急性缺血性脑卒中患者系统使用 Gugging 吞咽筛查的影响。

Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke.

机构信息

Neurology Department, Hospital de Braga, Braga.

Neurology Department, Unidade Local de Saúdo do Alto Minho, Viana do Castelo.

出版信息

Eur J Neurol. 2019 May;26(5):722-726. doi: 10.1111/ene.13825. Epub 2018 Oct 26.

DOI:10.1111/ene.13825

PMID:30298612

Abstract

BACKGROUND AND PURPOSE

Post-stroke dysphagia occurs in up to three quarters of patients with acute stroke and is associated with a higher risk of respiratory infections and poor outcome. Systematic screening of dysphagia in the acute stroke unit is essential to identify patients at risk of aspiration and to provide dietary recommendations. Our study aimed to assess the impact of the systematic application of the Gugging Swallowing Screen (GUSS) in patients with acute ischaemic stroke.

METHODS

This was a retrospective study of consecutive patients with acute ischaemic stroke admitted to an acute stroke unit in two time periods: pre-GUSS (February 2014-July 2015), when the 10-mL water-swallowing test was systematically administered, and GUSS (August 2015-October 2016), when the GUSS test was systematically administered. Groups were compared with regard to baseline and stroke characteristics, and the occurrence of stroke-associated pneumonia (SAP), in-hospital death and 3-month outcome.

RESULTS

Of the 344 patients who were included in the study (median age 71 years), 51.7% were male with a median National Institutes of Health Stroke Scale score of 11. A total of 204 patients were included during the pre-GUSS period and 140 during the GUSS period. Patients in the GUSS period more frequently had diabetes and partial anterior circulation syndromes, and were more frequently treated with thrombectomy. There was no difference in the occurrence of SAP between the two groups (pre-GUSS, 12.5%; GUSS, 15.1%; P = 0.490) and no differences were found concerning in-hospital mortality (P = 0.996), 3-month functional independence (P = 0.647) or 3-month mortality (P = 0.598).

CONCLUSIONS

The systematic administration of GUSS in a population of patients with acute ischaemic stroke did not reduce the occurrence of SAP, mortality or 3-month functional dependence when compared with the systematic administration of the 10-mL water-swallowing test.

摘要

背景与目的

卒中后吞咽困难（post-stroke dysphagia）在多达四分之三的急性卒中患者中发生，并与更高的呼吸道感染风险和较差的预后相关。在急性卒中单元中对吞咽困难进行系统筛查对于识别有吸入风险的患者并提供饮食建议至关重要。我们的研究旨在评估在急性缺血性卒中患者中系统应用 Gugging 吞咽筛查（Gugging Swallowing Screen，GUSS）的效果。

方法

这是一项回顾性研究，纳入了连续在两个时间段入住急性卒中单元的急性缺血性卒中患者：在 GUSS 之前（2014 年 2 月至 2015 年 7 月），系统进行 10 毫升水吞咽测试；在 GUSS 期间（2015 年 8 月至 2016 年 10 月），系统进行 GUSS 测试。比较两组患者的基线和卒中特征、卒中相关性肺炎（stroke-associated pneumonia，SAP）、住院死亡率和 3 个月结局。

结果

本研究纳入了 344 例患者（中位年龄 71 岁），其中 51.7%为男性，美国国立卫生研究院卒中量表评分中位数为 11 分。204 例患者在 GUSS 之前期间纳入，140 例在 GUSS 期间纳入。GUSS 期间的患者更常患有糖尿病和部分前循环综合征，更常接受血栓切除术治疗。两组 SAP 的发生率无差异（GUSS 之前期间，12.5%；GUSS 期间，15.1%；P=0.490），住院死亡率（P=0.996）、3 个月功能独立性（P=0.647）或 3 个月死亡率（P=0.598）也无差异。