老年脑卒中病人肌少症与卒中后吞咽功能障碍的相关性研究

doi:10.3969/j.issn.1003-9198.2023.09.020

摘要/Abstract

摘要： 目的分析肌少症与老年脑卒中病人卒中后吞咽功能障碍的相关性。方法选取2019年11月至2021年4月我院收治的119例老年脑卒中病人为研究对象,入院后24 h内接受肌少症简易五项评分问卷(SARC-F)调查,并采用标准吞咽功能评估量表(SSA)评估卒中后的吞咽功能,根据是否发生卒中后吞咽功能障碍分为吞咽功能障碍组和非吞咽功能障碍组,并分析肌少症与卒中后吞咽功能障碍之间的相关性。采用Logistic回归分析卒中后吞咽功能障碍的影响因素。结果 119例老年脑卒中病人肌少症发生率为21.01%,卒中后吞咽功能障碍发生率为35.29%;吞咽功能障碍组和非吞咽功能障碍组间年龄,合并糖尿病、慢性心力衰竭、肾功能衰竭、营养不良、肌少症及每天活动时间＞30 min的比例差异有统计学意义(P<0.05);老年脑卒中病人SARC-F评分与SSA评分呈显著正相关(r=0.624,P<0.01);Logistic回归分析显示,年龄> 70岁、糖尿病、慢性心力衰竭、营养不良、肌少症是老年脑卒中后发生吞咽功能障碍的危险因素(P＜0.05)。结论肌少症是卒中后吞咽功能障碍发生的高危因素,评估老年脑卒中病人肌少症发生情况有助于临床判断卒中后发生吞咽功能障碍的风险。

关键词: 肌少症, 吞咽功能障碍, 老年人, 脑卒中, 影响因素

Abstract: Objective To analyze the correlation between sarcopenia and post-stroke swallowing dysfunction in the elderly patients with stroke. Methods A total of 119 elderly patients with stroke admitted to our hospital from November 2019 to April 2021 were enrolled in this study, and the sarcopenia and post-stroke swallowing dysfunction of the patients was assessed within 24 h after admission using the myalgia simple five-item score questionnaire(SARC-F) and the Standardized Swallowing Assessment scale (SSA) respectively. The patients were divided into swallowing dysfunction group and non-swallowing dysfunction group, and the correlation between sarcopenia and post-stroke swallowing dysfunction was analyzed. Logistic regression analysis was used to analyze the influencing factors of post-stroke swallowing dysfunction. Results The incidence rate of sarcopenia in 119 elderly stroke patients was 21.01%, and the incidence rate of post-stroke swallowing dysfunction was 35.29%. There were significant differences in age, and the proportion of diabetes mellitus, chronic heart failure, malnutrition, activity time ＞30 min and sarcopenia between swallowing dysfunction group and non-swallowing dysfunction group(P<0.05). The score of SARC-F was significantly associated with SSA score in the elderly patients with stroke (r=0.624, P<0.01); Logistic regression analysis showed that age > 70 years, diabetes mellitus, chronic heart failure, malnutrition and sarcopenia were the risk factors for the development of swallowing dysfunction after stroke in the elderly (P<0.05). Conclusions Sarcopenia is a high-risk factor for the development of post-stroke swallowing dysfunction. Assessing the occurrence of sarcopenia can be helpful for clinical judgment of the risk of swallowing dysfunction after stroke in elderly.

Key words: sarcopenia, swallowing dysfunction, aged, stroke, influencing factors

中图分类号:

R 743.32

陈礼荣, 叶晓莉. 老年脑卒中病人肌少症与卒中后吞咽功能障碍的相关性研究[J]. 实用老年医学, 2023, 37(9): 947-950.

CHEN Li-rong, YE Xiao-li. Correlation between sarcopenia and post-stroke swallowing dysfunction in elderly patients with stroke[J]. Practical Geriatrics, 2023, 37(9): 947-950.

参考文献

[1] 王陇德,彭斌,张鸿祺,等.《中国脑卒中防治报告2020》概要[J].中国脑血管病杂志,2022,19(2):136-144.
[2] 齐琲,张振香,王永利,等. 老年脑卒中住院患者吞咽体验与衰弱和营养状况的相关性[J]. 中国康复理论与实践,2020,26(11):1269-1274.
[3] 李博宁,陈健尔. 肌少症相关吞咽障碍的研究进展[J]. 中国康复理论与实践,2020,26(3):344-349.
[4] XU Z, GU Y, LI J, et al. Dysphagia and aspiration pneumonia in elderly hospitalization stroke patients: risk factors, cerebral infarction area comparison[J]. J Back Musculoskelet Rehabil, 2019;32(1):85-91.
[5] 饶明俐. 中国脑血管病防治指南[M]. 北京:人民卫生出版社, 2007:126.
[6] CRUZ-JENTOFT A J, BAHAT G, BAUER J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis[J]. Age Ageing,2019,48(1):16-31.
[7] CHEN L K, WOO J, ASSANTACHAI P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020,21(3):300-307.
[8] 孙伟平,黄一宁,王峥,等. 标准吞咽功能评估在卒中后误吸筛查中的应用价值[J]. 中国康复理论与实践,2009,15(4):345-347.
[9] 黄艳能,毛忠南,高嘉敏,等. 肌少症性吞咽障碍生理病理机制及治疗进展[J]. 中国临床研究,2022,35(8):1151-1155,1158.
[10] SAKAI K, NAKAYAMA E, TOHARA H, et al. Diagnostic accuracy of lip force and tongue strength for sarcopenic dysphagia in older inpatients: a cross-sectional observational study[J]. Clin Nutr, 2019,38(1):303-309.
[11] CHA S, KIM W S, KIM K W, et al. Sarcopenia is an independent risk factor for dysphagia in community-dwelling older adults[J]. Dysphagia, 2019,34(5):692-697.
[12] 李雯艳,路娜,阮海慧,等. 老年人肌少症性吞咽障碍患病率及危险因素的系统评价[J]. 实用老年医学,2022,36(4):390-394.
[13] 薄莹莹,莫永珍,欧阳晓俊,等. 老年肌少症住院病人合并吞咽功能障碍的影响因素分析[J]. 实用老年医学,2022,36(6):632-635.
[14] MAEDA K, TAKAKI M, AKAGI J. Decreased skeletal muscle mass and risk factors of sarcopenic dysphagia: a prospective observational cohort study[J]. J Gerontol A Biol Sci Med Sci, 2017,72(9):1290-1294.
[15] 王坤,罗炯,刘立,等.老年人肌少症的成因、评估及应对[J].中国组织工程研究,2019,23(11):1767-1773.
[16] MACHIDA N, TOHARA H, HARA K, et al. Effects of aging and sarcopenia on tongue pressure and jaw-opening force[J]. Geriatr Gerontol Int, 2017,17(2):295-301.
[17] 石敏,张娜娜,王琼,等. 老年2型糖尿病患者肌肉减少症发生及其影响因素[J]. 中国老年学杂志,2021,41(19):4182-4185.
[18] 薛刚,吴永华,王敏红,等. 老年慢性心力衰竭病人并发肌少症的相关因素分析[J]. 实用老年医学,2020,34(12):1266-1269.
[19] 雷振,刘景芳. 养老院老年住户营养不良状况和吞咽障碍之间关系的调查研究[J]. 中国临床保健杂志,2020,23(6):801-803.