急性脑卒中患者吞咽障碍检出率的Meta分析

doi:10.3969/j.issn.1674-490X.2022.02.008

摘要/Abstract

摘要： 目的系统评价急性脑卒中患者吞咽障碍状况。方法在PubMed、EMbase、Web of Science、The Cochrane Library、中国生物医学文献数据库(CBM)、维普(VIP)、中国知网(CNKI)及万方(WanFang)等数据库进行文献检索,汇集有关急性脑卒中患者吞咽障碍检出率的研究,检索时限为建库至2021年11月5日。分别由2名护理研究者根据文献的纳入和排除标准对检索得到的文献进行独立筛选、资料提取并评价纳入文献的偏倚风险后,应用Stata16软件进行Meta分析。结果最终共纳入29篇文献,包括26 799例调查对象。Meta分析结果显示,急性脑卒中患者吞咽障碍检出率为53%(95%CI:0.46~0.60)。亚组分析结果显示,男性为20%(95%CI:0.17~0.22),女性为20%(95%CI:0.17~0.24);50岁以下患者检出率为6%(95%CI:-0.03~0.15),50~59岁患者检出率为9%(95%CI:0.04~0.15),60~69岁患者检出率为26%(95%CI:-0.04~0.56),70~79岁患者检出率为29%(95%CI:0.03~0.54),80岁及以上患者检出率为39%(95%CI:-0.24~1.03);脑干、小脑、大脑、脑干+小脑、脑干+半球卒中患者吞咽障碍检出率分别为39%、13%、21%、33%、90%;完全前循环梗死、部分前循环梗死、后循环梗死、腔隙性梗死患者的吞咽障碍检出率分别为58%、25%、26%、16%;心源性脑卒中、大血管闭塞、小血管闭塞、动脉粥样硬化人群吞咽障碍检出率分别为18%、14%、9%、14%;现病史中高胆固醇血症、高血压、吸烟、糖尿病、房颤、高脂血症患者吞咽障碍检出率分别为19%、22%、19%、22%、22%、10%;既往史中高血压、糖尿病、吸烟、饮酒患者吞咽障碍检出率分别为28%、27%、38%、16%。结论急性脑卒中患者吞咽障碍检出率较高。但受纳入文献质量及数量的限制,上述结论仍需纳入更高质量文献予以考证。

关键词: 急性脑卒中, 吞咽障碍, 检出率, Meta分析

Abstract: Objective To systematically evaluate the status of dysphagia in patients with acute stroke. Methods PubMed, EMbase, Web of Science, The Cochrane Library, Chinese Biomedical Literature Database(CBM), VIP, CNKI, WanFang and other databases were used to search literatures on the detection rate of dysphagia in patients with acute stroke from the establishment of the database to November 5, 2021. Two nursing researchers independently screened the retrieved literatures according to the inclusion and exclusion criteria, extracted data, and evaluated the bias risk of the included literatures. Then Stata16 software was used for Meta analysis. Results A total of 29 articles were included, including 26799 subjects. The prevalence of dysphagia in acute stroke patients was 53%(95%CI:0.46-0.60). Subgroup analysis showed 20% of males(95%CI:0.17-0.22)and 20% of females(95%CI:0.17-0.24). The detection rates were 6%(95%CI:-0.03-0.15)in patients under 50 years old, 9%(95%CI:0.04-0.15)in patients 50 to 59 years old, 26%(95%CI:-0.04-0.56)in patients 60 to 69 years old, 29%(95%CI:0.03-0.54)in patients aged 70-79 years, and 39%(95%CI:-0.24-1.03)in patients aged 80 years or older. The prevalence of dysphagia in cerebral stem, cerebellum, cerebellum, brainstem + cerebellum and brainstem + hemisphere stroke patients was 39%, 13%, 21%, 33% and 90% respectively. The detection rates of swallowing disorders in patients with total anterior circulation infarction(TACI), partial anterior circulation infarction(PACI), posterior circulation infarction(POCI)and lacunar infarction(LACI)were 58%, 25%, 26% and 16% respectively. The prevalence of dysphagia in patients with cardiogenic stroke, large vessel occlusion, small vessel occlusion and atherosclerosis was 18%, 14%, 9% and 14% respectively. The prevalence of dysphagia in patients with hypercholesterolemia, hypertension, smoking, diabetes, atrial fibrillation and hyperlipidemia were 19%, 22%, 19%, 22%, 22% and 10% respectively. The prevalence of dysphagia in hypertension, diabetes, smoking and drinking was 28%, 27%, 38% and 16% respectively. Conclusion The rate of dysphagia in acute stroke patients is high. However, due to the limitations of the quality and quantity of the included literatures, the above conclusions still need to be verified by incorporating higher-quality literatures.

