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2019年冠状病毒病重症患者的吞咽困难——潜在的神经病因

Dysphagia in Patients With Severe Coronavirus Disease 2019-Potential Neurologic Etiologies.

作者信息

Dziewas Rainer, Hufelschulte Lisa-Marie, Lepper Johannes, Sackarnd Jan, Minnerup Jens, Teismann Inga, Ahring Sigrid, Claus Inga, Labeit Bendix, Muhle Paul, Suntrup-Krüger Sonja, Warnecke Tobias, Padberg Jan-Sören

机构信息

Department of Neurology, University Hospital Münster, 48149 Münster, Germany.

Department of Cardiology, University Hospital Münster, 48149 Münster, Germany.

出版信息

Crit Care Explor. 2021 Jan 22;3(1):e0332. doi: 10.1097/CCE.0000000000000332. eCollection 2021 Jan.

Abstract

IMPORTANCE

Dysphagia is a common complication of critical illness, and many known risk factors are also present in critically ill coronavirus disease 2019 victims.

OBJECTIVES

To investigate dysphagia in patients with severe coronavirus disease 2019.

DESIGN SETTING AND PARTICIPANTS

In this case series, we report results of dedicated evaluation of swallowing function in six consecutive, tracheotomized coronavirus disease 2019 patients after they had survived acute respiratory distress syndrome and were weaned from the respirator.

MAIN OUTCOMES AND MEASURES

Dysphagia was assessed with flexible endoscopic evaluation of swallowing.

RESULTS

Three patients suffered from severe dysphagia and airway compromise precluding decannulation, whereas in the other, three swallowing was less critically impaired, and the tracheal cannula could be removed. Four patients presented with additional laryngeal dysfunctions not typically seen in acute respiratory distress syndrome survivors.

CONCLUSION AND RELEVANCE

Dysphagia with impaired airway protection is a key feature in coronavirus disease 2019 acute respiratory distress syndrome survivors. Apart from critical illness polyneuropathy, coronavirus disease 2019-related involvement of the peripheral and central nervous system may contribute to swallowing impairment and laryngeal dysfunction.

摘要

重要性

吞咽困难是危重症的常见并发症,许多已知风险因素在危重症新型冠状病毒肺炎患者中也存在。

目的

研究重症新型冠状病毒肺炎患者的吞咽困难情况。

设计、地点和参与者:在本病例系列中,我们报告了对连续6例气管切开的新型冠状病毒肺炎患者进行吞咽功能专项评估的结果,这些患者均已从急性呼吸窘迫综合征中存活且已脱机。

主要结局和测量指标

通过吞咽功能的软性内镜评估来评估吞咽困难情况。

结果

3例患者存在严重吞咽困难和气道受损,无法拔管;而另外3例患者吞咽功能受损程度较轻,气管套管可以拔除。4例患者出现了急性呼吸窘迫综合征幸存者中不常见的额外喉部功能障碍。

结论及意义

气道保护受损的吞咽困难是新型冠状病毒肺炎急性呼吸窘迫综合征幸存者的关键特征。除了危重症多发性神经病外,新型冠状病毒肺炎相关的外周和中枢神经系统受累可能导致吞咽障碍和喉部功能障碍。

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