Chest:有创机械通气后ICU患者吞咽困难的危险因素

2020-06-08 MedSci原创 MedSci原创

基础神经系统疾病、急诊入院和有创机械通气时间是吞咽困难的重要独立危险因素。由于所有机械通气后的ICU患者都应考虑有吞咽困难的风险,因此建议对各个危重患者进行吞咽困难的系统筛查。

吞咽困难很常见,并可独立预测ICU患者的死亡。吞咽困难的危险因素在很大程度上未知,有创机械通气的ICU患者出现吞咽困难的关键危险因素是什么?

近日,呼吸领域权威杂志chest上发表了一篇研究文章,研究人员对来自单中心前瞻性观察研究(DYnAMICS)的数据进行事后分析,并使用综合统计模型确定拔管后吞咽困难的潜在危险因素。

在一家三级教学医院调查了933例成年外科ICU患者(中位年龄为65岁[IQR为54-73],n=666(71%)男性)。拔管后3小时内,患者对吞咽困难进行了系统的床旁筛查。吞咽困难筛查阳性(n=116)患者在24小时内进行确认检查。 调整混杂因素后,基础神经系统疾病(OR为4.45,95%CI:2.74-7.24,p<0.01)、急诊入院(OR为2.04,95%CI:1.15-3.59,p<0.01)、机械通气天数(OR为1.19,95%CI:1.06-1.34,p<0.01)、肾脏替代治疗天数(OR为1.1,95%CI:1-1.23,p=0.03)以及疾病严重程度(在第一个24小时内APACHE II评分; OR为1.03,95%CI:0.99-1.07,p<0.01)仍然是拔管后吞咽困难的独立危险因素。增加的体重指数可降低吞咽困难的风险(OR为0.94,95%CI:0.9-0.99,p=0.03)。

在ICU患者中,基础神经系统疾病、急诊入院和有创机械通气时间是吞咽困难的重要独立危险因素。由于所有机械通气后的ICU患者都应考虑有吞咽困难的风险,因此建议对各个危重患者进行吞咽困难的系统筛查。

原始出处:

Patrick Zuercher.et al.Risk factors for dysphagia in ICU patients following invasive mechanical ventilation.chest.2020.https://doi.org/10.1016/j.chest.2020.05.576

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    2020-07-23 ms7000001244967919

    学习了

    0

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    2021-05-04 Smile2680
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