Lundine Jennifer P, Dempster Robert, Carpenito Kirby, Miller-Tate Holly, Burdo-Hartman Wendelin, Halpin Elizabeth, Khalid Omar
Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio.
Division of Clinical Therapies, Nationwide Children, s Hospital, Columbus, Ohio.
Congenit Heart Dis. 2018 Sep;13(5):706-712. doi: 10.1111/chd.12636. Epub 2018 Aug 12.
Swallowing dysfunction is a known complication for infants with complex congenital heart disease (CHD), but few studies have examined swallowing outcomes following the hybrid procedure for stage 1 palliation in children with single ventricle physiology.
(1) Identify the incidence of aspiration in all infants with single ventricle physiology who underwent the hybrid procedure and (2) Compare results of clinical bedside and instrumental swallowing evaluations to examine the predictive value of a less invasive swallowing assessment for this population of high-risk infants.
This was a retrospective cohort chart review study. All patients with single-ventricle physiology who underwent the hybrid procedure received a referral for subsequent instrumental swallow assessment during a 4-year period. Results from clinical bedside evaluations were compared to those of the instrumental assessment.
Fifty infants were included in this study. During instrumental swallow assessment, aspiration was observed in 28% of infants following the hybrid procedure. Normal swallowing function was identified in 44% of infants, and 28% demonstrated laryngeal penetration. Neither length of intubation nor prematurity were found to be predictors of aspiration. Thirty-six of these infants were assessed via clinical bedside evaluation prior to the instrumental evaluation. The sensitivity of the clinical bedside evaluation was 0.73 and the specificity was 0.92.
This study reports on a cohort of infants with single ventricle physiology following the hybrid procedure and found the incidence of aspiration to be lower than previously reported. Improved clinical bedside evaluation guidelines are needed so that clinicians can predict more reliably which infants are at risk for aspiration following the hybrid procedure.
吞咽功能障碍是复杂先天性心脏病（CHD）婴儿的一种已知并发症，但很少有研究探讨单心室生理儿童一期姑息性杂交手术后的吞咽结果。
（1）确定所有接受杂交手术的单心室生理婴儿的误吸发生率，（2）比较临床床边吞咽评估和仪器吞咽评估的结果，以检验这种侵入性较小的吞咽评估对该高危婴儿群体的预测价值。
这是一项回顾性队列图表审查研究。所有接受杂交手术的单心室生理患者在4年期间都被转诊进行后续的仪器吞咽评估。将临床床边评估结果与仪器评估结果进行比较。
本研究纳入了50名婴儿。在仪器吞咽评估期间，杂交手术后28%的婴儿观察到误吸。44%的婴儿吞咽功能正常，28%表现为喉穿透。插管时间和早产均未被发现是误吸的预测因素。其中36名婴儿在仪器评估前通过临床床边评估进行了评估。临床床边评估的敏感性为0.73，特异性为0.92。
本研究报告了一组接受杂交手术后单心室生理婴儿的情况，发现误吸发生率低于先前报道。需要改进临床床边评估指南，以便临床医生能够更可靠地预测哪些婴儿在杂交手术后有发生误吸的风险。
