社区老年慢性病患者吞咽障碍的流行病学及相关性研究

关键词：社区  老年人  慢性病  吞咽障碍  流行病学  患病率  相关性

Keywords:community  elderly  chronic diseases  dysphagia  epidemiology  prevalence rate  correlation

摘要：

      摘要 目的：调查社区老年慢性病患者吞咽障碍的流行病学现状，分析慢性病类别与吞咽障碍发生率的相关性。 方法：选取广州市天河区石牌社区卫生服务中心常见的5种慢性病人群（高血压、糖尿病、冠心病、呼吸系统疾病、肝胆疾病）且年龄≥60岁的老年人，采用EAT-10吞咽问卷和洼田饮水测试评估吞咽功能，年龄校正后的Charlson合并症指数（age-adjusted Charlson comorbidity index，ACCI）分级、握力试验，以及4m步行试验评估患者体力耐力。观察以上5种慢性疾病、慢病共病分级的社区老年人吞咽障碍患病率，分析不同性别、年龄、慢性疾病、握力，以及步行耐力与吞咽障碍之间的相关性。 结果：总调查人数为2352例，其中有效调查人数为2121例，吞咽障碍阳性人数252例，吞咽障碍患病率为11.88%。各种慢性疾病吞咽障碍患病率分别为：高血压患者吞咽障碍患病率63.89%、糖尿病患者吞咽障碍患病率28.57%、冠心病患者吞咽障碍患病率39.68%、呼吸系统疾病患者吞咽障碍患病率8.73%、肝胆疾病患者吞咽障碍患病率2.78%。不同性别、年龄及握力与吞咽障碍的相关性，差异无显著性意义。单因素回归分析显示：呼吸系统疾病（t=3.987，P＜0.001）、肝胆疾病（t=2.158，P＜0.05）、ACCI（t=2.745，P＜0.05）、4m步行试验（t=7.082，P＜0.001），结果均具有显著性意义（P＜0.05）。 结论：吞咽障碍在社区慢性疾病老年人群中患病率处于较高水平。呼吸系统疾病、肝胆疾病、ACCI、4m步行试验与吞咽障碍患病率呈正相关关系。

Abstract:

      Abstract Objective： To investigate the prevalence of dysphagia in community-dwelling elderly patients with chronic diseases and to analyze the correlation between the categories of chronic diseases and the prevalence of dysphagia. Method： Elderly people (aged ≥60 years) with one of five common chronic diseases （hypertension， diabetes， coronary heart disease， respiratory diseases， and hepatobiliary diseases） were recruited from Shipai Community health service center of Tianhe District. Eating assessment tool-10 and Water Swallow Test were used to evaluate swallowing function. Age-adjusted Charlson comorbidity index（ACCI） classification， grip strength test and 4-meter walking test were used to evaluate physical endurance of patients. The prevalence of dysphagia was determined among individuals with these chronic diseases and varying degrees of multimorbidity. The correlation between dysphagia and gender， age， chronic diseases， grip strength and walking endurance was analyzed. Result： The total number of respondents was 2352， of which 2121 were effectively surveyed. Among them， 252 cases were positive for dysphagia， and the prevalence of dysphagia was 11.88%. The prevalence of dysphagia was 63.89% for hypertension， 28.57% for diabetes， 39.68% for coronary heart disease， 8.73% for respiratory diseases， and 2.78% for hepatobiliary diseases. There was no statistically significant difference in the correlation between gender， age and grip strength and dysphagia. Univariate regression analysis showed that respiratory diseases （t=3.987，P<0.001）， hepatobiliary diseases （t=2.158，P<0.05）， ACCI （t=2.745，P<0.05）， 4-meter walk test （t=7.082，P<0.001）， the results were statistically significant （P<0.05）. Conclusion： Dysphagia is highly prevalent among elderly individuals with chronic diseases in the community. Respiratory diseases， hepatobiliary diseases， ACCI score， and 4m walk test are positively correlated with the prevalence of dysphagia.