Atkins B Zane, Trachtenberg Melissa S, Prince-Petersen Rebecca, Vess Gina, Bush Errol L, Balsara Keki R, Lin Shu S, Davis R Duane
Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
J Heart Lung Transplant. 2007 Nov;26(11):1144-8. doi: 10.1016/j.healun.2007.07.038.
Gastroesophageal reflux is associated with lung transplantation (LT) and bronchiolitis obliterans syndrome, limiting allograft functional longevity. LT patients may also develop post-operative oropharyngeal dysphagia, exposing the allograft to further risk. However, the magnitude of this problem is unknown. We examined LT recipients post-operatively for swallowing disorders and correlated findings with pre- and post-operative variables.
Two hundred sixty-three LT patients (January 2001 to July 2005) at a single center were retrospectively reviewed. Each underwent clinical swallowing assessment. Provocative swallowing evaluation (SE) was performed in 149 patients (Group 1); 114 patients did not receive formal SE (Group 2). SE studies were considered positive with laryngeal penetration (PEN) or tracheal aspiration (ASP) of thin liquids. Groups were compared with respect to pre-, peri- and post-operative variables using analysis of variance (ANOVA) and chi-square tests.
After LT, 56.7% of patients underwent post-operative SE (mean 19 +/- 20 days), most of whom (87.9%) had fiber-optic endoscopic studies. SE was positive for PEN or ASP in 70.5% (n = 105). Aspiration occurred in 63.8% (n = 67) of positive SEs; 77.6% (n = 52) of ASP assessments were clinically silent. Pre-operative gastroesophageal reflux disease (GERD) and post-operative complications, including vocal cord paresis, pleural processes, venous thromboses and severe rejection episodes, were more common among Group 1. Group 2 had a significantly reduced hospital length of stay (p = 0.004).
Prospective SE identified strikingly high rates of dysphagia after LT. Because many of these deficits are silent, aggressive pulmonary toilet is especially important after post-operative LT. Pre-operative SE may clarify those at increased risk for new-onset oropharyngeal dysphagia after LT.
胃食管反流与肺移植（LT）及闭塞性细支气管炎综合征相关，会限制移植肺的功能寿命。LT患者术后还可能出现口咽吞咽困难，使移植肺面临进一步风险。然而，这一问题的严重程度尚不清楚。我们对LT受者术后的吞咽障碍进行了检查，并将检查结果与术前和术后变量进行关联分析。
对单中心的263例LT患者（2001年1月至2005年7月）进行回顾性研究。每位患者均接受了临床吞咽评估。149例患者（第1组）进行了激发性吞咽评估（SE）；114例患者未接受正式的SE（第2组）。若稀薄液体出现喉穿透（PEN）或气管误吸（ASP），则SE研究被视为阳性。使用方差分析（ANOVA）和卡方检验对两组患者的术前、术中和术后变量进行比较。
LT术后，56.7%的患者接受了术后SE（平均19±20天），其中大多数患者（87.9%）进行了纤维内镜检查。70.5%（n = 105）的患者SE检查显示PEN或ASP为阳性。63.8%（n = 67）的阳性SE检查出现误吸；77.6%（n = 52）的ASP评估在临床上无明显症状。术前胃食管反流病（GERD）和术后并发症，包括声带麻痹、胸膜病变、静脉血栓形成和严重排斥反应，在第1组中更为常见。第2组的住院时间显著缩短（p = 0.004）。
前瞻性SE发现LT术后吞咽困难的发生率极高。由于这些缺陷大多无明显症状，积极的肺部护理在LT术后尤为重要。术前SE可能有助于明确LT术后新发口咽吞咽困难风险增加的患者。
