拔管后吞咽障碍对ICU内机械通气老年患者预后的影响  

Association between post-extubation dysphagia and the prognosis among older adults in ICU

作　　者：李杰[1] 刘士立 尹月秋[1] 李京[1] 刘震[1] 赵丽[1] LI Jie;LIU Shili;YIN Yueqiu;LI Jing;LIU Zhen;ZHAO Li(Department of Emergency,Fuxing Hospital,Capital Medical University,Beijing,100038,China)

机构地区：[1]首都医科大学附属复兴医院急诊科,北京100038

出　　处：《临床急诊杂志》2020年第5期389-392,共4页Journal of Clinical Emergency

摘　　要：目的:回顾性分析2015-12—2019-12期间我院急诊ICU收治的因急性呼吸衰竭给予气管插管及机械通气的老年病例,探讨拔管后吞咽障碍对ICU内机械通气老年患者短期及长期预后的影响。方法:使用FEES的方法对拔管后合并吞咽障碍的老年患者的吞咽功能进行评估及分组,并比较不同组之间预后相关指标的差异(包括是否有再插管、总住院时间、拔管后吸入性肺炎发生率、住院期间病死率)。并对顺利出院患者进行为期1年的随访,统计其1年后病死率。结果:共81例患者纳入本研究,吞咽功能正常组共33例(40.7%),合并吞咽功能障碍组48例(59.3%),其中隐性误吸共24例(29.2%)。吞咽功能正常组及合并吞咽障碍组之间,在总住院时间、再插管率及住院期间病死率方面差异有统计学意义(P=0.001、0.040、0.011)。顺利出院共56例(吞咽功能正常组28例,吞咽功能障碍组28例),2组之间1年后病死率差异无统计学意义(P=0.079)。结论:本研究发现合并拔管后吞咽功能障碍的ICU内老年患者短期预后较差,其拔管后再插管率及病死率较高,住院时间较长;但在顺利出院的患者中,是否合并吞咽障碍与其1年后病死率无明显相关。Objective: To investigate the association between the prognosis and postextubation dysphagia(PED) among older adults with mechanical ventilation in ICU from December 2015 to December 2019. Method: The swallowing function of the elderly patients after extubation was evaluated with fiberoptic endoscopic evaluation of swallowing(FEES) and the patients were divided into two groups according results. Reintubation rate, total length of stay, the incidence of aspiration pneumonia after extubation and mortality during hospitalization between the two groups were compared. The association between PED and 1-year mortality was also investigated. Result: A total of 81 patients were included in this study. After extubation, 48(59.3%) had PED, and 24(29.2%) aspirated silently. In univariate analyses, the total length of stay, the reintubation rate and the mortality during hospitalization were statistically significant between the two groups(P=0.001, 0.040, 0.011). In the 56 survivors, dysphagia was not associated with 1-year mortality.(P=0.079).Conclusion: This study found that the development of postextubation dysphagia among older adults with mechanical ventilation in ICU was associated with poor patient outcomes. There was no significant difference in 1-year mortality in those with clinically significant dysphagia compared to those without in who survived to hospital discharge.

关 键 词：拔管后吞咽障碍 老年 机械通气 ICU 预后 

分 类 号：R459.6[医药卫生—治疗学]