Arquivos de Neuro-Psiquiatria (Jun 2004)
Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência Incidence of oropharyngeal dysphagia associated with stroke in a regional hospital in São Paulo State - Brazil
Abstract
A doença vascular encefálica (AVE) é a principal causa de morte no Brasil. As seqüelas em indivíduos pós-acidente vascular encefálico incluem distúrbios motores, distúrbios de fala ou de linguagem e distúrbios de deglutição. A disfagia orofaríngea ocorre em cerca de 50% dos pacientes com AVE. Este estudo teve por objetivo determinar a incidência da disfagia após AVE. Foram avaliados todos os pacientes que deram entrada em hospital universitário de referência no período de um ano, tão logo apresentassem condições para avaliação clínica, fonoaudiológica e neurológica (102 pacientes), com análise objetiva da deglutição (61 pacientes). Foi observada incidência de disfagia em 76,5% dos pacientes avaliados clinicamente, este percentual elevando-se a 91% com avaliação videofluoroscópica. A alta incidência de disfagia observada neste estudo que avaliou pacientes com amplo espectro de gravidade, em diferentes fases de recuperação, ressalta a importância de equipe multidisciplinar, incluindo fonoaudiólogos capacitados, para avaliar os distúrbios da deglutição nos diversos momentos de recuperação dos AVEs.Cerebrovascular disease is recognized as to be associated with the highest mortality rate in Brazil. Dysphagia, speech and language disturbances are common consequences of the high incidence of stroke. Dysphagia is known to occur in at least 50% of the patients with acute stroke. The study is designed to stablish the incidence of stroke in a reference hospital. One hundred and two consecutive patients admitted between January 2001 and January 2002 underwent a neurological examination with dysphagia specific analysis, performed by speech/dysphagia professionals as soon as they have clinical conditions. The localization of the lesions are determined by computer tomography or magnetic resonance image of the brain. Sixty one patients underwent videofluorscopic evaluation of swallowing. There was detected oropharyngeal dysphagia in 78 patients (76.5%) if the examination was limited to the clinical evaluation. Neverthless, if complemented by videofluorscopic evaluation, the incidence grows to 90%. The explanation for the high incidence observed in this study could be pointed to the fact that dysphagia was registered on different times of the convalescence period. The data reinforces the importance of repeated evaluations made by different professionals of the sttaff involved in acute stroke attendance.
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