Ihrke Manuela, Meisel Andreas, Nelde Alexander, Neumann Konrad, Mürbe Dirk, Voß Linda J, Caffier Philipp P
Department of Audiology and Phoniatrics, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Sci Rep. 2025 Oct 3;15(1):34479. doi: 10.1038/s41598-025-22020-3.
Dysphagia patients are at increased risk of stroke-associated pneumonia (SAP). This bicenter study evaluated whether dietary restrictions, specifically nil per os (NPO) and texture-modified food (TMF), reduce SAP incidence in post-stroke dysphagia (PSD). Data from 160 consecutive acute PSD patients treated in two university stroke units were retrospectively analyzed. The primary outcome was SAP incidence; secondary outcomes included length of hospitalization, mortality, and nasogastric tube placement. Stroke severity, male sex, and age emerged as significant SAP risk factors. On admission, 63% of SAP patients were already on NPO, 33.3% received TMF, and only 3.7% had unrestricted oral intake. Notably, NPO patients were 2.5 times more likely to develop SAP than those without dietary restrictions (p = 0.008). Most SAP cases were diagnosed before any oral intake, with the majority occurring by day three. These findings align with emerging evidence highlighting the role of oral hygiene factors and immune alterations in pulmonary bacterial defense. This study provides no support for NPO or TMF as effective pneumonia prophylaxis in PSD. Instead, early intervention and comprehensive care strategies are essential to mitigate SAP risk. Appropriate dysphagia diets enhancing residual swallowing capacity could positively impact both SAP rates and dysphagia rehabilitation.
吞咽困难患者发生卒中相关性肺炎（SAP）的风险增加。这项双中心研究评估了饮食限制，特别是禁食（NPO）和质地改良食物（TMF），是否能降低卒中后吞咽困难（PSD）患者的SAP发生率。对在两个大学卒中单元接受治疗的160例连续性急性PSD患者的数据进行了回顾性分析。主要结局是SAP发生率；次要结局包括住院时间、死亡率和鼻胃管置入情况。卒中严重程度、男性性别和年龄是显著的SAP危险因素。入院时，63%的SAP患者已处于禁食状态，33.3%接受了质地改良食物，只有3.7%的患者口服摄入不受限制。值得注意的是，禁食患者发生SAP的可能性是无饮食限制患者的2.5倍（p = 0.008）。大多数SAP病例在任何口服摄入之前就已被诊断出来，大多数发生在第三天。这些发现与新出现的证据一致，这些证据强调了口腔卫生因素和免疫改变在肺部细菌防御中的作用。本研究不支持将禁食或质地改良食物作为PSD中有效的肺炎预防措施。相反，早期干预和综合护理策略对于降低SAP风险至关重要。适当的吞咽困难饮食可提高残余吞咽能力，这可能对SAP发生率和吞咽困难康复产生积极影响。
