老年脑卒中患者吞咽功能异常对衰弱的中介效应分析-现代医学

老年脑卒中患者吞咽功能异常对衰弱的中介效应分析

单位：首都医科大学附属北京康复医院神经康复中心, 北京 100144

分类号：R742

出版年·卷·期（页码）：2025·53·第十一期（1751-1757）

摘要：

目的：探究老年脑卒中患者吞咽功能异常对衰弱的中介效应。方法：纳入2021年6月—2024年6月首都医科大学附属北京康复医院的老年脑卒中患者110例为研究对象，采用埃德蒙顿衰弱量表(EFS)、洼田饮水试验、日常生活能力量表(ADL)、简易精神量表(MMSE)、微型营养评定简表(MNA-SF)、老年抑郁量表(GDS)分别评估患者的衰弱状况、吞咽功能、日常生活能力、认知功能、营养状态、抑郁状态。采用Logistic回归分析老年脑卒中患者衰弱的影响因素，采用卡方检验比较不同吞咽功能状态的患者生活能力、认知功能、营养状态、抑郁状态的差异。以衰弱状况为因变量，吞咽功能为自变量，生活能力受损、认知功能障碍、营养不良、存在抑郁为中介变量，性别、高血压史、糖尿病史、卒中发作次数、卒中严重程度为协变量进行中介效应分析。结果： 110例老年脑卒中患者中无衰弱38例、衰弱前期32例、衰弱40例，吞咽功能正常52例、吞咽功能异常58例。男性，有高血压、糖尿病，卒中发作次数≥2次，中重度卒中，吞咽功能异常，生活能力受损，认知功能障碍，营养不良和抑郁的老年脑卒中患者衰弱比例更高(P＜0.05)；Logistic回归分析结果显示，糖尿病，卒中发作次数≥2次，中重度卒中，吞咽功能异常，生活能力受损，认知功能障碍，营养不良和抑郁是老年脑卒中患者衰弱的危险因素(均P<0.05)。吞咽功能异常的老年脑卒中患者中生活能力受损，认知功能障碍，营养不良和抑郁状态比例显著高于吞咽功能正常患者(均P<0.05)。中介效应分析结果显示，吞咽功能异常影响老年脑卒中患者衰弱的直接效应值为0.800，占总效应值的46.80%；通过生活能力受损、认知功能障碍、营养不良、抑郁间接影响衰弱的中介效应值分别为0.257、0.406、0.525、0.387，分别占总效应值的20.54%、9.78%、13.23%、9.65%。结论：老年脑卒中患者吞咽功能异常不仅可直接增加患者的衰弱风险，还可通过生活能力受损、认知功能障碍、营养不良、抑郁间接增加患者的衰弱风险。老年脑卒中患者存在吞咽功能异常时应积极改善其生活能力、认知功能、营养状态、抑郁水平，以降低衰弱的发生风险。

Objective: To explore the mediating effect of dysphagia on frailty in elderly stroke patients. Methods: A total of 110 elderly stroke patients in Beijing Rehabilitation Hospital Affiliated to Capital Medical University from Jun. 2021 to Jun. 2024 were enrolled. The patients' frailty, swallowing function, activities of daily living, cognitive function, nutritional status and depression were evaluated by the Edmonton frailty scale(EFS), the Watanabe Drinking Test, the activities of daily living scale(ADL), the mini mental state scale(MMSE), the mini nutritional assessment-short form(MNA-SF) and the Geriatric Depression Scale(GDS), respectively. Logistic regression was used to analyze the influencing factors of frailty in elderly stroke patients. Chi-square test was used to compare activities of daily living, cognitive function, nutritional status and depression in patients with different swallowing functions. The mediating effect was analyzed with frailty as the dependent variable, swallowing function as the independent variable, impaired activities of daily living, cognitive impairment, malnutrition and depression as the mediating variables, and gender, hypertension, diabetes mellitus, stroke frequency and stroke severity as the covariates. Results: Among the 110 elderly stroke patients, 38 had no frailty, 32 had pre-frailty, 40 had frailty； 52 had normal swallowing function, and 58 had dysphagia. The prevalence of frailty was significantly higher among elderly stroke patients who were male, had hypertension or diabetes mellitus, experienced ≥2 stroke, presented with moderate-to-severe stroke, exhibited dysphagia, had impaired activities of daily living, cognitive dysfunction, malnutrition, or depression(P<0.05). Logistic regression analysis showed that diabetes mellitus, ≥2 stroke, moderate-to-severe stroke, dysphagia, impaired activities of daily living, cognitive dysfunction, malnutrition and depression were risk factors for frailty in elderly stroke patients(all P<0.05). The prevalence of impaired activities of daily living, cognitive dysfunction, malnutrition and depression was significantly higher in elderly stroke patients with dysphagia than in those with normal swallowing function(all P<0.05). The mediating effect analysis showed that the direct effect of dysphagia on frailty in the elderly stroke patients was 0.800, accounting for 46.80% of the total effect. The mediating effects of impaired activities of daily living, cognitive impairment, malnutrition and depression were 0.257, 0.406, 0.525 and 0.387, respectively, accounting for 20.54%, 9.78%, 13.23% and 9.65% of the total effect. Conclusion: Dysphagia in elderly stroke patients can increase the risk of frailty not only directly but also indirectly through impaired activities of daily living, cognitive dysfunction, malnutrition and depression. When dysphagia is present, interventions should target these mediators—activities of daily living, cognition, nutrition and depressive symptoms—to reduce the risk of frailty.

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