康复病房亚急性卒中吞咽困难患者吞咽轨迹及影响因素：一项纵向研究
Swallowing trajectories and influencing factors among subacute stroke patients with dysphagia in rehabilitation wards: a longitudinal study.
文献信息
| PMID | 42812247 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yanan Zhu |
| 作者单位 | Department of Rehabilitation Medicine, Shandong Medical and Pharmaceutical University Hospital, Binzhou, China. |
| 期刊 | Frontiers in neurology |
| SCI 分区 | Q2 |
| IF | 3.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 康复训练对亚急性卒中吞咽困难患者至关重要。然而，关于入住康复病房后临床吞咽表现轨迹及相关影响因素的研究仍相当有限。本研究旨在识别该特定患者群体中的这些轨迹及影响因素。
方法： 采用便利抽样法，于2024年4月至2025年7月期间从康复病房招募了143例亚急性卒中吞咽困难患者。所有患者在入院24小时内完成基线评估，使用标准化吞咽评估（SSA）、口腔健康评估工具（OHAT）、2002营养风险筛查（NRS 2002）、疲劳严重程度量表（FSS）和患者健康问卷-9（PHQ-9）。随后在入院后第7、14、21和28天使用SSA重新评估临床吞咽表现。基于4周随访期间重复SSA评分，采用潜在类别增长模型（LCGM）识别不同的临床吞咽表现轨迹，并使用多项logistic回归分析其影响因素。
结果： 基于纵向SSA数据，住院康复中亚急性卒中吞咽困难患者的临床吞咽表现轨迹分为三组：轻度快速改善组（31%）、中度稳定改善组（41%）和重度缓慢改善组（28%）。年龄、口腔健康状况、抑郁和疲劳与轨迹归属显著相关。
结论： 亚急性住院卒中后吞咽困难患者表现出三种不同的临床吞咽表现轨迹，显示出显著的组间异质性。这些轨迹可能有助于早期风险分层和个体化护理计划。
英文摘要
BACKGROUND: Rehabilitation training is crucial for subacute stroke patients with dysphagia. However, research on trajectories of clinical swallowing performance and associated influencing factors following admission to rehabilitation wards remains quite limited. This study aimed to identify these trajectories and influencing factors among this specific patient population.
METHODS: A total of 143 subacute stroke patients with dysphagia were recruited from the rehabilitation ward between April 2024 and July 2025 by convenience sampling. All patients completed baseline assessments within 24 h of admission using the Standardized Swallowing Assessment (SSA), Oral Health Assessment Tool (OHAT), Nutritional Risk Screening 2002 (NRS 2002), Fatigue Severity Scale (FSS), and Patient Health Questionnaire-9 (PHQ-9). Clinical swallowing performance was then reassessed using the SSA at 7, 14, 21, and 28 days after admission. Latent class growth modeling (LCGM) based on repeated SSA scores over the 4-week follow-up was used to identify distinct clinical swallowing performance trajectories, and multinomial logistic regression was used to analyze their influencing factors.
RESULTS: Based on the longitudinal SSA data, the clinical swallowing performance trajectories of subacute stroke patients with dysphagia in inpatient rehabilitation were classified into three groups: a mild-rapid improvement group (31%), a moderate-steady improvement group (41%), and a severe-slow improvement group (28%). Age, oral health status, depression, and fatigue were significantly associated with trajectory membership.
CONCLUSION: Subacute inpatients with post-stroke dysphagia exhibit three distinct clinical swallowing performance trajectories, demonstrating significant group heterogeneity. These trajectories may assist in early risk stratification and individualized care planning.