Study On The Influencing Factors Of The Severity Of Dysphagia After Stroke

Objective: This study hopes to analyze and understand the influencing factors of the severity of dysphagia after stroke,and compare the clinical characteristics of dysphagia after stroke in different parts of stroke,so as to provide the basis for the rehabilitation treatment of patients with dysphagia.Methods:In Liaoning Province,we selected the rehabilitation departments that had carried out rehabilitation treatment for more than three years in the past,collected the medical records of patients with dysphagia after stroke from January 2017 to December2018,and recorded the clinical characteristics and severity of stroke location and dysphagia of different patients.The survey included basic information,past history,current medical history of patients,including the current situation of stroke on admission,swallowing specialist examination and so on.Epi Data v3.1 was used to establish the database,and two persons and two persons entered the database for verification and comparison.Lesion location and swallowing status of selected post-stroke dysphagia patients were described by different statistical methods according to different variable types using SPSS24.0 software,and counting data were presented as number and percentile.In this study,the normal measurement data were analyzed by ANOVA,the counting data were analyzed by chi-square test,and the non parametric rank sum test is used for non normal measurement data and rank data.Factors influencing the severity of swallowing impairment after stroke were analyzed multivariate with ordinal logistic regression.Univariate analysis was used to analyze the association between lesion stroke location and patients’ swallowing clinical characteristics.P < 0.05 was taken as the testing level for statistics.Results:A total of 401 cases were included,of which 173,43.3%,were rated grade III by the water swallowing test,93,23.3%,were rated grade IV,and 134,33.5%,were rated grade V.And of which 192,47.8%,were rated grade III by the water swallowing test,93,23.3%,were rated grade IV,and 134,33.5%,were rated grade V.Including 192 cases(47.8%)in the anterior circulation(AC)group,130 cases(32.4%)in the posterior circulation(PC)group and 79 cases(19.7%)in the mixed(AC + PC)group.For ordinal multiple logistic regression analysis for dysphagia severity,the results showed that patients with the presence of the following factors had a relatively severe degree of dysphagia : the disappearance of the swallow initiation(OR= 17.167,95% CI:6.903 to 42.734,P<0.001),the delay of the swallow initiation(OR= 3.762,95%CI: 2.100 to 6.746,P <0.001),the disappearance of the lip and drum(OR= 2.901,95%CI:1.177～7.149,P=0.021),Attenuation of Supralaryngeal lifting(OR=2.898,95%CI:1.560～5.387,P=0.001),no problem in oral preparation(OR=3.666,95% CI:1.781～7.546,P<0.001),and the results showed that patients with the presence of the following factors had a relatively mild degree of dysphagia: Age 60 to 70 years(OR= 0.412,95% CI:0.177 to0.959,P = 0.040),site of onset in the anterior circulation(OR =0.494,95% CI: 0.267 to0.913,P = 0.024),and no problems in the oral phase(OR =0.271,95% CI: 0.130 to 0.563,P <0.001).Targeting the site of stroke onset in comparison with clinical indicators related to swallowing disorders concluded that there was a statistically significant difference between the mixed group in both the lingual body movement indicators and swallowing initiation,which were more severe proportions than the posterior circulation group(P =0.025 and 0.005,respectively).On the closed lip drum mumps,water swallowing test and cognitive impairment indexes,both the anterior circulation group and the mixed group were statistically different from the posterior circulation group(P=0.027 and 0.005,0.044 and 0.038 0.011 and 0.010,respectively).Other indicators did not exhibit statistical differences among the three groups.Conclusion: 1.The factors associated with the severity of swallowing disorders after stroke mainly include age,site of onset,initiation of swallowing,mumps of closed lip,lifting of larynx,oral phase problems and oral preparation phase problems,which should be paid attention to observation and prompt detection of the presence of swallowing disorders in patients after stroke.2.Patients in the mixed group had more prominent indicators of problems with swallowing impairment and should be given significant attention.Different site of onset and have different effects on clinical features associated with swallowing disorders.There is a great relationship between swallowing disorders and the location of stroke lesions.