The study aimed to determine the incidence of swallowing disorders in acute stroke patients in Valiasr Hospital, Zanjan. Dysphagia is seen as a complication in many of these patients who have suffered an acute stroke.
Deficiency in the function of the mouth, tongue, palate, larynx, pharynx, or the upper part of the esophagus causes problems in swallowing and swallowing disorders. It can lead to many issues, such as aspiration, suffocation, lung infection, and even death. Therefore, its evaluation and diagnosis in these patients in the early hours after the occurrence of stroke can interventions during treatment and cause rehabilitation, as well as the mortality rate due to aspiration and lung infections, hospital costs can reduce the duration of hospitalization and increase the quality of life of a person after a stroke. The rapid diagnosis of swallowing disorders in stroke patients can create a suitable intervention to reduce pneumonia or other side effects. Various interventions can be utilized in this manner, like rehabilitation, deviation of the alimentary canal by installation of percutaneous endoscopic gastrostomy (PEG) or nasogastric tube (N.G.), empirical antibiotic therapies in high-risk patients, and serial swallow assessment [23, 24]. This study aims to investigate the incidence of swallowing disorder in stroke patients and the factors affecting this disorder rather than swimming.
Many influencing factors can be identified, and their complications can be reduced. The occurrence of dysphagia disorder was present in a significant percentage. The results of the chi-score test showed that different types and severity of stroke, swallowing reflex, 3 O.Z. water test, and TPA are changes that affect swallowing disorders. All people who aspire to the 3 O.Z. water test have Dysphagia. The incidence of this disorder among these 100 patients is 45%, a significant percentage. In the study of Cui Yang (25.51%), patients had Dysphagia after a stroke, and There was no significant difference in the gender between Dysphagia and no dysphagia patients. That was in line with our study. In the study of Cui Yang, hypertension and diabetes were associated with Dysphagia in patients with ischemic stroke (all P < 0.05). In our research, in Hypertension, P-value = 0.161 and D.M. p-value = 0.341 didn’t align with our study. The difference can be due to differences in sample size [25] in the Arnold et al. Stroke severity rather than infarct location was associated with Dysphagia; in our study, there was a significant relationship between stroke severity and Dysphagia, which was in line with our study [26]. In the survey, Dysphagia was more frequent in older patients, and men didn’t align with our study [27]. In this study, Dysphagia in the ischemic group was highly associated with diabetes mellitus (D.M.), and hypertension (HTN) didn’t align with our research—Dysphagia with ICH with ventricular extension. Stroke severity and lesion size were the main determinants of dysphagia severity. That was in line with our study [28] in a 2020 study by Chiho and his colleagues.
The modified water swallow test and the repetitive saliva swallow test are commonly used as bedside screening methods for swallowing dysfunction. Participants were between August 1, 2016, and June 30, 2018. A videofluoroscopic swallowing study was carried out on all patients. Aspiration was observed in 9.3% of patients when swallowing 3 ml of water. These aspirated patients showed significantly delayed swallowing reflex on videofluoroscopic; the results of this research were consistent with our study [29]. It was displayed in another research conducted in 2020 that Dysphagia is common in Asian post-stroke patients [30]. In a survey performed in 2019, 110 post-stroke patients were selected. Assess the common risk factors, namely the presence of diabetes mellitus, dyslipidemia, hypertension, alcohol usage, and smoking habits. Variables such as age, gender, type of lesion, side of lesion, and tobacco chewing were also evaluated using a structured interview method. Age type of lesion showed a significant association with the severity of Dysphagia following stroke. This study, in terms of the lack of influence of factors such as HTN, diabetes mellitus, and smoking, is consistent with our study [31]. Another study included 469 stroke patients whose severity independently predicted severe swallowing impairment in discharge. Also, Dysphagia after stroke continued to affect functional outcomes for up to 1 year; our results were consistent with this study [32].
A study conducted in 2021 showed Eighty-four patients were classified as Dysphagia. A higher volume of ICH and a higher degree of disability were associated with Dysphagia [33]. A 2023 study included 264 patients with acute ischemic stroke, with the incidence of severe swallowing disorder within 72 hours of admission at 19.3% [34]. Our results were consistent with this study. Out of 106 patients hospitalized for acute stroke, 60 had Dysphagia. Factors associated with Dysphagia include older age, stroke severity, and greater volume of the lesion, even though 68.80% of patients with temporal lobe lesions had Dysphagia. There was no difference in the location of the lesion in the studied areas. In this study, Dysphagia was not affected by the lateralization of the lesion or the type of stroke (ischemic/hemorrhagic), which was contrary to the results of our study. In this study, the severity of stroke was related to Dysphagia, which was consistent with the result of our study [35]. The only approved treatment option for the treatment of acute ischemic stroke prescribed (TPA) is angioedema, rarely a complication. The incidence of angioedema increases in patients receiving angiotensin–converting enzyme inhibitors (ACE). Angioedema with prominent topical edema is often found in the dermis. Angioedema can occur shortly after injection of TPA in about 1–5% of acute stroke patients [36]. The side effect of this drug is angioedema، which causes difficulty swallowing, which is in line with our study.