Factors influencing and predictive value of rehabilitation treatment responsiveness in stroke patients with swallowing disorders
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摘要:
目的 分析脑卒中后吞咽障碍患者康复治疗反应性的相关影响因素，探讨可能导致康复治疗反应不良的潜在危险因素，为降低康复治疗反应不良提供理论基础。 方法 选取2021年1月—2023年1月于浙江省人民医院淳安分院接受康复治疗的脑卒中吞咽障碍患者314例为研究对象，根据康复治疗反应性分为反应良好组及反应不良组。采用单因素、多因素分析研究康复治疗反应性的影响因素，绘制ROC曲线验证影响因素对治疗反应性的预测价值。 结果 经康复治疗的314例脑卒中吞咽障碍患者中，83例患者康复治疗反应不良，231例患者康复治疗反应良好，反应不良发生率为26.43%。治疗反应良好组患者吞咽障碍病程短于反应不良组，依从性评分高于反应不良组，入院美国国立卫生研究院卒中量表(NIHSS)评分、洼田饮水试验评级(WST)评分、听觉障碍，感觉性失语发生率均低于反应不良组(P < 0.05)。多因素logistic回归分析显示，高入院NIHSS评分、高WST评分、吞咽功能障碍病程长为康复治疗反应的独立危险因素；高依从性为康复治疗反应的保护因素(P < 0.05)。ROC曲线分析显示，依从性评分、入院NIHSS评分、WST评分、吞咽障碍病程AUC分别为0.706、0.633、0.613、0.610，依从性评分的预测价值最高。 结论 依从性、入院NIHSS评分、WST评分、吞咽障碍病程均为脑卒中吞咽障碍患者康复治疗反应性的影响因素。 Abstract:Objective This study aims to analyze the factors influencing rehabilitation treatment responsiveness in post-stroke dysphagia patients, identify potential risk factors for adverse rehabilitation treatment reactions, and provide a theoretical basis for reducing adverse rehabilitation treatment reactions. Methods A total of 314 stroke patients with swallowing disorders who received rehabilitation treatment at the Chun ' an Branch of Zhejiang Provincial People ' s Hospital from January 2021 to January 2023 were selected as the study subjects. They were divided into a good response group and an adverse response group based on their rehabilitation treatment responsiveness. In order to explore the factors influencing rehabilitation treatment responsiveness, the univariate and multivariate analyses were conducted, and ROC curves were used to verify their predictive value. Results Among the 314 stroke patients with swallowing disorders who received rehabilitation treatment, 83 patients (26.43%) experienced adverse reactions to rehabilitation treatment, while 231 patients showed good reactions to rehabilitation treatment. The patients in the good response group had a shorter duration of swallowing disorders, higher compliance scores, and lower scores on the National Institute of Health stroke scale (NIHSS) and water swallowing test (WST) compared to those in the poor response group (P < 0.05). Multivariate logistic regression analysis showed that high admission NIHSS score, high WST score, and prolonged swallowing dysfunction were independent risk factors for rehabilitation treatment response, while high compliance was a protective factor for rehabilitation treatment response (P < 0.05). ROC analysis showed that the compliance score had the highest predictive value (AUC=0.706), followed by admission NIHSS score (AUC=0.633), WST score (AUC=0.613), and swallowing disorder course (AUC=0.610). Conclusion Compliance, admission NIHSS score, WST score, and duration of swallowing disorders are key factors influencing rehabilitation treatment responsiveness in stroke patients with swallowing disorders. -
Key words:
- Stroke /
- Swallowing disorders /
- Rehabilitation therapy /
- Predictive factors
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图 1 各因素预测脑卒中吞咽障碍患者康复治疗反应性的ROC曲线
Figure 1. ROC curves of various factors for predicting rehabilitation responsiveness in post-stroke patients with pharyngeal dysphagia
表 1 2组脑卒中吞咽障碍患者临床资料比较
Table 1. Comparison of clinical data between two groups of patients with post-stroke pharyngeal dysphagia
项目 反应良好组(n=231) 反应不良组(n=83) 统计量 P值 性别[例(%)] 2.031a 0.154 男性 182(78.79) 59(71.08) 女性 49(21.21) 24(28.92) 年龄(x±s, 岁) 63.26±10.22 61.42±10.68 1.362b 0.176 BMI(x±s) 24.63±1.65 24.37±1.71 1.199b 0.233 吸烟[例(%)] 100(43.29) 26(31.33) 3.638a 0.056 合并糖尿病[例(%)] 91(39.39) 30(36.14) 0.272a 0.602 合并高血压[例(%)] 77(33.33) 29(34.94) 0.071a 0.791 合并高脂血症[例(%)] 85(36.80) 22(26.51) 2.878a 0.090 依从性评分(x±s, 分) 97.14±1.22 96.29±1.11 5.826b < 0.001 入院NIHSS评分(x±s, 分) 10.12±3.24 11.68±3.21 3.788b < 0.001 听觉障碍[例(%)] 10(4.33) 9(10.84) 4.558a 0.033 感觉性失语[例(%)] 7(3.03) 8(9.64) 5.862a 0.015 卒中类型[例(%)] 0.214a 0.644 脑梗死 178(77.06) 66(79.52) 脑出血 53(22.94) 17(20.48) WST评分(x±s, 分) 3.14±1.02 3.54±1.01 2.816b 0.005 吞咽障碍病程(x±s, d) 15.14±2.11 16.08±2.31 3.252b 0.001 注：a为χ2值，b为t值。 
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表 2 各变量赋值情况
Table 2. Variable assignment
变量 赋值方法 依从性评分 连续变量，以实际值赋值 入院NIHSS评分 连续变量，以实际值赋值 听觉障碍 无=1，有=0 感觉性失语 无=1，有=0 WST评分 连续变量，以实际值赋值 吞咽障碍病程 连续变量，以实际值赋值 康复治疗反应性 反应不良=1，反应良好=0
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表 3 脑卒中吞咽障碍患者康复治疗反应的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis of rehabilitation response in stroke patients with pharyngeal dysphagia
变量 B SE Waldχ2 P值 OR值 95% CI 依从性评分 -0.625 0.127 24.128 < 0.001 0.535 0.417~0.687 入院NIHSS评分 0.152 0.045 11.542 0.001 1.164 1.067~1.271 听觉障碍 0.595 1.271 0.219 0.640 1.813 0.150~21.908 感觉性失语 -1.387 1.401 0.981 0.322 0.250 0.016~3.889 WST评分 0.404 0.143 7.985 0.005 1.498 1.132~1.984 吞咽障碍病程 0.222 0.069 10.378 0.001 1.248 1.091~1.429
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