Jang Bo Seong, Park Jun Young, Lee Jae Hyun, Sim Young Joo, Jeong Ho Joong, Kim Ghi Chan
Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea.
Ann Rehabil Med. 2021 Feb;45(1):33-41. doi: 10.5535/arm.20149. Epub 2021 Feb 9.
To investigate the clinical factors associated with successful gastrostomy tube weaning in patients with prolonged dysphagia after stroke.
This study involved a retrospective medical chart review of patients diagnosed with prolonged dysphagia after stroke who underwent gastrostomy tube insertion between May 2013 and January 2020. Forty-seven patients were enrolled and consequently divided into gastrostomy tube sustaining and weaning groups. The numbers of patients in the sustaining and weaning groups were 31 and 16, respectively. The patients' demographic data, Korean version of Mini-Mental State Examination (K-MMSE) score, Korean version of the Modified Barthel Index (K-MBI), Functional Dysphagia Scale (FDS) score, and Penetration-Aspiration Scale (PAS) score were compared between the two groups. A videofluoroscopic swallowing study was performed before making the decision of gastrostomy tube weaning. The clinical factors associated with gastrostomy tube weaning were then investigated.
There were significant differences in age; history of aspiration pneumonia; K-MMSE, FDS, and PAS scores; and K-MBI between the groups. In the multiple logistic regression analysis, the FDS (odds ratio [OR]=0.791; 95% confidence interval [CI], 0.634-0.987) and PAS scores (OR=0.205; 95% CI, 0.059-0.718) were associated with successful gastrostomy tube weaning. In the receiver operating characteristic curve analysis, the FDS and PAS were useful screening tools for successful weaning, with areas under the curve of 0.911 and 0.918, respectively.
In patients with prolonged dysphagia, the FDS and PAS scores are the only factors associated with successful gastrostomy tube weaning. An evaluation of the swallowing function is necessary before deciding to initiate gastrostomy tube weaning.
探讨与中风后长期吞咽困难患者胃造口管成功拔除相关的临床因素。
本研究对2013年5月至2020年1月期间因中风后长期吞咽困难而接受胃造口管置入术的患者进行回顾性病历审查。共纳入47例患者，随后分为胃造口管维持组和拔除组。维持组和拔除组的患者人数分别为31例和16例。比较两组患者的人口统计学数据、韩国版简易精神状态检查表（K-MMSE）评分、韩国版改良巴氏指数（K-MBI）、功能性吞咽困难量表（FDS）评分和渗透-误吸量表（PAS）评分。在决定拔除胃造口管之前进行了视频荧光吞咽造影检查。然后研究与胃造口管拔除相关的临床因素。
两组患者在年龄、误吸性肺炎病史、K-MMSE、FDS和PAS评分以及K-MBI方面存在显著差异。在多因素逻辑回归分析中，FDS（比值比[OR]=0.791；95%置信区间[CI]，0.634-0.987）和PAS评分（OR=0.205；95%CI，0.059-0.718）与胃造口管成功拔除相关。在受试者工作特征曲线分析中，FDS和PAS是成功拔除胃造口管的有用筛查工具，曲线下面积分别为0.911和0.918。
在长期吞咽困难患者中，FDS和PAS评分是与胃造口管成功拔除相关的唯一因素。在决定开始拔除胃造口管之前，有必要对吞咽功能进行评估。
