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吞咽困难的非神经疾病患者的气道侵犯:吞咽过程中的促成因素及相关问题。一项回顾性观察研究。

Airway invasion in non-neurologically ill patients with dysphagia: Contributing factors and associated problems during swallowing process. A retrospective observational study.

作者信息

Kim Kang Lip, Park Gi-Young, Kwon Dong Rak, Kwon Do Yun, Kwak Sang Gyu, Cho Hee Kyung

机构信息

Department of Physical Medicine and Rehabilitation.

Department of Medical Statistics, Catholic University of Daegu School of Medicine, Republic of Korea.

出版信息

Medicine (Baltimore). 2020 Nov 6;99(45):e22977. doi: 10.1097/MD.0000000000022977.

Abstract

Dysphagia can occur among patients receiving medical care despite having no history of neurologic disease. The current study aimed to investigate factors contributing to airway invasion among non-neurologically ill patients with dysphagia.This retrospective study included 52 non-neurologically ill patients who complained of swallowing difficulty and consulted the Department of Rehabilitation Medicine for videofluoroscopic swallowing studies between January 2018 and June 2019. Patients were then divided into 2 groups according to the presence of airway invasion (penetration or aspiration) based on videofluoroscopic swallowing study findings, with group 1 (n = 26) consisting of patients with airway invasion and group 2 (n = 26) consisting of those without airway invasion. Demographic information, functional ambulation ability within the past 3 months, presence of community acquired pneumonia (CAP), nutritional status, degree of dehydration, history of intensive care unit stay, history of endotracheal intubation, and videofluoroscopic dysphagia scale were reviewed.Patients with airway invasion exhibited decreased functional ambulation ability, greater incidence of CAP, and lower serum albumin concentration than patients without airway invasion (P < .05). Airway invasion among non-neurologically ill patients was significantly associated with functional ambulation ability [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.14-11.19; P = .03], serum albumin concentration under 3.5 g/dL (OR, 4.90; 95% CI, 1.39-17.32; P = .01), and presence of CAP (OR, 5.06; 95% CI, 1.56-16.44; P = .01). Groups 1 and 2 had a videofluoroscopic dysphagia scale score of 37.18 and 16.17, respectively (P < .05). Moreover, bolus formation, tongue-to-palate contact, premature bolus loss, vallecular residue, coating of pharyngeal wall, and aspiration score differed significantly between both groups (P < .05).Airway invasion among non-neurologically ill patients was related to decreased functional ambulation ability, lower serum albumin concentration, and presence of CAP. The results presented herein can help guide clinical management aimed at preventing airway invasion among non-neurologically ill patients.

摘要

尽管没有神经疾病史,但接受医疗护理的患者仍可能出现吞咽困难。本研究旨在调查非神经疾病性吞咽困难患者发生气道侵犯的相关因素。这项回顾性研究纳入了52例无神经疾病的患者,这些患者在2018年1月至2019年6月期间因吞咽困难而就诊于康复医学科,并接受了电视荧光吞咽造影检查。然后根据电视荧光吞咽造影检查结果,将患者按是否存在气道侵犯(穿透或误吸)分为两组,第1组(n = 26)为存在气道侵犯的患者,第2组(n = 26)为无气道侵犯的患者。回顾了患者的人口统计学信息、过去3个月内的功能步行能力、社区获得性肺炎(CAP)的存在情况、营养状况、脱水程度、重症监护病房住院史、气管插管史以及电视荧光吞咽困难量表评分。与无气道侵犯的患者相比,存在气道侵犯的患者功能步行能力下降、CAP发生率更高且血清白蛋白浓度更低(P <.05)。非神经疾病患者的气道侵犯与功能步行能力[比值比(OR),3.57;95%置信区间(CI),1.14 - 11.19;P =.03]、血清白蛋白浓度低于3.5 g/dL(OR,4.90;95% CI,1.39 - 17.32;P =.01)以及CAP的存在(OR,5.06;95% CI,1.56 - 16.44;P =.01)显著相关。第1组和第2组的电视荧光吞咽困难量表评分分别为37.18和16.17(P <.05)。此外,两组之间的食团形成、舌 - 腭接触、食团过早丢失、会厌谷残留、咽壁覆盖以及误吸评分存在显著差异(P <.05)。非神经疾病患者的气道侵犯与功能步行能力下降、血清白蛋白浓度降低以及CAP的存在有关。本文给出的结果有助于指导旨在预防非神经疾病患者气道侵犯的临床管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d107/7647595/d9f7b69d5c1e/medi-99-e22977-g001.jpg

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