心脏外科术后患者获得性吞咽障碍发病率的Meta分析

Dysphagia Incidence after Cardiac Surgery:a Meta-analysis

背景随着心脏外科中复杂手术及高龄患者增多,患者术后获得性吞咽障碍的发病率逐渐上升,成为心脏外科手术的严重并发症之一,影响患者的身体健康及术后恢复。目的综合既往证据,分析心脏外科术后患者获得性吞咽障碍发病率。方法计算机检索PubMed、Embase、Cochrane Library、CINAHL、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据知识服务平台、维普网,检索从建库至2022年5月经国内外公开发表的关于心脏外科术后患者获得性吞咽障碍发病率的相关文献。由2名研究者独立进行文献筛选、质量评价和信息提取,采用Stata 15.0进行心脏外科术后患者获得性吞咽障碍发病率的Meta分析。结果共纳入15篇文献,包括7880例患者。Meta分析结果显示,心脏外科术后患者获得性吞咽障碍总体发病率为13.3%〔95%CI(10.1%,16.5%)〕。亚组分析结果显示,亚洲、北美洲、大洋洲心脏外科术后患者获得性吞咽障碍发病率分别为16.6%〔95%CI(10.4%,22.8%)〕、10.0%〔95%CI(6.1%,13.8%)〕、17.4%〔95%CI(12.3%,23.5%)〕;男性和女性心脏外科术后患者获得性吞咽障碍发病率分别为16.9%〔95%CI(11.8%,21.9%)〕、16.4%〔95%CI(11.1%,21.8%)〕;<70岁和≥70岁心脏外科术后患者获得性吞咽障碍发病率分别为10.9%〔95%CI(8.6%,13.5%)〕、28.4%〔95%CI(19.7%,37.9%)〕;纽约心脏病协会(NYHA)心功能分级为Ⅰ~Ⅱ级、Ⅲ~Ⅳ级的心脏外科术后患者获得性吞咽障碍发病率分别为11.8%〔95%CI(7.4%,16.3%)〕、21.0%〔95%CI(11.0%,30.9%)〕;围术期气管插管时间<12 h、12~24 h、25~48 h和>48 h的心脏外科术后患者获得性吞咽障碍发病率分别为1.0%〔95%CI(0.3%,1.8%)〕、6.4%〔95%CI(4.4%,8.3%)〕、16.8%〔95%CI(9.5%,24.1%)〕、55.0%〔95%CI(28.0%,82.0%)〕;另外,患有慢性肾脏疾病、慢性肺部疾病、术前有脑血管意外史、心房颤动史、心力衰竭史以及术中使用经食管超声心动图(TEE)、患有围术期脑卒中、败血症的患者,心脏外科术后获得性吞咽障碍发病率更高。敏感性分析结果显示Meta分析结果比较稳健。Begg's检验和Egger's检验均显示P<0.05,提示研究存在一定发表偏倚。结论当前证据表明,心脏外科术后患者获得性吞咽障碍发病率较高(13.3%),需及时对术后患者进行早期筛查与有效处理。

Background Dysphagia incidence after cardiac surgery is increasing due to increased complexity of the surgery and number of older patients,which has become one of the most severe complications of cardiac surgery,affecting patients'physical health and recovery.Objective To perform a review of available evidence on the incidence of dysphagia after cardiac surgery.Methods Databases of PubMed,Embase,Cochrane Library,CINAHL,Web of Science,CBM,CNKI,Wanfang Data,and VIP were searched from inception to May 2022 for published studies on the incidence of dysphagia after cardiac surgery.Two researchers independently conducted a literature enrollment,quality assessment,and data extraction.Meta-analysis was conducted using Stata 15.0.Results Fifteen studies with 7880 patients were included.The meta-analysis revealed that the overall incidence of dysphagia after cardiac surgery was 13.3%〔95%CI(10.1%,16.5%)〕.Further regionspecific analysis indicated that,the incidence of dysphagia following cardiac surgery in Asia,North America,and Oceania was 16.6%〔95%CI(10.4%,22.8%)〕,10.0%〔95%CI(6.1%,13.8%)〕,and 17.4%〔95%CI(12.3%,23.5%)〕,respectively.According to sex-specific analysis,the incidence of dysphagia following cardiac surgery was 16.9%〔95%CI(11.8%,21.9%)〕,and 16.4%〔95%CI(11.1%,21.8%)〕in male and female patients,respectively.The analysis based on age group indicated that the dysphagia incidence following cardiac surgery in patients aged<70 years and≥70 years was 10.9%〔95%CI(8.6%,13.5%)〕and 28.4%〔95%CI(19.7%,37.9%)〕,respectively.And analysis based on NYHA class found that the dysphagia incidence was 11.8%〔95%CI(7.4%,16.3%)〕in patients with NYHA classⅠorⅡ,and was 21.0%〔95%CI(11.0%,30.9%)〕in those with NYHA classⅢorⅣ.In accordance with analysis based on the duration of perioperative endotracheal intubation,the incidence of dysphagia following cardiac surgery in patients with<12 hours,12-24 hours,25-48 hours and>48 hours was 1.0%〔95%CI(0.3%,1.8%)〕,6.4%〔95%CI(4.4%,8.3%)〕,16.8%〔95%CI(9.5%,24.1%)〕,and 55.0%〔95%CI(28.0%,82.0%)〕,respectively.In addition,chronic kidney disease,chronic lung disease,previous history of cerebrovascular accident,atrial fibrillation,heart failure,intraoperative transesophageal echocardiography,perioperative stroke and sepsis were associated with a higher incidence of dysphagia after cardiac surgery.The results of the meta-analysis were robust,as shown by sensitivity analysis.Both Begg's and Egger's tests yielded P-value<0.05,indicating that publication bias existed in the studies.Conclusion Current evidence indicates that the incidence of dysphagia after cardiac surgery is high(13.3%),therefore,prompt postsurgical screening and treatment of dysphagia should be administered.