背景:饮食,饮酒和吞咽困难是OA/TOF患者出生时常见的疾病.这项研究旨在确定饮食的性质和患病率,据报道,该人群饮酒和口咽吞咽困难。
方法:进行系统评价和meta比例分析(PROSPERO:CRD42020207263)。MEDLINE,EMBASE,CINAHL,Pubmed,Scopus,检索了WebofScience数据库和灰色文献。提取与吞咽损伤相关的定量和定性数据,使用进餐时间适应和饮食相关的生活质量。使用叙述和元比例分析方法对定量数据进行汇总。使用元聚合方法合成定性数据。如果定量和定性数据描述了相同的现象,采用收敛分离的方法来合成数据。
结果:纳入65项研究。确定了六个口咽吞咽特征,和汇总患病率计算:误吸(24%),喉渗透(6%),口腔期功能障碍(11%),咽部残留物(13%),鼻反流(7%),延迟吞咽开始(31%)。确定了四个患者报告的饮食/饮料困难,和汇总患病率计算:吞咽困难固体(45%),吞咽困难的液体(6%),吞咽困难(30%),吃饭时咳嗽(38%)。确定了三个患者报告的进餐时间适应,和汇总患病率计算:进食时需要水(49%),慢慢吃(37%)修改纹理(28%)。心理社会影响的混合方法综合确定了34%的父母经历了进餐时间焦虑,25%的父母报告了具有挑战性的进餐时间行为,反映在五个定性主题中:与饮食相关的恐惧和创伤,孤立和缺乏支持,意识到和感激,支持应对和损失。
结论:进食和饮料困难在OA/TOF修复的成人和儿童中很常见。口咽吞咽困难可能比以前报道的更普遍。吃,饮酒和吞咽困难会影响心理健康和生活质量,对于个人和父母/家庭成员。长期的,有必要采取多学科的后续行动。
BACKGROUND: Eating, drinking and swallowing difficulties are commonly reported morbidities for individuals born with OA/TOF. This study aimed to determine the nature and prevalence of eating, drinking and oro-pharyngeal swallowing difficulties reported in this population.
METHODS: A systematic review and meta-proportional analysis were conducted (PROSPERO: CRD42020207263). MEDLINE, EMBASE, CINAHL, Pubmed, Scopus, Web of Science databases and grey literature were searched. Quantitative and qualitative data were extracted relating to swallow impairment, use of mealtime adaptations and eating and drinking-related quality of life. Quantitative data were summarised using narrative and meta-proportional analysis methods. Qualitative data were synthesised using a meta-aggregation approach. Where quantitative and qualitative data described the same phenomenon, a convergent segregated approach was used to synthesise data.
RESULTS: Sixty-five studies were included. Six oro-pharyngeal swallow characteristics were identified, and pooled prevalence calculated: aspiration (24%), laryngeal penetration (6%), oral stage dysfunction (11%), pharyngeal residue (13%), nasal regurgitation (7%), delayed swallow initiation (31%). Four patient-reported eating/drinking difficulties were identified, and pooled prevalence calculated: difficulty swallowing solids (45%), difficulty swallowing liquids (6%), odynophagia (30%), coughing when eating (38%). Three patient-reported mealtime adaptations were identified, and pooled prevalence calculated: need for water when eating (49%), eating slowly (37%), modifying textures (28%). Mixed methods synthesis of psychosocial impacts identified 34% of parents experienced mealtime anxiety and 25% report challenging mealtime behaviours reflected in five qualitative themes: fear and trauma associated with eating and drinking, isolation and a lack of support, being aware and grateful, support to cope and loss.
CONCLUSIONS: Eating and drinking difficulties are common in adults and children with repaired OA/TOF. Oro-pharyngeal swallowing difficulties may be more prevalent than previously reported. Eating, drinking and swallowing difficulties can impact on psychological well-being and quality of life, for the individual and parents/family members. Long-term, multi-disciplinary follow-up is warranted.