Meals Clifton, Roy Siddharth, Medvedev Gleb, Wallace Matthew, Neviaser Robert J, O'Brien Joseph
Orthopedics. 2016 Jan-Feb;39(1):e93-7. doi: 10.3928/01477447-20151222-07. Epub 2015 Dec 30.
To identify and potentially modify the risk of pulmonary complications in a group of older patients with hip fracture, the authors obtained speech and language pathology consultations for these patients. Then they performed a retrospective chart review of all patients 65 years and older who were admitted to their institution between June 2011 and July 2013 with acute hip fracture, were treated surgically, and had a speech and language pathology evaluation in the immediate perioperative period. The authors identified 52 patients who met the study criteria. According to the American Society of Anesthesiologists (ASA) classification system, at the time of surgery, 1 patient (2%) was classified as ASA I, 12 patients (23%) were ASA II, 26 (50%) were ASA III, and 12 (23%) were ASA IV. Based on a speech and language pathology evaluation, 22 patients (42%) were diagnosed with dysphagia. Statistical analysis showed that ASA III status and ASA IV status were meaningful predictors of dysphagia and that dysphagia itself was a strong risk factor for pulmonary aspiration, pneumonia, and aspiration pneumonitis. Evaluation by a speech and language pathologist, particularly of patients classified as ASA III or ASA IV, may be an efficient means of averting pulmonary morbidity that is common in older patients with hip fracture.
为了识别并可能改变一组老年髋部骨折患者发生肺部并发症的风险，作者为这些患者安排了言语和语言病理学会诊。然后，他们对2011年6月至2013年7月期间入住其机构、因急性髋部骨折接受手术治疗且在围手术期立即接受言语和语言病理学评估的所有65岁及以上患者进行了回顾性病历审查。作者确定了52名符合研究标准的患者。根据美国麻醉医师协会（ASA）分类系统，手术时，1名患者（2%）被分类为ASA I，12名患者（23%）为ASA II，26名（50%）为ASA III，12名（23%）为ASA IV。根据言语和语言病理学评估，22名患者（42%）被诊断为吞咽困难。统计分析表明，ASA III级和ASA IV级是吞咽困难的有意义预测因素，吞咽困难本身是肺误吸、肺炎和吸入性肺炎的强风险因素。由言语和语言病理学家进行评估，特别是对被分类为ASA III或ASA IV的患者，可能是避免老年髋部骨折患者常见肺部疾病的有效手段。
