Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
Department of Rehabilitation Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Oral Rehabil. 2020 Aug;47(8):983-988. doi: 10.1111/joor.13026. Epub 2020 Jun 15.
Swallowing disorder or dysphagia is quite common in hospitalised patients. Using fibre-optic endoscopic evaluation of swallowing (FEES) is one of the clinical standards for evaluating swallowing disorder to prevent serious consequences such as aspiration pneumonia. This study aimed to determine the prevalence and the associated risk of dysphagia in hospitalised patients by using FEES finding. We retrospectively analysed the FEES records from the patients who were screened and suspected of swallowing problems by a certified nurse of dysphagia nursing (CNDN). The FEES findings were compared between dysphagia and without dysphagia to evaluate the associated risk of dysphagia. Six-hundred and nine FEES records were analysed. We found dysphagia 76% in patients who suspected swallowing problems by CNDN. FEES was assessed after the subjects had been admitted for 22 days on average. There was no difference in age between dysphagia and without dysphagia participants. However, the advanced age (age > 85 years old) increased the odd of dysphagia 1.18, P = .03. The primary disease of the subjects was mainly cerebrovascular disease (24%) and pneumonia (22%). Abnormal FEES findings including soft palate elevation, velopharyngeal contraction, whiteout, volitional cough, glottis closure during breath holding, cough reflex and presence of secretion in pharynx were found in hospitalised patients with dysphagia. The prevalence of dysphagia was high in hospitalised patients. Hence, screening the swallowing problem by nurse and FEES evaluation is essential to detect and prevent the complication in the patient who has dysphagia.
吞咽障碍或吞咽困难在住院患者中较为常见。使用纤维光学内镜吞咽评估（FEES）是评估吞咽障碍的临床标准之一，以预防吸入性肺炎等严重后果。本研究旨在通过 FEES 发现确定住院患者吞咽困难的患病率和相关风险。我们对经吞咽障碍护理认证护士（CNDN）筛查和怀疑吞咽问题的患者的 FEES 记录进行了回顾性分析。将吞咽困难和无吞咽困难患者的 FEES 结果进行比较，以评估吞咽困难的相关风险。共分析了 609 份 FEES 记录。我们发现，经 CNDN 筛查怀疑吞咽问题的患者中，吞咽困难的发生率为 76%。FEES 评估是在患者平均住院 22 天后进行的。吞咽困难组和无吞咽困难组的年龄无差异。然而，高龄（年龄>85 岁）使吞咽困难的几率增加 1.18 倍，P=0.03。患者的主要疾病主要是脑血管病（24%）和肺炎（22%）。吞咽困难患者的 FEES 异常发现包括软腭抬高、软腭咽收缩、白色遮挡、自主咳嗽、屏气时声门关闭、咳嗽反射和咽部有分泌物。住院患者吞咽困难的患病率较高。因此，通过护士筛查和 FEES 评估吞咽问题，对发现和预防吞咽困难患者的并发症至关重要。
