心脏术后患者发生获得性吞咽障碍的危险因素分析

Risk factors of acquired swallowing disorders among patients after cardiac surgery

目的探讨心脏术后患者获得性吞咽障碍发生的危险因素。方法采用病例一对照研究．将2015年3～7月在阜外医院采用洼田饮水试验筛出的32例心脏术后发生获得性吞咽障碍的患者作为病例组。从同期同病区心脏术后无获得性吞咽障碍的452例患者随机抽取128例（1：4）作为对照组，使用Logistic归分析筛出获得性吞咽障碍的危险因素。结果经Logistic归分析，年龄（OR=1．045）、性别（OR=2．321）、慢性肺部疾病（OR=6．517）、心外动脉病（OR=3．222）、不稳定心绞痛（OR=2．555）、陈旧性心肌梗死（OR=4．634）、心律失常病史（OR=2．555）、介入及手术史（OR=2．444）、心功能（OR=3．008）、Euroseoree评分（OR=1．246）、气管插管时间（OR=1．103）、留置胃管时间（OR=1．085）等为心脏术后患者发生获得性吞咽障碍的危险因素。结论对于具有以上特征的高危患者，在术后饮水时医务人员应特别注意，采取相应的措施，尽量减少获得性吞咽障碍相应并发症的发生。

Objective To investigate the risk factors of acquired swallowing disorders among patients after cardiac surgery. Methods A case-control study was performed among adult patients after cardiac surgery admitted into Fuwai Hospital from March to June 2015. A total of 32 patients were screened as acquired swallowing disorder cases by Water Swallowing Test. And 128 controls were randomly selected by the same tool within the same period of time. Data were analyzed by non-conditional logistic regression methods using SPSS 17.0 software. Results By mono-factorial logistic regression analysis, 14 related factors were identified for acquired swallowing disorders among patients after cardiac surgery,which were age （OR=1.045）,gender（OR=2.321）,chronic pulmonary diseases （OR=6.517）, peripheral arterial diseases （ OR =3.222 ）, unstable angina （ OR =2.555 ）, old myocardial infarction （ OR =4.634 ）, arrhythmia （OR=2.555）,previous cardiac intervention or operation （ OR =2.444 ） , heart function grade of NYHA（OR=3.008）, Euroscore（OR=1.246）,the duration of endotracheal intubation（OR=1.103）,the duration of stomach tubes（OR=1.085）, etc. Conclusion Our medical workers should pay much attention to patients with such characteristics,and take effective measures to reduce complications of the acquired swallowing disorders.