UCSF Fresno, Department of Surgery, 2823 Fresno Street, Fresno, CA 93721, USA.
Am J Surg. 2013 Dec;206(6):924-7; discussion 927-8. doi: 10.1016/j.amjsurg.2013.08.010. Epub 2013 Oct 9.
There is a significant incidence of unrecognized postextubation dysphagia in trauma patients. The purpose of this study was to evaluate the incidence, ascertain the risk factors, and identify patients with postextubation dysphagia who will require clinical swallow evaluation.
A prospective observational study was performed on 270 trauma patients. Bedside clinical swallow evaluation was done within 24 hours of extubation. Logistic regression analysis was used to adjust for confounding variables.
The incidence of oropharyngeal dysphagia (OD) in our study was 42%. Ventilator days was the strongest independent risk factor for OD (3.6 vs 8.0, P < .001). The odds ratio showed a 25% risk for OD for each additional ventilator day. Silent aspiration was found in 37% of patients with OD.
Trauma patients requiring mechanical ventilation for ≥2 days are at increased risk for dysphagia and should undergo routine swallow evaluations after extubation.
创伤患者在拔管后存在明显的未被识别的吞咽困难发生率。本研究旨在评估其发生率，确定危险因素，并确定需要进行临床吞咽评估的拔管后吞咽困难患者。
对 270 例创伤患者进行前瞻性观察性研究。在拔管后 24 小时内进行床边临床吞咽评估。使用逻辑回归分析调整混杂变量。
本研究中口咽性吞咽困难（OD）的发生率为 42%。通气天数是 OD 的最强独立危险因素（3.6 与 8.0，P<.001）。比值比显示每增加 1 天通气天数，OD 的风险增加 25%。在 37%的 OD 患者中发现了无声误吸。
需要机械通气≥2 天的创伤患者发生吞咽困难的风险增加，应在拔管后常规进行吞咽评估。
