Barnes Jason H, Orbelo Diana M, Armstrong Michael F, Bayan Semirra L, Lohse Christine M, Ekbom Dale C
Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Ann Otol Rhinol Laryngol. 2020 Nov;129(11):1129-1134. doi: 10.1177/0003489420933650. Epub 2020 Jun 8.
Recurrent laryngeal nerve injury is a potential complication of cardiothoracic surgery and cause of unilateral vocal fold paralysis (UVFP). Injection laryngoplasty (IL) is an intervention offered to patients with UVFP to alleviate symptoms including dysphagia, dysphonia and weak cough. There is no definitive evidence that IL prevents pneumonia. In this study, we compare rates of pneumonia in patients with UVFP secondary to cardiothoracic surgery who did or did not undergo IL.
A retrospective chart review identified patients diagnosed with UVFP by an otolaryngologist using flexible laryngoscopy following cardiothoracic surgery from January 1, 2008 to December 31, 2017. Each subject was grouped by IL status and assessed for subsequent pneumonia within 6 months of their diagnosis of UVFP. The association of IL with pneumonia was evaluated using Cox proportional hazards regression.
Of 92 patients who met inclusion criteria, 35 (38%) underwent IL and 57 (62%) did not. Twenty patients developed pneumonia, four who had undergone IL and 16 who had not; 12 patients developed aspiration pneumonia including two having undergone IL and 10 who had not. Those who had IL were less likely to develop total pneumonia compared to those who had not (HR = 0.33, = .045). The protective effect of IL was not as clearly sustained when measuring for aspiration pneumonia, specifically (HR = 0.34; = .10).
Injection laryngoplasty may reduce the risk of pneumonia in patients with UVFP secondary to cardiothoracic surgery; however, further research is needed to quantify the potential protective nature of IL in this patient population.
3 (A retrospective cohort study).
喉返神经损伤是心胸外科手术的一种潜在并发症，也是单侧声带麻痹（UVFP）的病因。注射喉成形术（IL）是针对UVFP患者提供的一种干预措施，以缓解包括吞咽困难、发音障碍和咳嗽无力等症状。目前尚无确凿证据表明IL可预防肺炎。在本研究中，我们比较了因心胸外科手术继发UVFP且接受或未接受IL治疗的患者的肺炎发生率。
通过回顾性病历审查，确定2008年1月1日至2017年12月31日期间心胸外科手术后经耳鼻喉科医生使用可弯曲喉镜诊断为UVFP的患者。根据IL治疗情况对每个受试者进行分组，并在其诊断为UVFP后的6个月内评估是否发生随后的肺炎。使用Cox比例风险回归评估IL与肺炎的相关性。
在92名符合纳入标准的患者中，35名（38%）接受了IL治疗，57名（62%）未接受。20名患者发生了肺炎，其中4名接受了IL治疗，16名未接受；12名患者发生了吸入性肺炎，其中2名接受了IL治疗，10名未接受。与未接受IL治疗的患者相比，接受IL治疗的患者发生总体肺炎的可能性较小（风险比[HR]=0.33，P=0.045）。在测量吸入性肺炎时，IL的保护作用并不那么明显（HR=0.34；P=0.10）。
注射喉成形术可能会降低心胸外科手术继发UVFP患者发生肺炎的风险；然而，需要进一步研究来量化IL在该患者群体中的潜在保护作用。
3级（回顾性队列研究）。
