Nursing Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Vascular Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Stroke Vasc Neurol. 2022 Aug;7(4):294-301. doi: 10.1136/svn-2020-000746. Epub 2022 Mar 8.
Guidelines recommend dysphagia screening to identify those at high risk of pneumonia. However, little is known about the prevalence and predictors of dysphagia screening and pneumonia among patients with acute ischaemic stroke in China.
Using data from the Chinese Stroke Center Alliance, which is a multicentre, prospective, consecutive patient enrolment programme, univariate and multivariate analyses were conducted to identify patient and hospital characteristics associated with dysphagia screening and pneumonia during acute hospitalisation.
Of 790 811 patients admitted to 1476 hospitals, 622 718 (78.7%) underwent dysphagia screening, and 64 398 (8.1%) developed pneumonia. Patients in stroke units were more likely to be screened for dysphagia than those not in stroke units (OR 1.50; 95% CI 1.48 to 1.52), while patients with a past history of stroke were less likely to be screened (OR 0.87; 95% CI 0.86 to 0.88). Dysphagia screening (OR 1.46; 95% CI 1.30 to 1.65), dysphagia (OR 7.31; 95% CI 7.15 to 7.46), and admission to stroke units (OR 1.17; 95% CI 1.14 to 1.19) were significantly associated with a greater risk of pneumonia.
Dysphagia was a critical factor in the development of pneumonia. Nearly one in five patients with acute ischaemic stroke in the Chinese Stroke Center Alliance were not screened for dysphagia. Pneumonia prevention during acute hospitalisation is dependent not only on dysphagia screening but also on the effectiveness of subsequent dysphagia management interventions. Further studies are needed to elucidate the relationship between dysphagia screening, stroke unit care and pneumonia in patients with acute ischaemic stroke.
指南建议进行吞咽障碍筛查，以识别那些有肺炎高风险的患者。然而，对于在中国急性缺血性脑卒中患者中，吞咽障碍筛查和肺炎的流行率及预测因素知之甚少。
利用中国卒中中心联盟的数据，这是一个多中心、前瞻性、连续患者入组的方案，进行单因素和多因素分析，以确定与急性住院期间吞咽障碍筛查和肺炎相关的患者和医院特征。
在 1476 家医院收治的 790811 名患者中，622718 名（78.7%）接受了吞咽障碍筛查，64398 名（8.1%）发生了肺炎。与未入住卒中单元的患者相比，入住卒中单元的患者更有可能接受吞咽障碍筛查（OR 1.50；95%CI 1.48 至 1.52），而有卒中既往史的患者不太可能接受筛查（OR 0.87；95%CI 0.86 至 0.88）。吞咽障碍筛查（OR 1.46；95%CI 1.30 至 1.65）、吞咽障碍（OR 7.31；95%CI 7.15 至 7.46）和入住卒中单元（OR 1.17；95%CI 1.14 至 1.19）与肺炎风险增加显著相关。
吞咽障碍是肺炎发生的关键因素。中国卒中中心联盟中近五分之一的急性缺血性脑卒中患者未接受吞咽障碍筛查。急性住院期间的肺炎预防不仅依赖于吞咽障碍筛查，还依赖于随后吞咽障碍管理干预措施的有效性。需要进一步研究阐明急性缺血性脑卒中患者中吞咽障碍筛查、卒中单元护理与肺炎之间的关系。
