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预防误吸手术:与口腔状况、摄入量及吸痰频率改善相关的临床因素

Aspiration Prevention Surgery: Clinical Factors Associated With Improvements in Oral Status Intake and Suction Frequency.

作者信息

Koyama Misaki, Ueha Rumi, Sato Taku, Goto Takao, Yamauchi Akihito, Kaneoka Asako, Suzuki Sayaka, Nito Takaharu, Yamasoba Tatsuya

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. 2023 May;168(5):1146-1155. doi: 10.1002/ohn.183. Epub 2023 Jan 19.

Abstract

OBJECTIVE

In recent years, the use of aspiration prevention surgery (APS) for the treatment of severe dysphagia has been on the rise. However, relevant clinical studies have included small samples, and the frequency of, and risk factors for postoperative complications have not been clarified. We investigated the clinical features of patients undergoing APS and whether oral-intake status and suction frequency could be reduced.

STUDY DESIGN

A case series.

SETTING

Single-institution academic center.

METHODS

We retrospectively evaluated medical charts generated from 2010 to 2021. The clinical characteristics of patients undergoing APS, changes in the oral-intake status (Functional Oral Intake Scale, FOIS), suction frequency before and after surgery, risk factors for postoperative complications, and factors contributing to improvements in postoperative oral-intake status were retrieved.

RESULTS

We included the data of 100 patients (median age: 65 years, 72 men). Amyotrophic lateral sclerosis was the most common primary disease (28%), and glottis closure was the most common APS (69%). Postoperatively, 78% of patients showed improvements in the FOIS score, and suction frequency decreased in 85% of cases. Postoperative complications were observed in 10 patients (10%), wound infection in 6, and bleeding in 4; all improved. Higher preoperative FOIS scores were significantly associated with postoperative complications (p = 0.02).

CONCLUSION

APS contributed to improving the FOIS score and helped reduce the suction frequency in most cases. APS can be performed safely with proper perioperative management, even in patients with poor preoperative general conditions and nutritional status.

摘要

目的

近年来,采用预防误吸手术(APS)治疗严重吞咽困难的情况日益增多。然而,相关临床研究样本量较小,术后并发症的发生率及危险因素尚未明确。我们调查了接受APS治疗患者的临床特征,以及是否可以降低经口进食状态和吸痰频率。

研究设计

病例系列研究。

研究地点

单机构学术中心。

方法

我们回顾性评估了2010年至2021年期间生成的病历。收集了接受APS治疗患者的临床特征、经口进食状态的变化(功能性经口进食量表,FOIS)、手术前后的吸痰频率、术后并发症的危险因素以及有助于改善术后经口进食状态的因素。

结果

我们纳入了100例患者的数据(中位年龄:65岁,男性72例)。肌萎缩侧索硬化是最常见的原发性疾病(28%),声门闭合术是最常见的APS(69%)。术后,78%的患者FOIS评分有所改善,85%的病例吸痰频率降低。10例患者(10%)出现术后并发症,6例伤口感染,4例出血;所有患者均康复。术前FOIS评分较高与术后并发症显著相关(p = 0.02)。

结论

APS有助于提高FOIS评分,并在大多数情况下有助于降低吸痰频率。即使术前一般状况和营养状况较差的患者,通过适当的围手术期管理,也可以安全地进行APS手术。

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