张萍萍,李涛,王孝文,等.脑卒中吞咽障碍患者预后和住院费用相关性的回顾性研究[J].中华物理医学与康复杂志,2023,45(8):695-701
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| 脑卒中吞咽障碍患者预后和住院费用相关性的回顾性研究 |
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| DOI：10.3760/cma.j.issn.0254-1424.2023.08.005 |
| 中文关键词: 脑卒中 吞咽障碍 预后 负担 肺炎 |
| 英文关键词: Stroke Dysphagia Prognosis Hospitalization costs Pneumonia |
| 基金项目:2020年国家重点研发计划项目(SQ2020YFC200032);2021年中国残疾人联合会资助项目（2021CDPFAT-45）；潍坊医学院2022年校级大学生创新创业训练计划项目（X2022059） |
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| 中文摘要: |
| 目的 探讨吞咽障碍与脑卒中患者预后和住院费用之间的相关性。 方法 选取于潍坊市3家公立医院康复科就诊的脑卒中住院患者1370例，根据吞咽造影检查结果，将患者分为吞咽障碍组（499例）和非吞咽障碍组（871例）。收集患者临床资料，包括病案号、年龄、性别、医保类型、卒中类型、病灶部位、Charlson合并症指数（CCI）等。采用二元Logistic回归和多重线性回归模型分析吞咽障碍与肺炎发生情况、改良Rankin量表（mRS）评分、改良Barthel指数（MBI）、住院时长、住院总费用之间的相关性。 结果 本研究纳入脑卒中患者的吞咽障碍发生率为36.42%。校正混杂因素后，吞咽障碍组肺炎的发生风险是非吞咽障碍组的2.417倍［OR=2.417，95%CI（1.902，3.072），P=0.000］。出院时，吞咽障碍患者mRS评分≥3分和MBI＜60分的风险分别为3.272倍［OR=3.272，95%CI（2.508，4.269），P＜0.001］和1.670倍［OR=1.670，95%CI（1.230，2.268），P＜0.001］。多重逐步线性回归结果显示，吞咽障碍与出院时较高的mRS评分（β=0.265，P＜0.001）、较低的MBI评分（β=-0.210，P＜0.001）、较长的住院时间（β=0.053，P＜0.001）存在显著相关性。从标准化回归系数看，影响住院费用的程度，从大到小的顺序依次为住院时长（β=0.618）、吞咽障碍（β=0.147）、MBI评分（β=-0.416）、肺炎（β=0.133）、幕上卒中（β=-0.053）、出血性脑卒中（β=0.058）、CCI评分（β=0.039）。其中，吞咽障碍与住院费用存在显著相关性（β=0.147，P＜0.001）。 结论 吞咽障碍会对患者的预后和住院费用产生显著影响，应尽早识别并予以干预，以改善预后、减轻经济负担。 |
| 英文摘要: |
| Objective To seek any correlation between and prognosis and hospitalization costs of stroke survivors with dysphagia. Methods The records of 1370 stroke survivors admitted to the rehabilitation departments of 3 public hospitals in Weifang were studied. Of them, 499 (36.4%) were diagnosed with dysphagia and 871 were not. Binary logistic regression and multiple linear regression were employed to analyze the correlation between dysphagia and the occurrence of pneumonia, modified Rankin Scale (mRS) scores, modified Barthel index (MBI) scores, length of stay and total hospitalization cost. Results After adjusting for confounding factors, the risk of pneumonia in the dysphagia group was 2.4 times higher. At discharge, the risk of an mRS≥3 was 3.3 times greater and that of an MBI score <60 was 1.7 times greater with dysphagia. Multiple stepwise linear regression showed that dysphagia was significantly associated with higher mRS scores at discharge, lower MBI scores, and longer hospital stays. The standardized regression coefficients predict that after the length of stay, dysphagia is the strongest predictor of the cost of hospitalisation, followed by ADL ability, pneumonia, supratentorial, haemorrhagic stroke and CCI. Conclusions Dysphagia is a significant predictor of the hospitalization costs of stroke patients. It is recommended to identify and treat dysphagia as early as possible to improve the prognosis of such patients and reduce the economic burden. |
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