Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan.
Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan.
Clin Neurol Neurosurg. 2023 Jun;229:107760. doi: 10.1016/j.clineuro.2023.107760. Epub 2023 May 5.
Dysphagia due to stroke has a high prevalence, and evaluating the swallowing function of dysphagia and promoting oral intake is essential in patients with stroke. The psoas muscle mass index（cm2/height2（m2））, calculated by the psoas muscle area at the L3 level via abdominal computed tomography （CT）, can predict the development of dysphagia. However, knowledge about the impact of CT-based skeletal muscle mass on swallowing recovery, remains unknown. Therefore, we investigated whether CT-based low skeletal muscle mass impacted swallowing recovery.
A retrospective cohort study was conducted on patients with post-stroke dysphagia who underwent acute treatments along with a videofluoroscopic swallowing study（VFSS）. Swallowing recovery was identified as the improvement of the Functional Oral Intake Scale （FOIS） from the time of VFSS to discharge（observational period: ObPd）. The psoas muscle mass index's cut-off values for low skeletal muscle mass were 3.74 cm2/m2 and 2.29 cm2/m2 for men and women respectively.
There were 53 subjects （36 male, median age 73.9）. The median during the ObPd was 26 days, and the median days from onset to admission and admission to VFSS were 0 and 18, respectively. Sixteen patients had low skeletal muscle mass. The median improvement of FOIS during the ObPd was 2, and the median length of hospital stay was 51 days. In the stepwise multiple linear regression analysis for the improvement of FOIS during the ObPd, low skeletal muscle mass （β - 0.245; 95% confidence interval - 2.248 to - 0.127; p = 0.029） was a significant factor, even adjusted for serum albumin at admission, disturbance of consciousness at VFSS, FOIS at VFSS, and aspiration during VFSS.
CT-based low skeletal muscle mass negatively impacted swallowing recovery during the ObPd in patients with post-stroke dysphagia.
脑卒中引起的吞咽困难发病率较高，评估吞咽功能并促进经口摄食对脑卒中患者至关重要。通过腹部 CT 测量 L3 水平的腰大肌面积计算出的腰大肌质量指数（cm2/身高 2（m2））可预测吞咽困难的发生。然而，关于 CT 骨骼肌质量对吞咽恢复的影响的知识仍不清楚。因此，我们研究了 CT 骨骼肌质量低是否影响吞咽恢复。
对接受急性治疗并同时进行视频荧光透视吞咽研究（VFSS）的脑卒中后吞咽困难患者进行回顾性队列研究。吞咽恢复定义为 VFSS 至出院期间功能性口腔摄入量表（FOIS）的改善（观察期：ObPd）。男性和女性腰大肌质量指数的低骨骼肌质量截断值分别为 3.74 cm2/m2和 2.29 cm2/m2。
共有 53 名受试者（36 名男性，中位年龄 73.9 岁）。ObPd 的中位时间为 26 天，从发病到入院和入院到 VFSS 的中位天数分别为 0 和 18 天。16 名患者存在低骨骼肌质量。ObPd 期间 FOIS 的中位改善为 2，中位住院时间为 51 天。在 ObPd 期间 FOIS 改善的逐步多元线性回归分析中，低骨骼肌质量（β-0.245；95%置信区间-2.248 至-0.127；p=0.029）是一个显著因素，即使在校正入院时血清白蛋白、VFSS 时意识障碍、VFSS 时 FOIS 和 VFSS 期间误吸后，也是如此。
脑卒中后吞咽困难患者在 ObPd 期间，CT 骨骼肌质量低对吞咽恢复有负面影响。
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