Risk factors for pulmonary infection among stroke survivors with dysphagia / 中华物理医学与康复杂志

ABSTRACT

Objective:To analyze the risk factors for aspiration pneumonia among persons with post-stroke dysphagia.Methods:A total of 105 dysphagic stroke survivors were examined using videofluoroscopy. Those suffering from aspiration pneumonia constituted a pneumonia group, and the others were a non-pneumonia group. Univariate and multivariate logistic regression were conducted using data on nasal feeding, pharyngeal transit time (PTT), pharyngeal remnants, active coughing, diet adjustment and Rosenbek Penetration-aspiration Scale (PAS) scores to analyze the risk factors for aspiration pneumonia.Results:There were 29 in the pneumonia group and 76 in the non-pneumonia group. Significant age differences were observed between the two groups, and also significant differences in the location of the stroke, the course of the disease, the incidence of diabetes mellitus, nasal feeding, active coughing, PAS score, PTT, pharyngeal remnants and diet adjustment. But there were no significant differences in gender, Kubota drinking water grade, the incidence of hypertension or atrial fibrillation, or leukocyte count. Univariate analysis showed that stroke site, age≥65, type 2 diabetes, nasal feeding, active coughing, diet adjustment, a PAS score >6, prolonged PTT and pharyngeal residue were all significant predictors of pneumonia. Multivariate logistic analysis indicated that the incidence of pneumonia was significantly higher in patients with a brainstem or bilateral stroke than among those with unilateral stroke. Patients older than 64, with a PAS score >6, pharyngeal residue or prolonged PTT were at significantly greater risk of coming down with pneumonia, though active coughing was correlated with lower risk.Conclusions:Age >64, bilateral or brainstem stroke, a PAS score >6, prolonged pharyngeal transit time and pharynx remnants are independent risk factors for aspiration pneumonia among dysphagic stroke survivors, while active cough is a protective factor.