Arreola Viridiana, Vilardell Natàlia, Ortega Omar, Rofes Laia, Muriana Desiree, Palomeras Ernest, Álvarez-Berdugo Daniel, Clavé Pere
Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, 08036 Barcelona, Spain.
Geriatrics (Basel). 2019 Jul 9;4(3):42. doi: 10.3390/geriatrics4030042.
Oropharyngeal dysphagia is a prevalent complication following stroke (PS-OD), and one that is sometimes spontaneously recovered. This study describes the natural history of PS-OD between admission and three months post-stroke, and the factors associated with its prevalence and development. PS-OD was assessed with the volume-viscosity swallow test (V-VST) in all stroke patients on admission and at the three-month follow-up. We analyzed clinical, demographic, and neuroanatomical factors of 247 older post-stroke patients (National Institute of Health Stroke Scale (NIHSS) = 3.5 ± 3.8), comparing among those with PS-OD the ones with and without spontaneous recovery. PS-OD prevalence on admission was 39.7% (34.0% impaired safety; 30.8%, efficacy) and 41.7% (19.4% impaired safety; 39.3%, efficacy) at three months. Spontaneous swallow recovery occurred in 42.4% of patients with unsafe and in 29.9% with ineffective swallow, associated with younger age and optimal functional status. However, 26% of post-stroke patients developed new signs/symptoms of ineffective swallow related to poor functional, nutritional and health status, and institutionalization. PS-OD prevalence on admission and at the three-month follow-up was very high in the study population. PS-OD is a dynamic condition with some spontaneous recovery in patients with optimal functional status, but also new signs/symptoms can appear due to poor functionality. Regular PS-OD monitoring is needed to identify patients at risk of nutritional and respiratory complications.
口咽吞咽困难是中风后的一种常见并发症（PS-OD），有些情况会自发恢复。本研究描述了中风入院至中风后三个月期间PS-OD的自然病程，以及与其患病率和发展相关的因素。在所有中风患者入院时和三个月随访时，采用容量-黏度吞咽试验（V-VST）评估PS-OD。我们分析了247例老年中风后患者（美国国立卫生研究院卒中量表（NIHSS）=3.5±3.8）的临床、人口统计学和神经解剖学因素，比较了有PS-OD的患者中自发恢复和未自发恢复的患者。入院时PS-OD患病率为39.7%（安全性受损34.0%；有效性30.8%），三个月时为41.7%（安全性受损19.4%；有效性39.3%）。42.4%吞咽不安全的患者和29.9%吞咽无效的患者出现了吞咽自发恢复，这与年龄较小和最佳功能状态有关。然而，26%的中风后患者出现了与功能、营养和健康状况不佳以及机构化相关的吞咽无效新体征/症状。在研究人群中，入院时和三个月随访时PS-OD患病率非常高。PS-OD是一种动态情况，功能状态最佳的患者会有一些自发恢复，但功能不佳也可能出现新的体征/症状。需要定期监测PS-OD，以识别有营养和呼吸并发症风险的患者。
