拔管后吞咽障碍对ICU内机械通气老年患者预后的影响

李杰; 刘士立; 尹月秋; 李京; 刘震; 赵丽

doi:10.13201/j.issn.1009-5918.2020.05.011

拔管后吞咽障碍对ICU内机械通气老年患者预后的影响

- 首都医科大学附属复兴医院急诊科(北京, 100038)

详细信息

通讯作者: 李杰,E-mail:drlijie@sina.com

中图分类号: R459.6

收稿日期: 2020-02-29

Association between post-extubation dysphagia and the prognosis among older adults in ICU

- Department of Emergency, Fuxing Hospital, Capital Medical University, Beijing, 100038, China

More Information

Corresponding author: LI Jie, E-mail: drlijie@sina.com

Received Date: 29 February 2020

摘要

摘要: 目的:回顾性分析2015-12—2019-12期间我院急诊ICU收治的因急性呼吸衰竭给予气管插管及机械通气的老年病例,探讨拔管后吞咽障碍对ICU内机械通气老年患者短期及长期预后的影响。方法:使用FEES的方法对拔管后合并吞咽障碍的老年患者的吞咽功能进行评估及分组,并比较不同组之间预后相关指标的差异(包括是否有再插管、总住院时间、拔管后吸入性肺炎发生率、住院期间病死率)。并对顺利出院患者进行为期1年的随访,统计其1年后病死率。结果:共81例患者纳入本研究,吞咽功能正常组共33例(40.7%),合并吞咽功能障碍组48例(59.3%),其中隐性误吸共24例(29.2%)。吞咽功能正常组及合并吞咽障碍组之间,在总住院时间、再插管率及住院期间病死率方面差异有统计学意义(P=0.001、0.040、0.011)。顺利出院共56例(吞咽功能正常组28例,吞咽功能障碍组28例),2组之间1年后病死率差异无统计学意义(P=0.079)。结论:本研究发现合并拔管后吞咽功能障碍的ICU内老年患者短期预后较差,其拔管后再插管率及病死率较高,住院时间较长;但在顺利出院的患者中,是否合并吞咽障碍与其1年后病死率无明显相关。
- 拔管后吞咽障碍 /
- 老年 /
- 机械通气 /
- ICU /
- 预后
Abstract: Objective: To investigate the association between the prognosis and postextubation dysphagia(PED) among older adults with mechanical ventilation in ICU from December 2015 to December 2019. Method: The swallowing function of the elderly patients after extubation was evaluated with fiberoptic endoscopic evaluation of swallowing(FEES) and the patients were divided into two groups according results. Reintubation rate, total length of stay, the incidence of aspiration pneumonia after extubation and mortality during hospitalization between the two groups were compared. The association between PED and 1-year mortality was also investigated. Result: A total of 81 patients were included in this study. After extubation, 48(59.3%) had PED, and 24(29.2%) aspirated silently. In univariate analyses, the total length of stay, the reintubation rate and the mortality during hospitalization were statistically significant between the two groups(P=0.001, 0.040, 0.011). In the 56 survivors, dysphagia was not associated with 1-year mortality.(P=0.079).Conclusion: This study found that the development of postextubation dysphagia among older adults with mechanical ventilation in ICU was associated with poor patient outcomes. There was no significant difference in 1-year mortality in those with clinically significant dysphagia compared to those without in who survived to hospital discharge.
- postextubation dysphagia /
- older adults /
- mechanical ventilation /
- ICU /
- prognosis

HTML全文

参考文献(17)

[1]	Macht M,White SD,Moss M.Swallowing dysfunction after critical illness[J].Chest,2014,146(6):1681-1689.
[2]	Macht M,Wimbish T,Bodine C,et al.ICU-acquired swallowing disorders[J].Crit Care Med,2013,41(10):2396-2405.
[3]	Altman KW,Yu GP,Schaefer SD.Consequence of dysphagia in the hospitalized patient:Impact on prognosis and hospital resources[J].Arch Otolaryngol Head Neck Surg,2010,136:784-789.
[4]	El Solh A,Okada M,Bhat A,et al.Swallowing disorders post orotracheal intubation in the elderly[J].Intensive Care Med,2003,29(9):1451-1455.
[5]	Rosenbek JC,Robbins JA,Roecker EB,et al.A penetration-aspiration scale[J].Dysphagia,1996,11(2):93-98.
[6]	Skoretz SA,Flowers HL,Martino R.The incidence of dysphagia following endotracheal intubation:a systematic review[J].Chest,2010,137(3):665-673.
[7]	Dysphagia in the intensive care unit:epidemiology,mechanisms,and clinical management[J].Crit Care ,2019,23(1):103-103.
[8]	Francois B,Bellisant E,Gissot V,et al.12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema:a randomized double blind trial[J].Lancet,2007,369:1083-1089.
[9]	Macht M,Wimbish T,Clark BJ,et al.Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness[J].Crit Care,2011,15:R231.
[10]	Moraes DP,Sassi FC,Mangilli LD,et al.Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients[J].Crit Care,2013,18,17(5):R243.
[11]	Schefold JC,Berger D,Zürcher P,et al.Dysphagia in Mechanically Ventilated ICU Patients(DYnAMICS):A Prospective Observational Trial[J].Crit Care Med,2017,45(12):2061-2069.
[12]	Ajemian M,Nirmul G,Anderson MT,et al.Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation:implications for management[J].Arch Surg,2001,136(4):434-437.
[13]	Zuercher P,Moret C,Schefold JC.Dysphagia in the intensive care unit in Switzerland(DICE)-results of a national survey on the current standard of care[J].Swiss Med Wkly,2019,149:w20111.
[14]	Regala M,Marvin S,Ehlenbach WJ.Association Between Postextubation Dysphagia and Long-Term Mortality Among Critically Ill Older Adults[J].J Am Geriatr Soc,2019,67(9):1895-1901.
[15]	Donzelli J,Brady S,Wesling M.Using modified Evan’s blue dye test to predict aspiration[J].Laryngoscope,2004,114:1680-1681.
[16]	Barker J,Martino R,Reichardt B,et al.Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery[J].Can J Surg,2009,52:119-124.
[17]	Duncan S,Gaughey JM,Fallis R,et al.Interventions for oropharyngeal dysphagia in acute and critical care:a protocol for a systematic review and meta-analysis[J].Syst Rev,2019,20,8(1):283.