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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Predictors of Percutaneous Endoscopic Gastrostomy Placement in Acute Ischemic Stroke
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Predictors of Percutaneous Endoscopic Gastrostomy Placement in Acute Ischemic Stroke

机译：急性缺血性卒中经皮内窥镜胃术预测的预测因素

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Background:Dysphagia is a common complication of stroke and can have a lasting impact on morbidity and mortality; yet there are no standards to guide dysphagia management in stroke patients. We assessed predictors of percutaneous endoscopic gastrostomy (PEG) placement in an ischemic stroke cohort and sought to determine the utility of an objective scale in predicting PEG placement in a high-risk sub-set.Methods:Consecutive cases of ischemic stroke were retrospectively, identified and demographic and clinical variables were collected. Penetration-Aspiration (PAS) scores (1-2 normal; 3-5 penetration; 6-8 aspiration) were calculated for patients undergoing Fiberoptic Endoscopic Evaluation of Swallowing (FEES) or Modified Barium Swallowing Studies (MBSS). Multiple logistic regression analysis was used to assess predictors of PEG placement.Results: Among 724 patients, 131 underwent PEG placement. In univariate analysis of the overall cohort, sex, age, insured payer status, arrival National Institute of Health Stroke Scale (NIHSS), NIHSS level of consciousness severity, NIHSS dysarthria severity, diabetes mellitus, and prior International Conference for Harmonization (ICH) were all significantly associated with PEG placement. Among 197 high-risk patients undergoing FEES or MBSS, the multivariate logistic regression analysis showed that PAS scores 6-8 versus 1-2 (odds ratio [OR] 13.2; 95% confidence interval [CI] 4.58, 38.2), PAS score 3-5 versus 1.2 (OR 33.8; 95% CI 11.6, 98.3), Hispanic race (OR, 5.73; 95% CI 1.82, 18.0), male sex (OR, 2.59; 95% CI 1.05, 6.34), and arrival NIHSS (OR, 1.11; 95% CI 1.05, 1.18) were associated with PEG placement.Conclusions: Use of an objective dysphagia scale simplified the prediction model among acute ischemic stroke patients undergoing instrumental assessments of dysphagia with FEES or MBSS. Male sex and Hispanic race were also significantly associated with PEG placement in this analysis. These findings support the need for rigorously designed prospective studies to assess biological and social factors that influence PEG placement and to determine, how to best evaluate and manage patients with dysphagia.
机译：背景：吞咽困难是卒中的常见并发症，可以对发病率和死亡产生持久的影响;然而，没有标准在中风患者中引导吞咽症管理。我们评估了缺血性卒中队列中经皮内窥镜胃术（PEG）放置的预测因子，并试图确定客观规模的效用在高风险的亚置中预测PEG放置。方法：回顾性地，鉴定了连续的缺血性脑卒中病例并收集人口统计和临床变量。针对经历吞咽（费用）或改性钡吞咽研究（MBSS）的纤维内窥镜评估患者计算渗透 - 抽吸（PAS）评分（1-2正常; 3-5次渗透; 6-8次吸附）。使用多元逻辑回归分析来评估PEG展示率的预测因子。结果：724名患者中，131名接受PEG放置。在单变量分析整体队列的分析中，性别，年龄，保险人的状态，到达国家卫生冲程量表（NIHSS），NIHSS患者的严重程度，NIHSS Dysthria严重程度，糖尿病Mellitus和事先国际协调会议（ICH）是所有这些都与PEG放置有显着相关。在接受费用或MBS的197例高风险患者中，多变量逻辑回归分析显示PAS分数6-8与1-2（差距[或] 13.2; 95％置信区间[CI] 4.58,38.2），PAS得分3 -5对1.2（或33.8; 95％CI 11.6,98.3），西班牙裔比赛（或5.73; 95％CI 1.82,18.0），男性（或2.59; 95％CI 1.05,6.34）和到达NIHSS（或者，1.11; 95％CI 1.05,1.18）与PEG展示率相关联。结论：使用客观的吞咽尺度，简化了急性缺血性卒中患者的预测模型，急性缺血性患者进行了患有费用或MBSS的困难评估。男性性别和西班牙裔比赛也与本分析中的PEG放置有显着相关。这些调查结果支持需要严格设计的前瞻性研究，以评估影响PEG放置和确定如何最佳评估和管理吞咽患者的生物和社会因素。

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