Neuronale Regeneration nach akutem Schlaganfall mit schwerer neurogener oropharyngealer Dysphagie (NOD): eine Kaplan-Meier-Uberlebensanalyse

摘要

Background and Purpose:Dysphagia is estimated to occur in up to 50 % of the stroke neurorehabilitation population,Those patients with severe ncurogenic oropharyngeal dysphagia (NOD) may receive feeding gastrostomy tubes (FGT)if noninvasive therapies prove ineffective in eliminating aspiration or sustaining adequate nutritional intake. Our aim was to quantify the recovery of swallowing function after dysphagic stroke requiring FGT placement, and to identify variables predictive of survival for further analysis with the Kaplan-Meier method,Methods:We identified consecutive stroke patients with severe dysphagic stroke requiring FGT placement admitted to arehabilitation hospital between May 1998 and October 2001, The medical records were reviewed, and demo-graphic,clinical vidcoiluoroscopic (VSS) and neuroimaging information were abstracted. A follow-up telephone interview was performed to determine whether the FGT was still in use, had been removed, or if the patient had died, State death certificate records were reviewed to ascertain date of death for subjects who had expired by the time of follow-up.Univariate and multivariate analyses were performed in order to generate a Kaplan-Meier curve, Results:11.6% (77/664) of stroke patients admitted during the study period had severe dysphagic stroke with FGT insertion.Follow-up was available for 86% (66/77) of these individuals at a mean of two years after acute stroke. On follow-up 64% (42/66) of the patients were alive and 45% had had the FGT removed and resumed oral diets. On univariate analysis patients who were alive at the time of follow-up had received FGT feeding for a shorter period of time (p<0.0003) with a better discharge FIM-Score (Functional Independence Measure) for eating (DFIM-E; p<0.0002) and swallowing (DFAM-S; p<0,0001) as well as cognitive function (DFIM-C; p<0.002). On multivariate analysis we developed a Kaplan-Meier curve model consisting of non-aspiration during VSS (p<0.040) and I'GT removal at discharge from the rehabilitation hospital (p<0.011) that was significantly associ-aled with lousier survival time during follow-up.Conclusions: Severe dysphagia requiring FGT is common in patients with stroke referred for neurorehabilitation, Patients who had a FGT in place at the time of discharge from the stroke rehabilitation unit or aspirated during VSS were substantially more likely to have died by the time of follow-up compared to those who had had the FGT removed and had no signs of aspiration on VSS. However functional outcome measurements (FIM, FAM) including the cognitive function (attention, concentration etc.) could play an important role for the prediction of swallowing regeneration and survival after neurorehabilitation, These findings may have practical utility in guiding physicians and speech language pathologists when advising patients and families about prognosis in stroke survivors with severe dysphagia.