Sharma Om P, Oswanski Michael F, Singer Daniel, Buckley Brooke, Courtright Beth, Raj Shekhar S, Waite Phillip J, Tatchell Thomas, Gandaio Angela
Trauma Services, The Toledo Hospital & Toledo Children's Hospital, Toledo, Ohio, USA.
Am Surg. 2007 Nov;73(11):1117-21.
Tracheostomy is associated with increased aspiration rates, and swallowing disorders have not been well-studied in trauma patients with tracheostomy. Swallowing evaluations were conducted in 224 patients (102 trauma and 122 nontrauma patients). Half of the patients in each group had tracheostomies. Bedside swallow studies were conducted in 40 patients, videofluoroscopy swallow studies in 100 patients, and both studies in 84 patients. chi2, Fisher's exact test, Cramer's V, and descriptive statistics were used for data analysis. Aspiration occurred in 35 per cent (36 of 102) of trauma patients with or without tracheostomy and in 36 per cent (22 of 61) of nontrauma patients with tracheostomy. Aspiration with and without penetration was observed in 54 per cent of trauma patients (55% with tracheostomy) compared with 67 per cent of all nontrauma patients (61% with tracheostomy). Trauma patients with head injuries exhibited 41 per cent (26 of 63) aspiration and 68 per cent (43 of 63) dysphagia compared with 26 per cent (10 of 39) and 59 per cent (23 of 39) in trauma patients with other injuries. There was a lower incidence of dysphagia in trauma patients (65% versus 81% in nontrauma) and in patients with tracheostomy (71% versus 77% without tracheostomy). Tracheostomy was not associated with increased dysphagia or aspiration.
气管切开术与误吸率增加相关，而对于接受气管切开术的创伤患者，吞咽障碍尚未得到充分研究。对224例患者（102例创伤患者和122例非创伤患者）进行了吞咽评估。每组中有一半患者接受了气管切开术。对40例患者进行了床边吞咽研究，对100例患者进行了视频透视吞咽研究，对84例患者进行了两项研究。采用卡方检验、费舍尔精确检验、克莱默V检验和描述性统计进行数据分析。有或没有气管切开术的创伤患者中，35%（102例中的36例）发生误吸，接受气管切开术的非创伤患者中，36%（61例中的22例）发生误吸。54%的创伤患者（气管切开术患者中为55%）观察到有或无渗透的误吸，而所有非创伤患者中这一比例为67%（气管切开术患者中为61%）。与其他损伤的创伤患者相比，头部受伤的创伤患者出现误吸的比例为41%（63例中的26例），吞咽困难的比例为68%（63例中的43例），而其他损伤的创伤患者中这两个比例分别为26%（39例中的10例）和59%（39例中的23例）。创伤患者（非创伤患者中为65%对81%）和气管切开术患者（无气管切开术患者中为71%对77%）吞咽困难的发生率较低。气管切开术与吞咽困难或误吸增加无关。
