Takayanagi Hirohisa, Endo Tomonori, Nakayama Tuguhisa, Kato Takakuni
Department of Otorhinlaryngology, Fuji city central Hospital, Fuji.
Nihon Jibiinkoka Gakkai Kaiho. 2013 Jun;116(6):695-702. doi: 10.3950/jibiinkoka.116.695.
There is much concern about the acute phase of restarting an oral diet for hospital inpatients who have been prohibited from any oral intake. We found predictive factors for the successful resumption of oral intake in such patients. A total of 186 subjects who had been hospitalized without oral intake were screened for dysphagia between January 1st and December 31st in 2010 (mean age 80.9 years), and formed the study population. We observed them from the initial consultation day until the discharge. (mean days 32.6) We examined factors of age, sex, appetite, gag reflex, tongue activity, the repetitive saliva swallowing test (RSST), obeying commands, the status of the laryngopharynx, laryngeal sensation and the 3 ml water swallowing test under endoscopy. We excluded those who died in hospital after dysphagia screening because they were obviously lost to follow-up. One hundred and twelve patients (60.2%) could resume oral intake, 54 patients could not and 20 (10.8%) died. Logistic regression analysis identified seven significant factors in predicting the resumption of oral intake : 1) age (p = 0.01, OR = 0.938, 95% CI 0.903-0.976); 2) sex (p = 0.21, OR = 2.15, 95% CI 1.124-4.128); 3) appetite (p = 0.041, OR = 1.983, 95% CI 1.029-3.821); 4) gag reflex (p = 0.06, OR = 1.932, 95% CI 0.971-3.844); 5) tongue activity (P = 0.002, OR = 3.825, 95% CI 1.647-8.883); 6) RSST (P = 0.013, OR = 2.284, 95% CI 1.186-4.397); 7) obeying commands (p = 0.02, OR = 3.005, 95% CI 1.507-5.993); 8) the status of the laryngopharynx (P = 0.668, OR = 0.668, 95% CI 0.351-1.272); 9) laryngeal sensation (P = 0.081, OR = 1.841, 95% CI 0.928-3.650); and the 3 ml water swallowing test under endoscopy (P = 0.000, OR = 0.226, 95% CI 0.102-0.499). These predictive factors could be very useful for dysphagia screening to help forecast the successful resumption of oral intake in affected patients. When the likelihood of dysphagia and the onset of aspiration pneumonia are suggested by dysphagia screening, these factors must be taken into careful consideration when oral intake is to be resumed.
对于已被禁止经口摄入任何食物的住院患者重新开始经口饮食的急性期，人们存在诸多担忧。我们发现了此类患者成功恢复经口摄入的预测因素。2010年1月1日至12月31日期间，对总共186名住院期间未进行经口摄入的受试者（平均年龄80.9岁）进行了吞咽困难筛查，这些受试者构成了研究人群。我们从初次会诊日开始观察他们直至出院（平均天数32.6天）。我们检查了年龄、性别、食欲、咽反射、舌活动度、反复唾液吞咽试验（RSST）、听从指令情况、下咽状况、喉感觉以及内镜下3毫升水吞咽试验等因素。我们排除了吞咽困难筛查后在医院死亡的患者，因为他们显然无法进行随访。112名患者（60.2%）能够恢复经口摄入，54名患者不能恢复，20名患者（10.8%）死亡。逻辑回归分析确定了预测经口摄入恢复的七个显著因素：1）年龄（p = 0.01，OR = 0.938，95% CI 0.903 - 0.976）；2）性别（p = 0.21，OR = 2.15，95% CI 1.124 - 4.128）；3）食欲（p = 0.041，OR = 1.983，95% CI 1.029 - 3.821）；4）咽反射（p = 0.06，OR = 1.932，95% CI 0.971 - 3.844）；5）舌活动度（P = 0.002，OR = 3.825，95% CI 1.647 - 8.883）；6）RSST（P = 0.013，OR = 2.284，95% CI 1.186 - 4.397）；7）听从指令情况（p = 0.02，OR = 3.005，95% CI 1.507 - 5.993）；8）下咽状况（P = 0.668，OR = 0.668，95% CI 0.351 -
