Keser Tobias, Kofler Mario, Katzmayr Mariella, Schiefecker Alois J, Rass Verena, Ianosi Bogdan A, Lindner Anna, Gaasch Maxime, Beer Ronny, Rhomberg Paul, Schmutzhard Erich, Pfausler Bettina, Helbok Raimund
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Medical Informatics, UMIT - University for Health Sciences, Hall in Tirol, Austria.
Neurocrit Care. 2020 Aug;33(1):132-139. doi: 10.1007/s12028-019-00874-6.
Despite the tremendous impact of swallowing disorders on outcome following ischemic stroke, little is known about the incidence of dysphagia after subarachnoid hemorrhage (SAH) and its contribution to hospital complications, length of intensive care unit stay, and functional outcome.
This is a retrospective analysis of an ongoing prospective cohort study. Swallowing ability was assessed in consecutive non-traumatic SAH patients admitted to our neurological intensive care unit using the Bogenhausen Dysphagia Score (BODS). A BODS > 2 points indicated dysphagia. Functional outcome was assessed 3 months after the SAH using the modified Rankin Scale with a score > 2 defined as poor functional outcome.
Two-hundred and fifty consecutive SAH patients comprising all clinical severity grades with a median age of 57 years (interquartile range 47-67) were eligible for analysis. Dysphagia was diagnosed in 86 patients (34.4%). Factors independently associated with the development of dysphagia were poor clinical grade on admission (Hunt & Hess grades 4-5), SAH-associated parenchymal hematoma, hydrocephalus, detection of an aneurysm, and prolonged mechanical ventilation (> 48 h). Dysphagia was independently associated with a higher rate of pneumonia (OR = 4.32, 95% CI = 2.35-7.93), blood stream infection (OR = 4.3, 95% CI = 2.0-9.4), longer ICU stay [14 (8-21) days versus 29.5 (23-45) days, p < 0.001], and poor functional outcome after 3 months (OR = 3.10, 95% CI = 1.49-6.39).
Dysphagia is a frequent complication of non-traumatic SAH and associated with poor functional outcome, infectious complications, and prolonged stay in the intensive care unit. Early identification of high-risk patients is needed to timely stratify individual patients for dysphagia treatment.
尽管吞咽障碍对缺血性中风后的预后有巨大影响，但关于蛛网膜下腔出血（SAH）后吞咽困难的发生率及其对医院并发症、重症监护病房住院时间和功能预后的影响知之甚少。
这是一项对正在进行的前瞻性队列研究的回顾性分析。使用博根豪森吞咽困难评分（BODS）对入住我们神经重症监护病房的连续非创伤性SAH患者的吞咽能力进行评估。BODS>2分表示吞咽困难。SAH后3个月使用改良Rankin量表评估功能预后，评分>2定义为功能预后不良。
连续250例SAH患者，包括所有临床严重程度等级，中位年龄57岁（四分位间距47 - 67岁），符合分析条件。86例患者（34.4%）被诊断为吞咽困难。与吞咽困难发生独立相关的因素包括入院时临床分级差（Hunt & Hess分级4 - 5级）、SAH相关的脑实质血肿、脑积水、动脉瘤的发现以及机械通气时间延长（>48小时）。吞咽困难与较高的肺炎发生率（OR = 4.32，95%CI = 2.35 - 7.93）、血流感染（OR = 4.3，95%CI = 2.0 - 9.4）、更长的重症监护病房住院时间[14（8 - 21）天对29.5（23 - 45）天，p < 0.001]以及3个月后功能预后不良（OR = 3.10，95%CI = 1.49 - 6.39）独立相关。
吞咽困难是非创伤性SAH的常见并发症，与功能预后不良、感染性并发症以及重症监护病房住院时间延长相关。需要早期识别高危患者，以便及时对个体患者进行吞咽困难治疗分层。
