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拔管后吞咽困难

Postextubation Dysphagia.

作者信息

Rassameehiran Supannee, Klomjit Saranapoom, Mankongpaisarnrung Charoen, Rakvit Ariwan

机构信息

Department of Internal Medicine (Rassameehiran, Klomjit, Mankongpaisarnrung) and Division of Gastroenterology (Rakvit), Texas Tech University Health Science Center, Lubbock, Texas.

出版信息

Proc (Bayl Univ Med Cent). 2015 Jan;28(1):18-20. doi: 10.1080/08998280.2015.11929174.

Abstract

Postextubation dysphagia (PED) is a common problem in critically ill patients with recent intubation. Although several risk factors have been identified, most of them are nonmodifiable preexisting or concurrent conditions. Early extubation, small endotracheal tube size, and small bore of nasogastric tube potentially decrease the risk of PED. The majority of patients receive treatment based on only bedside swallow evaluations, which has an uncertain diagnostic accuracy as opposed to gold standard instrumental tests. Therefore, the treatment decision for patients may not be appropriately directed for each individual. Current treatments are mainly focused on dietary modifications and postural changes/compensatory maneuvers rather than interventions, but recent studies have shown limited proven benefits. Direct therapies in oromotor control, such as therapeutic exercises and neuromuscular stimulations, should be considered as potential effective treatments.

摘要

拔管后吞咽困难(PED)是近期插管的重症患者中的常见问题。尽管已确定了多种风险因素,但其中大多数是不可改变的既往或并发疾病。早期拔管、较小的气管内导管尺寸和较小的鼻胃管内径可能会降低PED的风险。大多数患者仅根据床边吞咽评估接受治疗,与金标准仪器检查相比,其诊断准确性不确定。因此,针对患者的治疗决策可能无法针对每个个体进行适当指导。目前的治疗主要集中在饮食调整和体位改变/代偿动作上,而不是干预措施,但最近的研究表明已证实的益处有限。口腔运动控制方面的直接疗法,如治疗性锻炼和神经肌肉刺激,应被视为潜在的有效治疗方法。

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