Wu Wenxiu, Lin Jingjing, Zhou Xuezhen, Ye Suzhen, Shao Mengmeng, Yu Jiangying, Zhou Chengye, Li Haiyan
Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
Eur J Phys Rehabil Med. 2024 Dec;60(6):929-937. doi: 10.23736/S1973-9087.24.08475-2. Epub 2024 Oct 23.
Low peak expiratory flow (PEF) rate is common in patients with stroke. Studies on changes in PEF rates in patients with stroke often have small sample sizes, limiting the generalizability of their findings.
This study aimed to compare the PEF rates between patients who were post-stroke with or without pneumonia and age- and sex-matched healthy controls and explore the PEF-pneumonia association among stroke survivors.
Prospective observational study.
Department of Rehabilitation, the First Affiliated Hospital of Wenzhou Medical University.
Initially, 809 patients with stroke undergoing inpatient rehabilitation were recruited.
Data collected included the demographics, stroke history, the presence of dysphagia, and the PEF rates on admission. Logistic regression analysis was conducted to identify the PEF threshold as predictive of pneumonia after adjusting for confounders.
Patients with stroke had a mean PEF rate of 243.89±139.38 L/min, significantly lower than that of the normal control group. The PEF rate was significantly lower in the pneumonia group than in the non-pneumonia group (P<0.001). Within the stroke cohort, the PEF rates were lower than the predicted rates (P<0.001). Older age, lower PEF(%),and dysphagia were associated with a higher pneumonia risk post-stroke per stepwise multivariate logistic regression analysis. Furthermore, the combination of these three significant predictors (PEF(%), swallowing function, and age) yielded an area under the curve of 0.857 .Regarding age, the cut-off point of ≥65.5 years was the optimal level to discriminate the presence of pneumonia among patients with stroke. For PEF%,the cut-off point of <60% was the optimal level to discriminate the presence of pneumonia among patients with stroke. For screening dysphagia, the patients with impaired safety only and those with impaired safety and efficacy faced a higher pneumonia risk.
Patients with stroke exhibited significantly lower peak expiratory flow rates compared to healthy controls after adjusting for age and sex and when compared to their reference values. Decreased PEF rates were independently associated with pneumonia development during inpatient rehabilitation in post-stroke patients.
This study suggests that low PEF rates may predict pneumonia and that the prevention of PEF rate decline may prevent pneumonia development.
呼气峰值流速（PEF）降低在卒中患者中很常见。关于卒中患者PEF变化的研究样本量往往较小，限制了研究结果的普遍性。
本研究旨在比较有或无肺炎的卒中后患者与年龄和性别匹配的健康对照者之间的PEF，并探讨卒中幸存者中PEF与肺炎的关联。
前瞻性观察性研究。
温州医科大学附属第一医院康复科。
最初招募了809例接受住院康复治疗的卒中患者。
收集的数据包括人口统计学资料、卒中病史、吞咽困难情况以及入院时的PEF。进行逻辑回归分析，以确定在调整混杂因素后可预测肺炎的PEF阈值。
卒中患者的平均PEF为243.89±139.38L/min，显著低于正常对照组。肺炎组的PEF显著低于非肺炎组（P<0.001）。在卒中队列中，PEF低于预测值（P<0.001）。逐步多因素逻辑回归分析显示，年龄较大、PEF（%）较低和吞咽困难与卒中后肺炎风险较高相关。此外，这三个重要预测因素（PEF（%）、吞咽功能和年龄）的组合产生的曲线下面积为0.857。关于年龄，≥65.5岁的截断点是区分卒中患者是否存在肺炎的最佳水平。对于PEF%，<60%的截断点是区分卒中患者是否存在肺炎的最佳水平。对于筛查吞咽困难，仅安全性受损的患者以及安全性和有效性均受损的患者面临更高的肺炎风险。
在调整年龄和性别后，卒中患者的呼气峰值流速显著低于健康对照者，且低于其参考值。PEF降低与卒中后患者住院康复期间肺炎的发生独立相关。
本研究表明，低PEF可能预测肺炎，预防PEF下降可能预防肺炎的发生。
