基于LASSO回归的缺血性脑卒中经鼻喂养患者吞咽障碍恢复的影响因素分析-现代医学

基于LASSO回归的缺血性脑卒中经鼻喂养患者吞咽障碍恢复的影响因素分析

单位：1. 成都医学院护理学院, 四川成都 610500;
2. 成都市第一人民医院护理部, 四川成都 610095

分类号：R473.5

出版年·卷·期（页码）：2024·52·第六期（858-865）

摘要：

目的： 探讨缺血性脑卒中经鼻喂养患者吞咽障碍恢复的影响因素。方法： 采用便利抽样法，回顾性分析2018年5月—2022年4月成都医学院第一附属医院收治的因吞咽障碍接受鼻胃管喂养的缺血性脑卒中患者的临床资料，根据出院时的洼田饮水试验结果将其分为预后不良组(n=111)与预后良好组(n=176)。采用LASSO回归与多因素Logistic回归分析探讨脑卒中后经鼻喂养患者吞咽障碍康复的影响因素。结果： 最终纳入287例患者，共111(38.68%)例患者发生吞咽障碍预后不良。患者的平均住院时间为(18.71±11.49)天，平均院内鼻胃管喂养时间为(13.36±9.71)天。多因素Logistic回归结果显示，年龄＞70岁[OR(95%CI)=4.86(2.32~10.17),P＜0.001]、中风次数＞2次[OR(95%CI)=5.65(1.63~19.50),P=0.006]、既往高血压[OR(95%CI)=11.65(5.23~25.95),P＜0.001]、电解质紊乱[OR(95%CI)=7.20(3.53~14.67),P＜0.001]、气管插管[OR(95%CI)=2.88(1.15~7.23),P=0.024]、入院时的NIHSS评分[OR(95%CI)=6.24(1.11~34.99),P=0.038]和入院时的Barthel指数[OR(95%CI)=0.06(0.01~0.47),P=0.007]是缺血性脑卒中经鼻喂养患者吞咽障碍恢复的影响因素(P＜0.05)。结论： 应从年龄、中风次数、既往高血压、电解质紊乱、气管插管、入院时的NIHSS评分和入院时的Barthel指数等方面对缺血性脑卒中经鼻喂养患者进行综合评估，筛选预后不良的高风险患者，制定个体化的治疗方案进行精准干预，以改善其疾病预后。

Objective: To investigate the influencing factors of swallowing disorders rehabilitation in ischemic stroke patients receiving nasogastric feeding. Methods: Using convenience sampling method, the clinical data of patients admitted to the First Affiliated Hospital of Chengdu Medical College after ischemic stroke who received nasogastric tube feeding for swallowing disorder from May 2018 to April 2022 were retrospectively analyzed and divided into a poor prognosis group(n=111) and a good prognosis group(n=176) based on the results of the Water Swallowing Test at the time of discharge. LASSO regression and multivariate Logistic regression analysis were explored to identify factors influencing the rehabilitation of swallowing disorders in post-stroke patients undergoing nasogastric feeding. Results: A total of 287 patients were included, with 111(38.68%) patients experiencing poor prognosis of swallowing disorders. The mean length of stay of the patients was(18.71±11.49) days, and the mean in-hospital nasogastric tube feeding time was(13.36±9.71) days. Multivariate Logistic regression analysis results showed that: age>70 years[OR(95%CI)=4.86(2.32-10.17), P＜0.001], number of strokes>2 [OR(95%CI)=5.65(1.63-19.50), P=0.006], previous hypertension[OR(95%CI)=11.65(5.23-25.95), P＜0.001], electrolyte disturbance[OR(95%CI)=7.20(3.53-14.67), P＜0.001], tracheal intubation[OR(95%CI)=2.88(1.15-7.23), P=0.024], NIHSS score at admission[OR(95%CI)=6.24(1.11-34.99), P=0.038], and Barthel index at admission[OR(95%CI)=0.06(0.01-0.47), P=0.007] were independent influencing factors of poor prognosis in ischemic stroke patients with swallowing disorders undergoing nasogastric feeding. Conclusions: Comprehensive assessment should be conducted among ischemic stroke patients receiving nasogastric feeding, focusing on age, stroke frequency, previous hypertension, electrolyte disturbances, tracheal intubation, NIHSS score at admission, and Barthel index at admission, is crucial for identifying high-risk patients with poor prognosis. Individualized treatment plans should be formulated for these patients to facilitate precise interventions and ultimately improve their disease outcomes related to swallowing disorders rehabilitation.

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