重症患者气管插管拔管后吞咽障碍危险因素的Meta分析

Risk factors of Post-extubation Dysphagia among patients in Intensive Care Units:a Meta-analysis

目的:系统评价重症患者气管插管拔管后吞咽障碍的危险因素,为及时识别吞咽障碍高危人群提供依据,以便采取有效预防措施。方法:通过检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方、维普及中国生物医学文献数据库等中英文数据库,收集关于重症患者气管插管拔管后并发获得性吞咽障碍危险因素的研究,检索时限为建库至2020年2月6日。采取Cochrane手册5.1.0、纽卡斯尔-渥太华量表及AHRQ质量评价标准进行文献质量评价,采用RevMan 5.3软件进行Meta分析。结果:共纳入19篇文献,包括5293例研究对象。Meta分析显示下列因素与重症患者气管插管拔管后吞咽障碍的发生相关:年龄[MD=6.23,95%CI(4.52~7.95)]、性别[OR=0.75,95%CI(0.60~0.94)]、带管时长[MD=66.46,95%CI(58.12~74.79)],合并心力衰竭[OR=2.65,95%CI(1.84~3.82)]、心律失常[OR=1.87,95%CI(1.08~3.26)]、房扑或房颤[OR=2.74,95%CI(1.75~4.28)]、慢性肾病[OR=3.66,95%CI(2.38~5.63)],术后脑血管意外[RR=4.37,95%CI(1.68~11.35)]、左心室射血分数[OR=0.57,95%CI(0.38~0.85)]、食管超声检查[RR=1.83,95%CI(1.05~3.19)],APACHE II评分[MD=3.68,95%CI(1.00~6.35)]及入ICU方式[OR=2.84,95%CI(1.05~7.71)]。结论:年龄>65岁、女性、插管时间长、合并心脑肾疾病、左心室功能较差、进行食管超声检查、高APACHE II评分及急诊入ICU是发生拔管后吞咽障碍的危险因素。

Objective:To systematically review the risk factors of Post-extubation Dysphagia(PED)among patients in intensive care units,so as to provide basis for timely identification of those with high risk of PED and take effective preventive measures.Methods:We searched PubMed,Web of Science,Cochrane Library,Embase,CNKI,Wanfang data,VIP,and CBM databases from inception to February 6,2020.Literatures on potential risk factors of PED among patients in intensive care units were reviewed.Cochrane handbook 5.1.0,Newcastle-Ottawa scale and AHRQ Quality Assessment Forms were used to perform quality appraisal.Review Manager 5.3 was used to perform Meta-analysis.Results:A total of 19 studies,including 5293 patients were analyzed.Significant risk factors for PED included age[MD=6.23,95%CI(4.52-7.95)],gender[OR=0.75,95%CI(0.60-0.94)],intubation duration[MD=66.46,95%CI(58.12-74.79)],with heart failure[OR=2.65,95%CI(1.84-3.82)],arrhythmia[OR=1.87,95%CI(1.08-3.26)],atrial fibrillation or atrial flutter[OR=2.74,95%CI(1.75-4.28)],chronic kidney disease[OR=3.66,95%CI(2.38-5.63)],postoperative cerebrovascular accident[RR=4.37,95%CI(1.68-11.35)],left ventricular ejection fraction[OR=0.57,95%CI(0.38-0.85)],examination with esophageal ultrasound[RR=1.83,95%CI(1.05-3.19)],APACHE II score[MD=3.68,95%CI(1.00-6.35)]and the admission way to ICU[OR=2.84,95%CI(1.05-7.71)].Conclusion:Age>65y,female,with long tracheal intubation time,with heart,cerebrovascular and kidney diseases,low left ventricular ejection fraction,esophageal ultrasound usage,high APACHE II score and emergency admission to ICU are risk factors of PED.