Root causes of aspiration risk in stroke patients with dysphagia: A correlation analysis from clinical assessment to real-world prognosis
脑卒中吞咽障碍误吸风险的真因挖掘——从临床评估到真实世界预后关联分析

摘要

目的 基于真实世界临床场景，挖掘脑卒中吞咽障碍患者误吸风险的核心影响因素，分析临床评估指标与真实世界预后的关联，构建针对性防控策略并验证其应用效果。方法 选取某三级甲等医院神经内科2022年10月-2025年10月收治的4000例脑卒中患者，采用回顾性队列研究设计，收集基线资料、吞咽功能评估（GUSS量表）及预后数据。通过单因素与多因素Logistic回归分析误吸独立危险因素，验证防控方案效果。结果 脑卒中吞咽障碍发生率37.50%，其吸入性肺炎发生率12.00%，显著高于无吞咽障碍组的1.00%（P＜0.001）。急性期肺炎占75.00%，隐性误吸是主要诱因，在两组中分别占75%和40%。年龄≥70岁、脑干卒中、GUSS评分≤8分及认知障碍是误吸的独立危险因素（P＜0.05）。结论 脑卒中吞咽障碍患者误吸风险受多因素影响，急性期与隐性误吸是防控关键。基于危险因素的个体化防控方案能有效降低误吸发生率，提升护理质量。

Abstract

Objective To identify the core influencing factors of aspiration risk in stroke patients with dysphagia based on real-world clinical scenarios, analyze the correlation between clinical assessment indicators and real-world prognosis, construct targeted prevention and control strategies, and verify their application effects.
Methods A retrospective cohort study was conducted on 4000 stroke patients admitted to the Department of Neurology of a tertiary-level hospital from October 2022 to October 2025. Baseline data, swallowing function assessment (GUSS scale), and prognostic data were collected. Univariate and multivariate logistic regression analyses were used to analyze independent risk factors for aspiration and to verify the effectiveness of the prevention and control strategies.
Results The incidence of dysphagia in stroke patients was 37.50%, with an aspiration pneumonia rate of 12.00%, significantly higher than the 1.00% in the group without dysphagia (P < 0.001). Acute pneumonia accounted for 75.00%, with silent aspiration being the main contributing factor, accounting for 75% and 40% in the two groups, respectively. Age ≥ 70 years, brainstem stroke, GUSS score ≤ 8, and cognitive impairment were independent risk factors for aspiration (P < 0.05).
Conclusion   The risk of aspiration in stroke patients with dysphagia is influenced by multiple factors, with acute aspiration and silent aspiration being key to prevention and control. Individualized prevention and control programs based on risk factors can effectively reduce the incidence of aspiration and improve the quality of nursing care.