背景：拔管后吞咽困难值得关注，因为它使患者在拔管后处于危险之中，特别是重症监护病房的危重病人。然而,关于拔管后早期吞咽困难的研究有限。
目的：探讨重症监护病房患者拔管24h内拔管后吞咽困难的发生率及相关因素。
方法：对广州市某三甲医院重症监护病房的173名成人患者进行了前瞻性描述性研究。中国。拔管后1、4和24h，使用Gugging吞咽屏幕评估患者的吞咽功能。从医疗记录中检索人口统计学和临床数据。
结果：拔管后1、4和24h内患者拔管后吞咽困难的发生率为86.71％（n=150），63.01%(n=109)和43.35%(n=75)，分别。危险因素包括年龄较大（OR=1.057,95CI[1.039,1.072]，p<.001),心血管疾病（OR=0.098，95CI[0.082，0.127]，p=.012)，甲状腺功能障碍（OR=5.042,95CI[1.527,13.684]，p<.001),非术后入院（OR=3.186,95CI[1.142,14.422]，p=.036)，机械通气持续时间>48小时(OR=3.558,95CI[1.217,10.385]，p=.020)，插管持续时间>24h（OR=0.533,95CI[0.278,0.898]，p=.048）和插管模型尺寸≤7（OR=0.327，95CI[0.158，0.788]，p<.01)。
结论：这项研究揭示了危重患者拔管后24小时内拔管后吞咽困难的发生率高，发病率随着时间的推移而下降。拔管后需要筛查早期拔管后吞咽困难，但是具体的评估时间点需要进一步调查。年龄较大的患者，脑血管疾病，甲状腺功能异常,术后入院,机械通气时间更长，更厚的插管模型和更长的插管时间有更高的发生拔管后吞咽困难的风险.
结论：拔管后吞咽困难的早期发生率很高。拔管后24h内，应积极评估患者的吞咽功能，并且应该警惕愿望的发生。年龄较大的患者，脑血管疾病，甲状腺功能异常,术后入院,机械通气时间更长，更厚的插管模式和更长的插管时间应该得到更多的关注。
BACKGROUND: Post-extubation dysphagia deserves attention because it places patients at risk following extubation, especially critically ill patients in intensive care unit. However, there are limited studies of post-extubation dysphagia in the early stages after extubation.
OBJECTIVE: To investigate the incidence and factors associated with post-extubation dysphagia among patients in intensive care unit within 24 h of extubation.
METHODS: A prospective descriptive study was carried out with 173 adult patients in intensive care unit with tracheal extubation at a tertiary hospital in Guangzhou,
China. The Gugging Swallowing Screen was used to evaluate the swallowing function of patients 1, 4 and 24 h after extubation. Demographic and clinical data were retrieved from medical records.
RESULTS: The incidence of post-extubation dysphagia in patients within 1, 4 and 24 h after extubation was 86.71% (n = 150), 63.01% (n = 109) and 43.35% (n = 75), respectively. The risk factors included older age (OR = 1.057, 95%CI [1.039, 1.072], p < .001), cardiovascular disease (OR = 0.098, 95%CI [0.082, 0.127], p = .012), thyroid dysfunction (OR = 5.042, 95%CI [1.527, 13.684], p < .001), non-post-operative admission (OR = 3.186, 95%CI [1.142, 14.422], p = .036), mechanical ventilation duration >48 h (OR = 3.558, 95%CI [1.217, 10.385], p = .020), intubation duration >24 h (OR = 0.533, 95%CI [0.278, 0.898], p = .048) and intubation model size ≤7 (OR = 0.327, 95%CI [0.158, 0.788], p < .01).
CONCLUSIONS: This study revealed a high incidence of post-extubation dysphagia in critical patients in the 24 h after extubation, with the incidence decreasing over time. Screening of early post-extubation dysphagia after extubation is needed, but the specific evaluation time point requires further investigation. Patients with older age, cerebrovascular disease, thyroid dysfunction, post-operative admission, longer mechanical ventilation time, thicker intubation models and longer intubation time have a higher risk of the occurrence of post-extubation dysphagia.
CONCLUSIONS: The incidence of post-extubation dysphagia is very high in the early stage. Within 24 h after extubation, the patient\'s swallowing function should be actively evaluated, and the occurrence of aspiration should be vigilant. Patients with older age, cerebrovascular disease, thyroid dysfunction, post-operative admission, longer mechanical ventilation time, thicker intubation models and longer intubation time should receive more attention.
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