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

doi:10.12114/j.issn.1007-9572.2025.0063

Chinese General Practice ›› 2025, Vol. 28 ›› Issue (29): 3631-3637.DOI: 10.12114/j.issn.1007-9572.2025.0063

• Dysphagia Section • Previous Articles Next Articles

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

1. Institute of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
2. National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
3. Laboratory of Dose-Effect Relationship, National Administration of Traditional Chinese Medicine (Level 3), Tianjin 300381, China
4. Tianjin Key Laboratory of Acupuncture and Moxibustion, Tianjin 300381, China
5. Department of Encephalopathy, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China

Received:2025-04-10 Revised:2025-05-28 Published:2025-10-15 Online:2025-08-26
Contact: FAN Xiaonong

卒中后吞咽障碍预后影响因素的综合评估：一项伞形综述

1．300381　天津市，天津中医药大学第一附属医院针灸研究所
2．300381　天津市，国家中医针灸临床医学研究中心
3．300381　天津市，国家中医药管理局针刺量效关系实验室（三级）
4．300381　天津市针灸学重点实验室
5．300120　天津市中医药研究院附属医院脑病科

通讯作者: 樊小农
作者简介:
作者贡献：
李仪丙提出研究命题与研究思路，进行研究设计和论文撰写；贾鸿博负责论文修订与文献质量评估；樊小农负责文章的质量控制与审查，对文章整体负责，监督管理；赵文君负责收集与整理原始数据；刘巍、葛文逸负责文献检索；李宋娇、雷康辰负责文献筛选；张梦龙、张薇薇负责提取数据；陈阳负责文章审校；李礼负责解决文献检索、筛选及数据提取过程中的分歧。
基金资助:
国家重点研发计划(2024YFC3507303，2018YFC1705004); 国家自然科学基金资助项目(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)

Abstract

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 Library, Embase, CNKI, Wanfang Data, VIP, and SinoMed) were searched from their inception to November 3, 2024 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 RevMan 5.4.

Results

Five systematic reviews (encompassing 39 original studies) were included, identifying 45 prognostic factors associated with PSD. 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, Deglutition disorders, Prognosis, Influencing factors, Umbrella review

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 Library、Embase、中国知网、万方数据知识服务平台、维普网、中国生物医学文献服务系统等8个数据库，检索时间为建库至2024-11-03，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4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RevMan 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），涉及影响卒中后吞咽障碍预后的45个因素，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、美国国立卫生研究院卒中量表（NIHSS）评分和改良Rankin量表（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

CLC Number:

R 743　R 571

LI Yibing,JIA Hongbo,FAN Xiaonong, et al. Comprehensive Evaluation of Prognostic Factors Affecting Dysphagia after Stroke: an Umbrella Review[J]. Chinese General Practice, 2025, 28(29): 3631-3637. DOI: 10.12114/j.issn.1007-9572.2025.0063.
李仪丙,贾鸿博,樊小农等. 卒中后吞咽障碍预后影响因素的综合评估：一项伞形综述[J]. 中国全科医学, 2025, 28(29): 3631-3637. DOI: 10.12114/j.issn.1007-9572.2025.0063.

Figures/Tables 4

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作者	发表时间（年）	检索时间	纳入研究数量（篇）	影响因素
张晓萌^[18]	2021	2000-01-01—2020-05-01	11	年龄，认知障碍，吞咽障碍程度，日常生活能力，NIHSS评分，失语，脑干卒中，康复介入时间
LIU^[19]	2022	未描述	18	意识水平下降，年龄，严重吞咽困难，营养不良，双侧半球卒中，日常生活能力，严重卒中，mRS评分，误吸，残留，自主神经咳嗽减弱，咽反射消失，气管插管，进食后声音变化，舌偏瘫，抬舌困难，构音障碍，视觉和听觉障碍，高脂血症，白细胞升高，出血性中风，白质改变严重程度，脑干损伤，心源性栓塞，血肿量，早期干预
D'NETTO^[6]	2023	建库至2021年6月	19	年龄，吞咽困难严重程度，双侧卒中，NIHSS评分，气管插管，FEES检查，口腔转运延迟，吞咽后残留物，面瘫，构音障碍，失语，白质损伤，前循环皮质下梗死
WANG^[20]	2023	建库至2022-09-21	28	意识障碍，年龄，性别，重度认知功能障碍，吞咽困难严重程度，营养不良，双侧半球卒中，日常生活能力，高NIHSS评分，mRS评分，流涎，误吸，残留，自主性咳嗽，咽反射消失，气管插管，进食后声音改变，FEES检查，口部运动障碍，舌偏瘫，舌上提困难，面瘫，肌力分级，构音障碍，视力和听力障碍，失语，低密度脂蛋白，高脂血症，白细胞升高，血红蛋白，卒中类型，脑白质损害，脑干卒中，心源性栓塞，多部位卒中，血肿体积，早期干预，电刺激
毛怡君^[21]	2024	建库至2022年12月	22	年龄，性别，认知障碍，营养不良，双侧卒中，日常生活能力，NIHSS评分，mRS评分，误吸，自主咳嗽能力，气管插管，口腔转运延迟，咀嚼肌麻痹，言语障碍，视听觉障碍，低密度脂蛋白≥3 mg/L，高脂血症，Norton压疮危险因素评分，白细胞计数，血红蛋白含量，既往脑梗死次数，康复介入时间，电刺激

