目的:证据表明,有20%-30%的患者是默默地吸气的。迄今为止的研究还没有明确的证据表明哪些患者有更高的无声误吸风险。我们的目的是使用回顾性病例回顾的单变量逻辑回归分析来确定无声误吸的潜在模式。
方法:我们对455例纤维内镜下吞咽评估(FEES)报告进行了回顾性分析。将患者分为四组:G1-神经系统疾病(n=93),G2-头颈部手术(n=200),G3-胃肠道疾病(n=94)和G4-其他患者(n=68)。数据包括唾液渗透或误吸的发生或不发生,无声流体/固体食物渗透或抽吸,渗透或抽吸类型,脑神经麻痹的发生,放疗和气管切开术。单因素logistic回归用于评估研究人群中沉默误吸的独立危险因素。考虑了具有不同自变量的三个模型。
结果:两组之间无声渗透和误吸的发生频率存在统计学上的显着差异(p<0.001),最常见的是插入性。在所有组中,液体和食物的渗透和抽吸与唾液渗透和抽吸相关(p<0.001)。颅神经麻痹(IX和X),放疗和气管切开术与唾液渗透和抽吸相关(脑神经麻痹p=0.020;放疗p=0.004;气管切开术p<0.001)。在患有体内抽吸的患者亚组中,115例患者(45.81%)患有颅神经麻痹(IX,X或IX-X)。
结论:应优先考虑或被认为需要更高的器械吞咽评估的患者是患有IX和X脑神经麻痹的患者。气管造口术和接受过放射治疗的人,唾液吞咽问题,尤其是副神经节瘤之后,甲状腺和甲状旁腺和中后窝肿瘤手术。
结论:本主题已知的渗透或误吸的临床体征包括咳嗽,喉咙清理和声音改变,而无声渗透或误吸患者吸出而没有表现出任何临床症状。无声吸入最常见的后果包括吸入性肺炎,反复下呼吸道感染和呼吸衰竭。此外,营养不良和脱水可以是无声愿望的指标。患者可能会在不知不觉中减少口服摄入并减轻体重。回顾性研究表明,20%-30%的患者默默地吸气(例如中风后的患者,获得性脑损伤,头颈癌治疗,长时间插管)。吞咽的临床检查可能会错过多达50%的无声抽吸病例。本文对现有知识的补充目前,沉默的愿望经常在神经学文献中讨论,但其在头颈部手术中的应用是有限的。在这项研究中,我们确定了头颈部手术患者,由于无症状吸入的风险较高,因此应优先考虑或认为需要更高的器械吞咽评估.这项工作的潜在或实际临床意义是什么?治疗后的结构变化可导致下颅神经麻痹(IX,X,XII)和面部受伤,其中迷走神经和舌咽神经受伤。气管切开术和放疗后,吞咽唾液有问题的患者需要仔细的临床检查,尤其是颅神经检查.
OBJECTIVE: Evidence shows that 20%-30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case
review to determine potential patterns of silent aspiration.
METHODS: We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (
FEES) reports. The patients were divided into four groups: G1 - neurological diseases (n = 93), G2 - head and neck surgery (n = 200), G3 - gastroenterological diseases (n = 94) and G4 - other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered.
RESULTS: There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX-X).
CONCLUSIONS: Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery.
CONCLUSIONS: What is already known on the subject Clinical signs of penetration or aspiration include coughing, throat clearing and voice changes, while silent penetration or aspiration patients aspirate without demonstrating any clinical symptoms. The most common consequences of silent aspiration include aspiration pneumonia, recurrent lower respiratory tract infections and respiratory failure. Additionally, malnutrition and dehydration can be indicators of silent aspiration. Patients may unknowingly reduce their oral intake and lose weight. Retrospective studies have shown that 20%-30% of patients aspirate silently (e.g. patients after stroke, acquired brain injury, head and neck cancer treatment, prolonged intubation). Clinical examination of swallowing can miss up to 50% of cases of silent aspiration. What this paper adds to existing knowledge Currently, silent aspiration is often discussed in neurological literature, but its applications to head and neck surgery are limited. In this study, we identify head and neck surgery patients who should be prioritised or considered to be in higher need of instrumental swallowing evaluation due to a higher risk of silent aspiration. What are the potential or actual clinical implications of this work? Post-treatment structural changes can result in lower cranial nerve paresis (IX, X, XII) and face injury, in which vagus and glossopharyngeal nerves are injured. After tracheostomy and radiotherapy, patients with problems swallowing saliva need careful clinical examination, particularly cranial nerve examination.