作者：燕春花，魏莉，李国庆，王伟韬，胡喜莲

单位：

100144北京市，首都医科大学附属北京康复医院老年康复中心

Units：

Department of Gerontology, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing 100144, China

关键词：

脑卒中；吞咽障碍；经皮胃造瘘术；生存质量；影响因素分析；干预策略

Keywords：

Stroke; Deglutition disorders; Percutaneous endoscopic gastrostomy; Quality of life; Root cause analysis;Intervention strategies

CLC：

R 743　R 571

DOI：

10.12114/j.issn.1008-5971.2022.00.233

Funds：

北京市残疾人联合会基金（GFTC18AA0252/01）；首都医科大学附属北京康复医院临床专项（2020-044）

摘要：

目的　探讨脑卒中吞咽障碍患者经皮胃造瘘术（PEG）后生存质量的影响因素。方法　本研究为前瞻性研究。采用便利抽样法选取2018年1月至2021年9月在首都医科大学附属北京康复医院行PEG的脑卒中吞咽障碍患者130例。采用自行设计的一般资料问卷、社会支持评定量表（SSRS）、微型营养评定简表（MNA-SF）分别调查患者的一般资料、社会支持水平及营养状况，采用健康状况调查问卷（SF-36）调查患者PEG后3个月生存质量。脑卒中吞咽障碍患者PEG后生存质量的影响因素分析采用单因素、多因素Logistic回归分析。结果　本研究失访5例患者，最终纳入125例患者，其中生存质量良好87例（生存质量良好组），生存质量不良38例（生存质量不良组）。两组年龄、家庭人均月收入、脑卒中病程、糖尿病发生率、有跌倒史者占比、造口并发症发生率、接受造口者占比及社会支持水平比较，差异有统计学意义（P ＜0.05）。单因素Logistic回归分析结果显示，年龄、糖尿病、造口并发症及高水平社会支持是脑卒中吞咽障碍患者PEG后生存质量的可能影响因素（P ＜0.05）；多因素Logistic回归分析结果显示，年龄＞60岁〔OR =9.742，95%CI （2.960，32.056）〕、糖尿病〔OR =5.037，95%CI （1.643，15.441）〕、造口并发症〔OR =4.477，95%CI （1.640，12.224）〕是脑卒中吞咽障碍患者PEG后生存质量的危险因素，高水平社会支持〔OR =0.165，95%CI （0.047，0.574）〕是脑卒中吞咽障碍患者PEG后生存质量的保护因素（P ＜0.05）。结论　年龄＞60岁、糖尿病、造口并发症是脑卒中吞咽障碍患者PEG后生存质量的危险因素，高水平社会支持是脑卒中吞咽障碍患者PEG后生存质量的保护因素。医护人员应提高风险预警意识，加强管理可控制的危险因素，以改善脑卒中吞咽障碍患者PEG后生存质量。

Abstract：

Objective　To investigate the influencing factors of quality of life in stroke patients with deglutitiondisorders after percutaneous endoscopic gastrostomy (PEG) .Methods　This study was a prospective study. From January 2018 to September 2021, 130 stroke patients with deglutition disorders who underwent PEG in Beijing Rehabilitation Hospital Affiliated to Capital Medical University were selected by convenient sampling method. The self-designed general information questionnaire,Social Support Rating Scale (SSRS) , Mini Nutritional Assessment Short Form (MNA-SF) were used to investigate the generalinformation, social support level and nutritional status of patients. The quality of life at 3 months after PEG was evaluated by the MOS Item Short Form Health Survey (SF-36) . The influencing factors of quality of life in stroke patients with deglutition disorders after PEG were analyzed by univariate and multivariate Logistic regression analysis.Results　In this study, 5 patients were lostto follow-up, and 125 patients were finally included, including 87 patients with good quality of life (group A) and 38 patientswith poor quality of life (group B) . There were significant differences in the age, per capita monthly income of families, course ofstroke, incidence of diabetes, proportion of patients with history of falls, incidence of stoma complications, proportion of patientsreceiving stoma and social support level between the two groups (P < 0.05) . Univariate Logistic regression analysis showed thatage, diabetes, stoma complications and high level of social support were the possible influencing factors of quality of life in strokepatients with deglutition disorders after PEG (P < 0.05) ; multivariate Logistic regression analysis showed that age > 60 years old[OR =9.742, 95%CI (2.960, 32.056) ] , diabetes [OR =5.037, 95%CI (1.643, 15.441) ] , stoma complications [OR =4.477, 95%CI(1.640, 12.224) ] were risk factors of quality of life in stroke patients with deglutition disorders after PEG, high level of social support [OR =0.165, 95%CI (0.047, 0.574) ] was protective factor of quality of life in stroke patients with deglutition disorders after PEG (P < 0.05) .Conclusion　Age > 60 years old, diabetes and stoma complications are the risk factors of quality of life in stroke patients with deglutition disorders after PEG, and high level of social support is the protective factor of quality of life instroke patients with deglutition disorders after PEG. Medical staff should enhance the awareness of risk warning and strengthen themanagement of controllable risk factors so as to improve the quality of life of patients.

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