非经口进食吞咽障碍脑卒中患者预后的相关因素及预测模型

doi:10.3969/j.issn.1006-9771.2022.04.012

Abstract

Abstract:

Objective To explore the factors related to the recovery of nil per os (NPO) patients after stroke by retrospective data analysis, and to establish a predictive model.Methods The information of demographics, evaluation and treatment of 141 stroke patients admitted to the Hearing and Language Department in Beijing Bo'ai Hospital from April, 2017 to November, 2020 were selected. The predictive model was established by univariate analysis and Logistic regression. The fitting degree and discriminant validity of the model were evaluated by Hosmer-Lemeshow (H-L) test and receiver operating characteristic (ROC) curve. Other 121 patients with post-stroke dysphagia from December, 2020 to November, 2021 were used as the validation set to verify the model.Results For univariate analysis, National Institute of Health Stroke Scale (NIHSS) score, drinking water test results, autonomous cough ability, cough after swallowing, movement ability of tongue and jaw, and electrical stimulation treatment were significantly associated with the outcome (H=65.803, χ² > 4.623, P<0.05). Multivariate Logistic regression analysis showed that NIHSS score (X₁, OR=0.772, 95%CI 0.64 to 0.82, P<0.001), spontaneous cough ability (X₂, OR=5.116, 95%CI 1.28 to 20.41, P=0.021), and electrical stimulation during treatment (X₃, OR=94.718, 95%CI 5.65 to 1589.26, P=0.002) were independent factors for the outcome of swallowing function. Thus, the predictive model was $P = 1 1 + e - (2.368 - 0.325 X 1 + 1.632 X 2 + 4.551 X 3)$ , which was well fitting (P=0.845), with the largest area under curve (0.884). The overall accuracy of the model in the validation set was 91.7%.Conclusion The patients with dysphagia would like to recover well if he/she was with lower NIHSS scores and normal autonomous cough ability; meanwhile, the addition of electrical stimulation therapy in comprehensive rehabilitation may be helpful. A predictive model has been established, which needs a further research.

Key words: dysphagia, oral feeding, prognostic model, Logistic regression

WANG Bo,YUAN Yongxue,ZHANG Qingsu. Factors related to swallowing recovery for nil per os patients after stroke and prediction model[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(4): 453-460.

Figures/Tables 5

References 37

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变量	赋值方式
NIHSS得分	计量资料
饮水试验	正常=1;可疑=2;异常=3
吞咽后呛咳	否=0;是=1
自主咳嗽	无=0;有=1
舌运动	正常=0;异常=1
下颌运动	正常=0;异常=1
综合训练含电刺激	否=0;是=1
预后良好	否=0;是=1

项目	回归系数	标准误	Wald值	P值	OR值	95%CI
NIHSS得分	-0.325	0.061	28.088	< 0.001	0.722	0.64~0.82
自主咳嗽	1.632	0.706	5.348	0.021	5.116	1.28~20.41
电刺激	4.551	1.439	10.004	0.002	94.718	5.65~1589.26
常数	2.368	1.504	2.479	0.115	10.675

指标	AUC	标准误	临界值	P值	95%CI
预测模型	0.884	0.033	0.5	< 0.001	0.819~0.948
NIHSS得分	0.091	0.024	16.5	< 0.001	0.044~0.138
自主咳嗽	0.616	0.049	0.5	0.020	0.520~0.712
电刺激	0.720	0.042	0.5	< 0.001	0.638~0.803

实际预后(n)	模型预测预后(n)		合计
实际预后(n)	不良(< 0.5)	良好(≥ 0.5)	合计
不良	67	4	71
良好	6	44	50
合计	73	48	121

Factors related to swallowing recovery for nil per os patients after stroke and prediction model

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变量	总数(n=141)	预后良好 (n=58)	预后不良 (n=83)	χ²/H值	P值
年龄(≥ 65岁)^a	53	18	35	1.804	0.179
性别				1.280	0.258
男	102	39	63
女	39	19	20
病程/d				0.067	0.967
< 30	38	16	22
30~< 90	60	25	35
≥ 90	43	17	26
卒中类型				0.024	0.877
脑梗死	91	37	54
脑出血	50	21	29
损伤侧				3.785	0.151
右侧	34	14	20
左侧	24	14	10
双侧	83	30	53
并发症				0.005	0.944
仅吞咽障碍	70	29	41
伴见构音障碍	71	29	42
NIHSS得分	14(14)	6(8)	19(10)	65.803	< 0.001
饮水试验分级				7.424	0.024
正常	30	17	13
可疑	55	30	25
异常	56	11	45
口颜面及喉部功能评估
呕吐反射异常^a	63	28	35	0.515	0.473
有吞咽后呛咳^a	63	13	50	19.765	< 0.001
自主咳嗽异常^a	97	32	65	8.516	0.004
有吞咽后嗓音变化^a	65	30	35	1.255	0.263
舌运动异常^a	78	46	32	22.944	< 0.001
唇运动异常^a	29	14	15	1.412	0.494
下颌运动异常^a	76	25	51	4.623	0.032
综合训练含电刺激^a	102	57	45	33.123	< 0.001
训练时间/d				0.058	0.971
≤ 30	60	24	36
>30~ 90	45	19	26
> 90	36	15	21

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