057 - 9.058;P = 0.039)。基于当前研究,作者建议评估营养状况以预测急性期患者的吞咽困难风险。