Leder S B, Cohn S M, Moller B A
Yale University School of Medicine, Department of Surgery, Section of Otolaryngology, Communication Disorders Center, New Haven 06504, Connecticut, USA.
Dysphagia. 1998 Fall;13(4):208-12. doi: 10.1007/PL00009573.
The purpose of this study was to investigate the incidence of aspiration following extubation in critically ill trauma patients. This prospective pilot study included 20 consecutive trauma patients who required orotracheal intubation for at least 48 hours. All subjects underwent a bedside transnasal fiberoptic endoscopic evaluation of swallowing at 24 +/- 2 hr after extubation to determine objectively aspiration status. Aspiration was defined as the entry of a blue dyed material into the airway below the level of the true vocal folds, with silent aspiration occurring in the absence of any external behavioral signs such as coughing or choking. Aspiration was identified in 9 of 20 (45%) subjects and 4 of these 9 (44%) were silent aspirators. Therefore, silent aspiration occurred in 20% of the study population. Eight of the 9 (89%) aspirating subjects resumed an oral diet from 2-10 days (mean, 5 days) following extubation. All subjects had no evidence of pulmonary complications. It was concluded that trauma patients after orotracheal intubation and prolonged mechanical ventilation have an increased risk of aspiration. An objective assessment of dysphagia to identify aspiration may reduce the likelihood of pulmonary complications after extubation.
本研究的目的是调查重症创伤患者拔管后误吸的发生率。这项前瞻性初步研究纳入了20例连续的创伤患者，这些患者需要经口气管插管至少48小时。所有受试者在拔管后24±2小时接受床边经鼻纤维光学内镜吞咽评估，以客观确定误吸状态。误吸定义为蓝色染色物质进入真声带水平以下的气道，无声误吸发生时无任何外部行为体征，如咳嗽或窒息。20名受试者中有9名（45%）被确定有误吸，这9名中有4名（44%）为无声误吸者。因此，无声误吸发生在20%的研究人群中。9名误吸受试者中有8名（89%）在拔管后2至10天（平均5天）恢复经口进食。所有受试者均无肺部并发症的证据。得出的结论是，经口气管插管和长时间机械通气后的创伤患者误吸风险增加。对吞咽困难进行客观评估以识别误吸可能会降低拔管后肺部并发症的可能性。