作者	发表时间（年）	检索时间	纳入研究数量（篇）	影响因素
张晓萌^[18]	2021	2000-01-01—2020-05-01	11	年龄，认知障碍，吞咽障碍程度，日常生活能力，NIHSS评分，失语，脑干卒中，康复介入时间
LIU^[19]	2022	未描述	18	意识水平下降，年龄，严重吞咽困难，营养不良，双侧半球卒中，日常生活能力，严重卒中，mRS评分，误吸，残留，自主神经咳嗽减弱，咽反射消失，气管插管，进食后声音变化，舌偏瘫，抬舌困难，构音障碍，视觉和听觉障碍，高脂血症，白细胞升高，出血性中风，白质改变严重程度，脑干损伤，心源性栓塞，血肿量，早期干预
D'NETTO^[6]	2023	建库至2021年6月	19	年龄，吞咽困难严重程度，双侧卒中，NIHSS评分，气管插管，FEES检查，口腔转运延迟，吞咽后残留物，面瘫，构音障碍，失语，白质损伤，前循环皮质下梗死
WANG^[20]	2023	建库至2022-09-21	28	意识障碍，年龄，性别，重度认知功能障碍，吞咽困难严重程度，营养不良，双侧半球卒中，日常生活能力，高NIHSS评分，mRS评分，流涎，误吸，残留，自主性咳嗽，咽反射消失，气管插管，进食后声音改变，FEES检查，口部运动障碍，舌偏瘫，舌上提困难，面瘫，肌力分级，构音障碍，视力和听力障碍，失语，低密度脂蛋白，高脂血症，白细胞升高，血红蛋白，卒中类型，脑白质损害，脑干卒中，心源性栓塞，多部位卒中，血肿体积，早期干预，电刺激
毛怡君^[21]	2024	建库至2022年12月	22	年龄，性别，认知障碍，营养不良，双侧卒中，日常生活能力，NIHSS评分，mRS评分，误吸，自主咳嗽能力，气管插管，口腔转运延迟，咀嚼肌麻痹，言语障碍，视听觉障碍，低密度脂蛋白≥3 mg/L，高脂血症，Norton压疮危险因素评分，白细胞计数，血红蛋白含量，既往脑梗死次数，康复介入时间，电刺激

作者	1	2^a	3	4^a	5	6	7^a	8	9^a	10	11^a	12	13^a	14	15^a	16	质量等级
张晓萌^[18]	Y	N	Y	Y	Y	Y	PY	PY	Y	N	Y	Y	Y	N	Y	Y	低
LIU^[19]	Y	N	Y	PY	N	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	低
D'NETTO^[6]	Y	Y	Y	Y	Y	Y	PY	Y	Y	N	NA	NA	Y	Y	NA	Y	高
WANG^[20]	Y	Y	Y	Y	Y	Y	PY	Y	Y	N	Y	Y	Y	Y	Y	Y	高
毛怡君^[21]	Y	N	Y	Y	Y	Y	PY	Y	Y	N	Y	N	Y	N	Y	Y	低

作者	1	2^a	3	4^a	5	6	7^a	8	9^a	10	11^a	12	13^a	14	15^a	16	质量等级
张晓萌^[18]	Y	N	Y	Y	Y	Y	PY	PY	Y	N	Y	Y	Y	N	Y	Y	低
LIU^[19]	Y	N	Y	PY	N	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	低
D'NETTO^[6]	Y	Y	Y	Y	Y	Y	PY	Y	Y	N	NA	NA	Y	Y	NA	Y	高
WANG^[20]	Y	Y	Y	Y	Y	Y	PY	Y	Y	N	Y	Y	Y	Y	Y	Y	高
毛怡君^[21]	Y	N	Y	Y	Y	Y	PY	Y	Y	N	Y	N	Y	N	Y	Y	低

证据等级	影响因素
强有力（robust/convincing）	1.意识障碍
高提示性（highly suggestive）	1.年龄
	2.性别
	3.认知障碍
	4.吞咽障碍严重程度
	5.营养不良
	6.双侧卒中
	7.日常生活能力
	8.NIHSS评分
	9.mRS评分
弱（weak）	1.流涎
	2.误吸
	3.咽部残留
	4.自主咳嗽
	5.咽反射消失
	6.气管插管
	7.进食后声音改变
	8.FEES检查
	9.口部运动障碍
	10.口腔转运延迟
	11.舌偏瘫
	12.舌抬起困难
	13.咀嚼肌麻痹
	14.面瘫
	15.肌力分级
	16.构音障碍
	17.视听觉障碍
	18.失语
	19.低密度脂蛋白≥3 mg/L
	20.高脂血症
	21.Norton压疮危险因素评分
	22.白细胞计数
	23.血红蛋白
	24.卒中类型
	25.既往梗死次数
	26.脑白质损伤
	27.脑干卒中
	28.前循环皮质下梗死
	39.心源性栓塞
	30.多部位卒中
	31.梗死体积
	32.血肿体积
	33.干预介入时间
	34.电刺激

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

卒中后吞咽障碍预后影响因素的综合评估：一项伞形综述

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