Kiran Kumar Dvs, Mathensingh Asisha, Kalimuthu Muruga Bharathy, George Philip, Benton Ronald Carey Albert, Thomas Raji, Micheal Rajiv, Mathew Suma Susan, Aaron Sanjith, Bedford Shipra, Santhosh Swapna, Mary Veena Helen, Synthia P Bindu, Visalakshi Jeyaseelan, Mishra Ajay Kumar, Sudarsanam Thambu David
Department of Medicine, CMC Vellore, Tamil Nadu, India.
Department of ENT, CMC Vellore, Tamil Nadu, India.
Neurol India. 2025 Jan 1;73(1):110-116. doi: 10.4103/ni.ni_972_21. Epub 2025 Feb 7.
Stroke patients commonly have dysphagia that can lead to aspiration pneumonia and, in some cases, death. The risk factors for poor outcomes have not been described well in a South Indian population.
We aimed to assess the incidence of dysphagia and subsequent pneumonia and mortality in a cohort of stroke patients.
We screened 472 consecutive stroke patients, among whom 100 were included. Each patient was assessed by the clinician, speech therapist, and ENT surgeon. We calculated the stroke scores - National Institute of Health Stroke Score (NIHSS), modified Rankin score - as well as the swallowing scores, that is, Mann's and Functional Oral Intake Scale (FOIS) score, and performed video laryngoscopy. We evaluated dysphagia, aspiration pneumonia, removal of nasogastric tube, and death for up to 3 months after the diagnosis.
Of 100 stroke patients, we found that 77 had dysphagia. Twenty-seven (35%) developed pneumonia; 16/27 (59.3%) died within 3 months of ictus. Among the 48 who did not develop pneumonia, six died (12.5%). Compared to a consensus definition of dysphagia, Mann's score less than 177 rules in dysphagia, while a score more than 187 rules out dysphagia. Higher NIHSS score and weak gag reflex were the independent factors for dysphagia. Most patients with dysphagia improved. Dysphagia is significantly associated with pneumonia (35%) and high mortality (20.8%).
Dysphagia was seen in 77% of our stroke patients; 28% developed pneumonia. In 3 months, majority recovered from dysphagia. Higher NIHSS scores and a weak gag were independent predictors of dysphagia. Also, 35% with dysphagia developed pneumonia, among whom the mortality was 59.3%.
中风患者常伴有吞咽困难，这可能导致吸入性肺炎，在某些情况下甚至会导致死亡。在南印度人群中，不良预后的风险因素尚未得到充分描述。
我们旨在评估一组中风患者中吞咽困难以及随后发生肺炎和死亡的发生率。
我们对472例连续的中风患者进行了筛查，其中100例被纳入研究。每位患者均由临床医生、言语治疗师和耳鼻喉科医生进行评估。我们计算了中风评分——美国国立卫生研究院中风量表（NIHSS）、改良Rankin量表——以及吞咽评分，即曼氏评分和功能性经口摄食量表（FOIS）评分，并进行了视频喉镜检查。我们评估了诊断后长达3个月的吞咽困难、吸入性肺炎、鼻胃管拔除情况以及死亡情况。
在100例中风患者中，我们发现77例有吞咽困难。27例（35%）发生了肺炎；其中16/27例（59.3%）在发病后3个月内死亡。在未发生肺炎的48例患者中，6例死亡（12.5%）。与吞咽困难的共识定义相比，曼氏评分低于177分提示存在吞咽困难，而评分高于187分则可排除吞咽困难。较高的NIHSS评分和较弱的咽反射是吞咽困难的独立因素。大多数吞咽困难患者病情有所改善。吞咽困难与肺炎（35%）和高死亡率（20.8%）显著相关。
我们的中风患者中有77%存在吞咽困难；28%发生了肺炎。在3个月内，大多数患者的吞咽困难有所恢复。较高的NIHSS评分和较弱的咽反射是吞咽困难的独立预测因素。此外，35%的吞咽困难患者发生了肺炎，其中死亡率为59.3%。
