缺血性卒中后吞咽功能障碍相关危险因素的分析

目的探讨缺血性卒中患者发生吞咽功能障碍的危险因素。方法连续纳入2009年3月—2011年12月,阜新市第二人民医院神经内科的缺血性卒中患者496例,对患者人口统计学、个人史等临床资料进行回顾性分析,分析缺血性卒中患者吞咽功能障碍的发生率及其危险因素。结果①在496例患者中,发生吞咽功能障碍的有103例,总发生率为20.8%。②吞咽功能障碍的发生率随年龄的升高而上升,年龄〉60岁各组与〈50岁组相对危险度的比较,均成倍增加,均P〈0.05。以小脑梗死为对照,脑干梗死发生吞咽功能障碍的危险度校正后是小脑梗死的3.67倍（95%CI：1.50～8.20）,P〈0.05。③吞咽功能障碍组高血压、糖尿病、不同病灶部位（右侧大脑半球、多发性梗死、脑干梗死）的发病例数均高于无吞咽障碍组,均P〈0.05。校正危险度后结果显示,有糖尿病的缺血性卒中患者发生吞咽功能障碍的危险度是无糖尿病病史的2.55倍（95%CI：0.74～5.99,P〈0.01）,有多发性梗死的患者发生吞咽困难的危险度是无多发性梗死者的2.88倍（95%CI：1.03～5.90,P〈0.05）。结论急性缺血性卒中患者吞咽功能障碍发生的独立危险因素为高龄、高血压、糖尿病、脑干梗死及多发性梗死。

Analysis of the risk factors associated with swallowing dysfunction in patients with ischemic stroke

Objective To investigate the risk factors for swallowing dysfunction in patients with ischemic stroke.Methods A total of 496 consecutive patients with ischemic stroke from the Department of Neurology,the Second People’s Hospital of Fuxin City were enrolled.The clinical data,such as demographic data of the patients and personal history were analyzed retrospectively.The incidence of swallowing dysfunction and its risk factors for patients with ischemic stroke were analyzed.Results ①Of the 496 patients,103 had swallowing dysfunction.The overall incidence was 20.8%.②The incidence of swallowing dysfunction increased with age.The relative risk in patients after 60 years old compared with <50 years old was doubled(all P<0.05).The risk of the occurrence of swallowing dysfunction in brainstem lesion was 3.67 times of the lesion in the cerebellum(95%CI 1.50-8.20;P<0.05).③The incidence of hypertension,diabetes,and cerebrovascular disease in the swallowing dysfunction group were higher than the non-swallowing dysfunction group(all P>0.05).The results after adjustment showed that the risk of swallowing dysfunction in ischemic stroke patients with diabetes was 2.55 times of those without diabetes.The difference was significant statistically significant(P<0.01).Conclusion The independent risk factors for the occurrence of swallowing dysfunction are advanced age,hypertension,diabetes,brainstem infarction,and multiple infarct lesions in patients with acute ischemic stroke.