Key words: acute cerebral apoplexy, dysphagia, detection rate, Meta-analysis

中图分类号:

R741

杨阳,王珏,刘宁. 急性脑卒中患者吞咽障碍检出率的Meta分析[J]. 医学研究与教育, 2022, 39(2): 54-65.

YANG Yang, WANG Jue, LIU Ning. A meta-analysis of the detection rate of dysphagia in patients with acute stroke[J]. Journal of Hebei Medical College for Continuing Education, 2022, 39(2): 54-65.

参考文献

[1] 宋美毅,王永锋,李伟,等.呼吸训练治疗脑卒中后吞咽功能障碍临床随机对照试验的Meta分析[J].全科护理, 2020, 18(23): 2950-2958. DOI: 10.12104/j.issn.1674-4748.2020.23.002.
[2] 王拥军,李子孝,谷鸿秋,等.中国卒中报告2019(中文版)(1)[J].中国卒中杂志,2020,15(10):1037-1043. DOI: 10.3969/j.issn.1673-5765.2020.10.001.
[3] 樊丹丹,屈秋民,高烨. 机械取栓治疗急性缺血性脑卒中预后的评估[J].解放军预防医学杂志, 2018, 36(3): 361-363. DOI: 10.13704/j.cnki.jyyx.2018.03.019.
[4] 孙宁.洼田饮水试验在急性脑卒中后吞咽障碍患者中的应用价值[J].中国医药指南, 2020, 18(1): 88-89. DOI: 10.15912/j.cnki.gocm.2020.01.077.
[5] 刘继红,秦燕.营养支持在脑卒中伴吞咽障碍患者中的研究进展[J].重庆医学, 2016, 45(21): 3007-3009. DOI: 10.3969/j.issn.1671-8348.2016.21.042.
[6] 李巧林.脑卒中后吞咽障碍的康复护理干预试验的方法学质量评价[J].赣南医学院学报, 2017, 37(1): 122-123, 125. DOI: 10.3969/j.issn.1001-5779.2017.01.036.
[7] 尹秀玲,杨初燕,冯珍,等.脑卒中吞咽障碍患者吞咽功能改善前后的呼吸功能变化[J].实用临床医学, 2012, 13(10): 24-27. DOI: 10.3969/j.issn.1009-8194.2012.10.009.
[8] 陆敏,孟玲,彭军.神经肌肉电刺激疗法与电针治疗脑卒中后吞咽障碍的疗效对比研究[J].中国康复医学杂志, 2010, 25(2): 135-138. DOI: 10.3969/j.issn.1001-1242.2010.02.009.
[9] 郑拯,饶阿敏,汤龙,等.吞咽障碍评估工具信效度研究[J].医学信息, 2020, 33(8): 32-34, 47. DOI: 10.3969/j.issn.1006-1959.2020.08.012.
[10] 吕丹,任佳,王海洋,等.纤维内镜检查在吞咽功能评估中的应用进展[J].中华物理医学与康复杂志, 2020, 42(7): 656-659. DOI: 10.3760/cma.j.issn.0254-1424.2020.07.018.
[11] 曾宪涛,刘慧,陈曦,等.Meta分析系列之四:观察性研究的质量评价工具[J].中国循证心血管医学杂志, 2012, 4(4): 297-299. DOI: 10.3969/j.1674-4055.2012.04.004.
[12] 刘小菠,张惠玲,李雨谿,等.中国2型糖尿病人群抑郁检出率的Meta分析[J].中国循证医学杂志, 2020, 20(8): 930-937.
[13] 李伟,张彩迪,罗金晶,等.新型冠状病毒肺炎疫情期间不同人群心理状态的Meta分析[J].同济大学学报(医学版), 2020, 41(2): 147-154. DOI: 10.16118/j.1008-0392.2020.02.002.
[14] 孙伟平,阿依古丽·艾山,王欣华, 等.115例急性脑卒中患者标准吞咽功能评估[J].中国康复理论与实践, 2006, 12(4): 282-284. DOI: 10.3969/j.issn.1006-9771.2006.04.003.
[15] 侯莹,王相明,李文.急性脑梗死OCSP分型与吞咽困难的相关性分析[J].神经疾病与精神卫生, 2009, 9(2): 120-122. DOI: 10.3969/j.issn.1009-6574.2009.02.010.
[16] 魏英玲,段晓琴.脑卒中发生部位对卒中患者摄食-吞咽功能及预后的影响[J].中国厂矿医学, 2009, 22(4): 415-416.
[17] 丛林,姜海涛.缺血性卒中后吞咽功能障碍相关危险因素的分析[J].中国脑血管病杂志, 2012, 9(8): 408-411. DOI: 10.3969/j.issn.1672-5921.2012.08.004.
