Sala R, Muntó M J, de la Calle J, Preciado I, Miralles T, Cortés A, Molla R, Alcaide M
Unidad de Enfermería de Medicina Interna, Hospital Virgen de los Lirios, Alcoy, Alicante, España.
Rev Neurol. 1998 Nov;27(159):759-66.
To determine the frequency of dysphagia in CVA, its natural history and value as a risk factor of respiratory infection, malnutrition and death.
A prospective study was made of 187 consecutive patients with cerebrovascular accidents (CVA). A standardized test for dysphagia was done during the first two days of the illness and repeated three days a week. The levels of urea, total proteins and albumin were determined on admission and on discharge. The patients were questioned by phone after 6 months.
There was dysphagia of liquids in 36.4% of the patients. The incidence of dysphagia for semisolids was of the same frequency but more severe. Coma was the cause of inability to swallow in 25.7% of the patients. During their stay in hospital one third of the patients with dysphagia died, one third became normal and one third still had dysphagia when they were discharged. After one week, one, three and six months respectively, the cure rate for dysphagia was 29.4%, 4.1%, 55.9% and 55.9%, and survival 83.8%, 67.6%, 61.8% and 60.3%. Thus after 6 months only 3 patients (4.4%) were alive and dysphagic. Half of the 'cures' occurred in the first week, and none occurred after more than 77 days. As compared to the non-dysphagic patients, the dysphagic patients had 10 times more risk of respiratory infection, 18 times higher risk of death, greater loss of albumin and less loss of urea.
There is a high prevalence of dysphagia in CVA and although functional prognosis is not unfavorable, respiratory infections, malnutrition and death are frequent.
确定脑血管意外（CVA）患者吞咽困难的发生率、自然病程及其作为呼吸道感染、营养不良和死亡危险因素的价值。
对187例连续的脑血管意外（CVA）患者进行了前瞻性研究。在疾病的前两天进行了标准化的吞咽困难测试，并每周重复三次。入院时和出院时测定尿素、总蛋白和白蛋白水平。6个月后通过电话对患者进行询问。
36.4%的患者存在液体吞咽困难。半固体吞咽困难的发生率相同，但更严重。25.7%的患者因昏迷导致无法吞咽。在住院期间，三分之一的吞咽困难患者死亡，三分之一恢复正常，三分之一出院时仍有吞咽困难。分别在一周、三个月和六个月后，吞咽困难的治愈率为29.4%、4.1%、55.9%和55.9%，生存率为83.8%、67.6%、61.8%和60.3%。因此，6个月后只有3例患者（4.4%）存活且有吞咽困难。一半的“治愈”发生在第一周，77天之后没有治愈病例。与无吞咽困难的患者相比，吞咽困难的患者发生呼吸道感染的风险高10倍，死亡风险高18倍，白蛋白损失更多，尿素损失更少。
CVA患者吞咽困难的患病率很高，尽管功能预后并非不利，但呼吸道感染、营养不良和死亡很常见。
