Gee Erica, Lancaster Elizabeth, Meltzer Jospeh, Mendelsohn Abie H, Benharash Peyman
Division of Cardiac Surgery and †Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Am Surg. 2015 Oct;81(10):979-82. doi: 10.1177/000313481508101014.
Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. A simple and sensitive screening test to identify patients requiring objective dysphagia evaluation is presently lacking. In this study, we evaluated the efficacy of a novel targeted swallow screen evaluation. This was a prospective trial involving all adult patients who underwent elective cardiac surgery with cardiopulmonary bypass at our institution over an 8-week period. Within 24 hours of extubation and before the initiation of oral intake, all postsurgical patients were evaluated using the targeted swallow screen. A fiberoptic endoscopic evaluation of swallowing was requested for failed screenings. During the study, 50 postcardiac surgery patients were screened. Fifteen (30%) failed the targeted swallow screen, and ten of the fifteen (66%) failed the subsequent fiberoptic endoscopic evaluation of swallowing exam and were confirmed to have dysphagia. The screening test had 100 per cent sensitivity for detecting dysphagia in our patient population, and a specificity of 87.5 per cent. The overall incidence of dysphagia was 20 per cent. We have shown that a targeted swallow evaluation can efficiently screen patients during the postcardiac surgery period. Furthermore, we have shown that the true incidence of dysphagia after cardiac surgery is significantly higher than previously recognized in literature.
术后吞咽困难会导致吸入性肺炎、住院时间延长，并与死亡率增加相关。目前缺乏一种简单且灵敏的筛查试验来识别需要进行客观吞咽困难评估的患者。在本研究中，我们评估了一种新型针对性吞咽筛查评估的效果。这是一项前瞻性试验，纳入了在我们机构接受择期心脏手术并使用体外循环的所有成年患者，为期8周。在拔管后24小时内且在开始经口进食前，所有术后患者均使用针对性吞咽筛查进行评估。筛查未通过者需进行纤维内镜吞咽功能评估。研究期间，对50例心脏手术后患者进行了筛查。15例（30%）未通过针对性吞咽筛查，其中10例（66%）随后未通过纤维内镜吞咽功能评估检查，并被确诊为吞咽困难。该筛查试验在我们的患者群体中检测吞咽困难的灵敏度为100%，特异性为87.5%。吞咽困难的总体发生率为20%。我们已证明，针对性吞咽评估可在心脏手术后期间有效地筛查患者。此外，我们还证明，心脏手术后吞咽困难的实际发生率明显高于先前文献中所认识到的。
