住院復健期腦中風患者吞嚥困難之決定因子探討

The Determinants of Dysphagia in Patients With Stroke During Hospitalized Rehabilitation

背景腦中風是國人第三大死因，研究發現中風復健期53.61%患者有咀嚼吞嚥障礙，可能導致肺吸入而致死，而國內住院復健期腦中風患者吞嚥困難的決定因子，仍欠缺完整性之探討。目的探討住院復健期腦中風患者吞嚥困難的發生率及其決定因子。方法本研究採描述性相關性研究設計，以方便取樣自北部某地區醫院復健科病房130位住院腦中風患者，以問卷及功能性評估進行資料收集，工具包括：個人特徵與臨床特徵資料問卷、美國國衛院腦中風量表、巴氏量表、認知狀態量表、老人憂鬱量表、標準化吞嚥評估表（Standardization SwallowingAssessment, SSA）及急性腦中風患者吞嚥困難篩檢表（Acute Stroke Dysphagia Screening, ASDS），資料分析包含描述性統計及羅吉斯迴歸分析。結果腦中風吞嚥困難發生率分別為63.8%（SSA）與64.6%（ASDS），雙變項羅吉斯迴歸顯示，年齡、婚姻狀態、中風部位、中風嚴重度及認知狀態，為吞嚥困難的顯著決定因子；而多變項羅吉斯迴歸分析發現，中風嚴重度和認知狀態是顯著獨立決定因子。結論／實務應用腦中風復健期患者吞嚥困難的發生率為2/3，中風嚴重度和認知狀態是顯著決定因子，故護理人員可依患者的臨床特徵，早期篩選出高危險群，以減少吸入性肺炎問題，並改善吞嚥困難患者的臨床照護品質。

Background: Stroke was the third leading cause of death in Taiwan in 2014. A study found that 53.61% of stroke patients suffered from dysphagia disorder during the rehabilitation phase, which may result in lung aspiration and death. The determinants of dysphagia among nationally hospitalized-rehabilitation stroke patients have not been explored comprehensively. Purposes: To explore the incidence of dysphagia among hospitalized-rehabilitation stroke patients and the related determinants of dysphagia. Methods: This descriptive and correlational research design employed a convenience sample of 130 hospitalized stroke patients from rehabilitation wards at a northern regional hospital in Taiwan. A questionnaire and functional assessment were used to collect data. Instruments used included personal and clinical characteristics data questionnaire, the National Institute of Health Stroke Scale (NIHSS), Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Standardization Swallowing Assessment (SSA), and Acute Stroke Dysphagia Screening (ASDS). Data analyses contained descriptive statistics and logistic regression. Results: The incidence of stroke dysphagia was 63.8% (SSA) and 64.6% (ASDS), respectively. Age, marital status, stroke site, stroke severity (NIHSS), and cognitive status (MMSE) were identified as significant determinants of dysphagia in bivariate logistic regression, whereas stroke severity and cognitive status were identified as significant independent determinants of dysphagia in multivariate logistic regression. Conclusions/Implications for Practice: Two-thirds of the participant sample were affected by dysphagia, for which NIHSS and cognitive status were identified as significant determinants. Thus, nurses may conduct early screening for high risk populations based on patients’ clinical characteristics in order to reduce aspiration pneumonia problems and to improve the quality of clinical care for dysphagia patients.