[18] 张文英,原小平.脑卒中与吞咽困难严重度的关系[J].基层医学论坛, 2012, 16(8): 974-975.
[19] 王林玉.老年患者脑卒中后吞咽障碍危险因素及临床特点分析[J].中国实用神经疾病杂志, 2013, 16(8): 22-23. DOI: 10.3969/j.issn.1673-5110.2013.08.010.
[20] FLOWERS H L, SILVER F L, FANG J M, et al. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke[J].J Commun Disord, 2013, 46(3): 238-248. DOI: 10.1016/j.jcomdis.2013.04.001.
[21] 李巍,孟然,张国平,等.急性脑卒中患者脑损伤部位与吞咽障碍的关系[J].中华老年医学杂志, 2014, 33(11): 1179-1182. DOI: 10.3760/cma.j.issn.0254-9026.2014.11.008.
[22] 王文忠.225例急性脑卒中吞咽功能评估[J].中国医药导刊,2014,16(9):1199-1200. DOI: 10.3969/j.issn.1009-0959.2014.09.006.
[23] MAESHIMA S, OSAWA A, YAMANE F, et al. Dysphagia following acute thalamic haemorrhage: clinical correlates and outcomes[J]. Eur Neurol, 2014, 71(3/4): 165-172. DOI: 10.1159/000355477.
[24] BONILHA H S, SIMPSON A N, ELLIS C, et al. The one-year attributable cost of post-stroke dysphagia[J]. Dysphagia, 2014, 29(5): 545-552. DOI: 10.1007/s00455-014-9543-8.
[25] 邓晓清,蒋红焱,方芳,等.伴吞咽障碍的急性脑梗死患者营养及水合状况的变化[J].中华脑科疾病与康复杂志(电子版), 2015, 5(2): 84-89. DOI: 10.3877/cma.j.issn.2095-123X.2015.02.004.
[26] 张国栋,肖飞,吕昕.急性缺血性脑卒中后吞咽功能障碍发生率及危险因素的分析[J].中西医结合心脑血管病杂志, 2016, 14(8): 910-912. DOI: 10.3969/j.issn.1672-1349.2016.08.039.
[27] ARNOLD M, LIESIROVA K, BROEG-MORVAY A, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome[J]. PLoS One, 2016, 11(2): e0148424. DOI: 10.1371/journal.pone.0148424.
[28] AL-KHALED M, MATTHIS C, BINDER A, et al. Dysphagia in patients with acute ischemic stroke: early dysphagia screening may reduce stroke-related pneumonia and improve stroke outcomes[J]. Cerebrovasc Dis, 2016, 42(1/2): 81-89. DOI: 10.1159/000445299.
[29] EHSAAN F, KHAN M S G, MALIK S N, et al. Frequency of post-stroke dysphagia in Pakistan: a hospital based study[J]. J Pak Med Assoc, 2016, 66(10): 1281-1285.
[30] FANDLER S, GATTRINGER T, EPPINGER S, et al. Frequency and predictors of dysphagia in patients with recent small subcortical infarcts[J]. Stroke, 2017, 48(1): 213-215. DOI: 10.1161/STROKEAHA.116.015625.
[31] 李超,张梦清,窦祖林,等.中国特定人群吞咽功能障碍的流行病学调查报告[J].中华物理医学与康复杂志, 2017, 39(12): 937-943. DOI: 10.3760/cma.j.issn.0254-1424.2017.12.014.
[32] HENKE C, FOERCH C, LAPA S. Early screening parameters for dysphagia in acute ischemic stroke[J]. Cerebrovasc Dis, 2017, 44(5/6): 285-290. DOI: 10.1159/000480123.
