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中国全科医学

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卒中后吞咽障碍预后影响因素的综合评估：一项伞形综述

李仪丙1，2，贾鸿博1，2，樊小农1，2，3，4*，赵文君1，2，刘巍1，2，葛文逸5，李宋姣1，2，雷康辰1，2，张梦龙1，2，张薇薇1，2，陈阳1，2，李礼1，2，3，4   

  1. 1.300381 天津，天津中医药大学第一附属医院针灸研究所 2.300381 天津，国家中医针灸临床医学研究中心 3.300381 天津，国家中医药管理局针刺量效关系实验室（三级） 4.300381 天津，天津市针灸学重点实验室 5.300120 天津，天津市中医院研究院附属医院脑病科
  • 收稿日期:2025-02-06 修回日期:2025-03-17 接受日期:2025-03-27
  • 通讯作者: 樊小农
  • 基金资助:
    国家自然科学基金项目(82374578); 天津市南开区中医药传承创新发展示范试点项目(20240204008); 天津市科技计划项目(21JCZDJC00890); 国家重点研发计划课题项目(2018YFC1705004)

Comprehensive Evaluation of Prognostic Factors Affecting Dysphagia after Stroke: An Umbrella Review

  • Received:2025-02-06 Revised:2025-03-17 Accepted:2025-03-27
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摘要： 背景　卒中后吞咽障碍是卒中常见且严重的并发症之一，可显著降低患者生活质量并增加死亡风险。目前研究提示多种因素与卒中后吞咽障碍预后相关，但相关证据的质量尚缺乏系统评估。目的　系统评估影响卒中后吞咽障碍预后的危险因素和保护因素，并明确各因素的证据质量。方法　检索PubMed、Web of Science、Cochrane、Embase、中国知网、万方、维普、中国生物医学文献库等8个数据库，纳入有关卒中后吞咽障碍预后影响因素的系统综述。采用AMSTAR 2量表评估文献质量，使用基于四级标准的分级方法对影响因素进行证据质量评价。对现有系统综述中所有相关原始研究的数据进行了整合，并使用STATA 16和Review Manager 5.4软件重新进行统计分析。结果　最终纳入5篇系统综述（39篇原始研究），涉及45个预后因素，其中仅1个因素（意识障碍）为强有力证据，年龄、性别、认知障碍、吞咽障碍严重程度、营养不良、双侧卒中、日常生活能力、NIHSS评分和mRS评分等9个因素为高提示性证据，其余因素均为弱证据。结论　卒中后吞咽障碍预后的影响因素可分为可逆因素与不可逆因素，临床干预可优先改善可逆因素以促进卒中后吞咽障碍康复。此外未来仍需更多高质量的研究以进一步验证这些因素的影响。

关键词: 卒中, 吞咽障碍, 预后, 影响因素, 伞形综述

Abstract: Background　Post-stroke dysphagia（PSD）is a common and severe complication of stroke，significantly reducing patients’ quality of life and increasing mortality risk. Although multiple factors have been proposed to correlate with PSD prognosis，the quality of evidence supporting these associations remains systematically underevaluated. Objective　To systematically evaluate risk and protective factors influencing PSD prognosis and assess the quality of evidence for each factor. Methods　Eight databases (PubMed，Web of Science，Cochrane，Embase，CNKI，Wanfang，VIP，and CBM) were searched to identify systematic reviews investigating prognostic factors for PSD. The methodological quality of the included reviews was appraised using the AMSTAR 2 checklist. A four-tiered evidence grading system was applied to evaluate the certainty of the prognostic factors. Data from all relevant original studies within the systematic reviews were synthesized and re-analyzed using STATA 16 and Review Manager 5.4. Results　Five systematic reviews (encompassing 39 original studies) were included，identifying 45 prognostic factors. Only one factor (impaired consciousness) was supported by strong evidence. Nine factors—age，sex，cognitive impairment，dysphagia severity，malnutrition，bilateral stroke，activities of daily living，NIHSS score，and mRS score—demonstrated highly suggestive evidence，while the remaining factors were supported by weak evidence. Conclusion　Prognostic factors for PSD can be categorized into reversible and irreversible determinants. Clinical interventions should prioritize modifiable factors to optimize rehabilitation outcomes. Further high-quality studies are warranted to validate these associations and refine evidence-based management strategies.

Key words: Stroke, Dysphagia, Prognosis, Influencing Factors, Umbrella Review

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