脳卒中後の嚥下障害の危険因子と嚥下機能訓練の効果評価

To investigate the independent risk factors of dysphagia after stroke, and to evaluate the clinical improvement of standardized swallowing function training.

Three hundred stroke patients admitted from January 2023 to January 2025 were enrolled, of whom 142 presented with dysphagia. All patients underwent videofluoroscopic swallowing study (VFSS), Risk factors, including age, muscle strength, and National Institute of Health stroke scale (NIHSS) score, were assessed by univariate and multivariate logistic regression analysis. Patients with dysphagia received multimodal swallowing training (neuromuscular electrical stimulation, tongue muscle resistance training, and cold stimulation) once daily for 4 weeks. Swallowing improvement was evaluated using water swallowing test (WST). Patient compliance and satisfaction were recorded.

VFSS score, upper esophageal sphincter (UES) openness, pharyngeal cavity constriction (PCR), age, muscle strength ≤ 3, and NIHSS ≥ 10 were identified as independent risk factors for dysphagia (P < 0.05). The overall effective rate of swallowing function training for dysphagia was 92.25%. Following intervention, the Standardized Swallowing Assessment (SSA) score decreased from 36.85 ± 5.67 to (24.56 ± 3.40), while WST grade reduced from (3.96 ± 0.83) to (1.74 ± 0.73), and VFSS parameters showed significant improvements in swallowing coordination. The overall compliance rate of the patients was 87.32%. Patient satisfaction rate was 92.96%, and the incidence of adverse reactions was 9.15%.

The multimodal swallowing training can preliminarily improve swallowing function. However, given the single-center, uncontrolled design, and the potential influence of spontaneous recovery, large-scale randomized controlled trials are warranted to confirm these findings.