[33] LOSURDO A, BRUNETTI V, BROCCOLINI A, et al. Dysphagia and obstructive sleep apnea in acute, first-ever, ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2018, 27(3): 539-546. DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.051.
[34] BEHARRY A, MICHEL P, FAOUZI M, et al. Predictive factors of swallowing disorders and bronchopneumonia in acute ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2019, 28(8): 2148-2154. DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.025.
[35] CARNABY G, SIA I, CRARY M. Associations between spontaneous swallowing frequency at admission, dysphagia, and stroke-related outcomes in acute care[J]. Arch Phys Med Rehabil, 2019, 100(7): 1283-1288. DOI: 10.1016/j.apmr.2019.01.009.
[36] STIPANCIC K L, BORDERS J C, BRATES D, et al. Prospective investigation of incidence and co-occurrence of dysphagia, dysarthria, and aphasia following ischemic stroke[J]. Am J Speech Lang Pathol, 2019, 28(1): 188-194. DOI: 10.1044/2018_AJSLP-18-0136.
[37] 曹猛,洪婧,梁丽,等.肢体肌力的变化对急性缺血性脑卒中患者吞咽障碍的预测价值[J].解放军护理杂志, 2020, 37(5): 61-64. DOI: 10.3969/j.issn.1008-9993.2020.05.015.
[38] 李苑媚,何任红,陈玉美,等.脑卒中急性期病人吞咽功能状况分析[J].护理研究, 2020, 34(9): 1644-1645. DOI: 10.12102/j.issn.1009-6493.2020.09.034.
[39] DE COCK E, BATENS K, HEMELSOET D, et al. Dysphagia, dysarthria and aphasia following a first acute ischaemic stroke: incidence and associated factors[J]. Eur J Neurol, 2020, 27(10): 2014-2021. DOI: 10.1111/ene.14385.
[40] ZHANG M Q, LI C, ZHANG F, et al. Prevalence of dysphagia in China: an epidemiological survey of 5943 participants[J]. Dysphagia, 2021, 36(3): 339-350. DOI: 10.1007/s00455-020-10138-7.
[41] KESER T, KOFLER M, KATZMAYR M, et al. Risk factors for dysphagia and the impact on outcome after spontaneous subarachnoid hemorrhage[J]. Neurocrit Care, 2020, 33(1): 132-139. DOI: 10.1007/s12028-019-00874-6.
[42] 曹猛,宋学梅,梁丽,等.急性缺血性脑卒中后吞咽障碍发病率及影响因素分析[J].护理学杂志, 2021, 36(2): 24-27. DOI: 10.3870/j.issn.1001-4152.2021.02.024.
[43] 林霞,刘月玲.标准吞咽功能评估及预见性护理对老年脑卒中吞咽障碍患者康复的影响[J].中国医药科学, 2018, 8(2):97-100.
[44] 罗美玲,谭红专,周权, 等.在R软件中实现单个率的Meta分析[J].循证医学, 2013, 13(3): 181-184, 188. DOI: 10.3969/j.issn.1671-5144.2013.03.014.