接受液体增稠建议后发生吸入性肺炎的危险因素。
Risk Factors for Aspiration Pneumonia After Receiving Liquid-Thickening Recommendations.
机构信息
Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan.
出版信息
Otolaryngol Head Neck Surg. 2022 Jul;167(1):125-132. doi: 10.1177/01945998211049114. Epub 2021 Sep 28.
OBJECTIVE
We examined the influence of liquid thickness levels on the frequency of liquid penetration-aspiration in patients with dysphagia and evaluated the clinical risk factors for penetration-aspiration and aspiration pneumonia development.
STUDY DESIGN
A case series.
SETTING
Single-institution academic center.
METHODS
We reviewed medical charts from 2018 to 2019. First, we evaluated whether liquid thickness levels influence the frequency of liquid penetration-aspiration in patients with dysphagia. Penetration-aspiration occurrence in a videofluoroscopic swallowing study was defined as Penetration-Aspiration Scale (PAS) scores ≥3. Second, the association between liquid thickness level and penetration-aspiration was analyzed, and clinical risk factors were identified. Moreover, clinical risk factors for aspiration pneumonia development within 6 months were investigated.
RESULTS
Of 483 patients, 159 showed penetration-aspiration. The thickening of liquids significantly decreased the incidence of penetration-aspiration ( < .001). Clinical risk factors for penetration-aspiration were vocal fold paralysis (odds ratio [OR], 1.99), impaired laryngeal sensation (OR, 5.01), and a history of pneumonia (OR, 2.90). Twenty-three patients developed aspiration pneumonia while undertaking advised dietary changes, including liquid thickening. Significant risk factors for aspiration pneumonia development were poor performance status (OR, 1.85), PAS score ≥3 (OR, 4.03), and a history of aspiration pneumonia (OR, 7.00).
CONCLUSION
Thickening of liquids can reduce the incidence of penetration-aspiration. Vocal fold paralysis, impaired laryngeal sensation, and history of aspiration pneumonia are significant risk factors of penetration-aspiration. Poor performance status, PAS score ≥3, and history of aspiration pneumonia are significantly associated with aspiration pneumonia development following recommendations on thickening liquids.
LEVEL OF EVIDENCE
目的
我们研究了液体厚度对吞咽困难患者液体渗透-吸入频率的影响，并评估了渗透-吸入和吸入性肺炎发展的临床危险因素。
研究设计
病例系列。
设置
单机构学术中心。
方法
我们回顾了 2018 年至 2019 年的病历。首先，我们评估了液体厚度是否会影响吞咽困难患者的液体渗透-吸入频率。透视吞咽研究中的渗透-吸入发生定义为渗透-吸入量表（PAS）评分≥3。其次，分析了液体厚度与渗透-吸入的关系，并确定了临床危险因素。此外，还研究了 6 个月内发生吸入性肺炎的临床危险因素。
结果
在 483 名患者中，有 159 名出现渗透-吸入。液体增稠显著降低了渗透-吸入的发生率（<0.001）。渗透-吸入的临床危险因素为声带麻痹（比值比[OR]，1.99）、喉感觉受损（OR，5.01）和肺炎史（OR，2.90）。23 名患者在接受建议的饮食改变（包括液体增稠）后发生了吸入性肺炎。吸入性肺炎发展的显著危险因素是较差的一般状态（OR，1.85）、PAS 评分≥3（OR，4.03）和肺炎史（OR，7.00）。
结论
液体增稠可以降低渗透-吸入的发生率。声带麻痹、喉感觉受损和肺炎史是渗透-吸入的显著危险因素。较差的一般状态、PAS 评分≥3 和肺炎史与建议增稠液体后吸入性肺炎的发展显著相关。
证据水平
3 级。
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