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经气管插管拔管后 COVID-19 患者的纤维内镜检查时的吞咽困难特征。

Dysphagia characteristics at FEES examination in post-extubation patients with COVID-19.

机构信息

Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy.

出版信息

Acta Otorhinolaryngol Ital. 2024 Jun;44(3):183-191. doi: 10.14639/0392-100X-N2816.

Abstract

OBJECTIVE

The aims of this study was to analyse fibreoptic endoscopic evaluation of swallowing (FEES) findings in tube-fed patients with coronavirus disease 2019 (COVID-19).

METHODS

Seventeen patients who had been intubated during intensive care unit (ICU) stay were enrolled. Pooling of secretions, dysphagia phenotype, penetration/aspiration and residue after swallow were assessed through FEES. The Functional Oral Intake Scale (FOIS) scores were also collected. Patients with significant swallowing impairment were evaluated again after 2 weeks.

RESULTS

All patients were tube-fed at enrollment. According to the FEES results, 7 started total oral feeding with at least one consistency. The more common dysphagia phenotypes were propulsive deficit and delayed pharyngeal phase. Pooling of secretions, penetration/aspiration, and residue after swallow were frequently documented. A significant improvement in FOIS scores was found during the second FEES examination.

CONCLUSIONS

Swallowing impairment in patients with severe COVID-19 after discharge from the ICU is characterised by propulsive deficit and delayed pharyngeal phase. Most of these patients required feeding restrictions even if feeding abilities seem to improve over time.

摘要

目的

本研究旨在分析 2019 冠状病毒病(COVID-19)患者经鼻饲管喂养后的纤维内镜吞咽功能评估(FEES)结果。

方法

共纳入 17 名在重症监护病房(ICU)住院期间插管的患者。通过 FEES 评估患者的分泌物积聚、吞咽障碍表现、吞咽后误吸/渗漏以及残留情况,并收集功能性口腔摄入量表(FOIS)评分。对于有明显吞咽障碍的患者,在 2 周后再次进行评估。

结果

所有患者入组时均经鼻饲管喂养。根据 FEES 结果,有 7 名患者开始至少经一种稠度的食物经口摄食。更常见的吞咽障碍表现为推进力不足和咽期延迟。分泌物积聚、误吸/渗漏以及吞咽后残留情况频繁出现。第二次 FEES 检查时 FOIS 评分显著改善。

结论

COVID-19 重症患者在 ICU 出院后存在吞咽障碍,表现为推进力不足和咽期延迟。这些患者大多需要限制喂养,即使随着时间的推移喂养能力似乎有所改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16c3/11166213/0e494c5c256f/aoi-2024-03-183-g002.jpg

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