Reder Lindsay, Bertelsen Caitlin, Angajala Varun, O'Dell Karla, Fisher Laurel
Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.
Laryngoscope. 2021 Jan;131(1):115-120. doi: 10.1002/lary.28606. Epub 2020 Mar 16.
To evaluate the impact of early inpatient bedside injection laryngoplasty (IL) in hospitalized patients with iatrogenic unilateral vocal fold immobility (UVFI).
Retrospective cohort study.
A retrospective review of hospitalized patients with iatrogenic UVFI undergoing IL between September 2013 and June 2017 was performed. Patients had a swallow evaluation by a speech-language pathologist and bedside IL. Evaluated outcomes included swallow scores, return to diet, secondary events/procedures, and hospital length of stay. Outcomes related to etiology of UVFI were also examined.
The cohort consisted of 90 patients (61% male, 52% after cardiac/cardiothoracic surgery). Seventy-seven percent of all patients who could improve had increased swallow scores after IL. The lowest number (40%) from the subgroup of patients with high vagal injuries as the cause of UVFI obtained improvement in swallow scores, whereas 87% of those in the cardiac surgery group improved. There were more bronchoscopies and reintubations in patients before IL than after IL.
Hospitalized patients with UVFI are at increased risk of morbidity and mortality due to dysphagia. We advocate for early swallow evaluation and intervention with IL if there is dysphagia and risk of aspiration. Coordination of care between interdisciplinary teams is paramount to a successful inpatient IL program.
2b Laryngoscope, 131:115-120, 2021.
评估早期住院患者床边注射喉成形术（IL）对医源性单侧声带麻痹（UVFI）住院患者的影响。
回顾性队列研究。
对2013年9月至2017年6月期间接受IL治疗的医源性UVFI住院患者进行回顾性研究。患者由言语病理学家进行吞咽评估并接受床边IL治疗。评估的结果包括吞咽评分、恢复经口饮食情况、二次事件/操作以及住院时间。还检查了与UVFI病因相关的结果。
该队列包括90例患者（61%为男性，52%在心脏/心胸手术后）。所有能够改善的患者中，77%在IL治疗后吞咽评分有所提高。以迷走神经高位损伤为UVFI病因的亚组中，改善吞咽评分的患者比例最低（40%），而心脏手术组中这一比例为87%。IL治疗前患者的支气管镜检查和再次插管次数多于治疗后。
UVFI住院患者因吞咽困难而出现发病和死亡的风险增加。如果存在吞咽困难和误吸风险，我们主张早期进行吞咽评估并采用IL进行干预。跨学科团队之间的护理协调对于成功开展住院患者IL项目至关重要。
2b 《喉镜》，2021年，第131卷，第115 - 120页
