CSICU患者拔管后发生吞咽困难的危险因素分析

Analysis of risk factors for dysphagia after extubation in patients with tracheal intubation in the CSICU

目的探讨心脏大血管外科重症监护病房(CSICU)拔管后患者出现吞咽困难的危险因素,评估拔管后吞咽困难的风险,为预防气管插管患者拔管后吞咽困难提供依据。方法选择于2020年9月—2021年10月在江苏省人民医院CSICU接受气管插管机械通气的患者,通过筛选排除后选取274例患者入组作为研究对象,其中观察组为出现拔管后吞咽困难的患者,共有79例;对照组为未出现吞咽困难的患者,共有195名。收集分析所有患者入院时的一般资料和临床特征,对所有资料进行单因素分析,将结果中具有统计学意义的危险因素纳入Logistic回归分析中进行多因素分析,筛选出CSICU患者拔管后吞咽困难的独立危险因素。最后通过受试者工作特征(ROC)曲线和曲线下面积(AUC)评估对于拔管后吞咽困难具有预测价值的变量。结果观察组患者的标准吞咽功能评定量表(SSA)评分、急性生理学和慢性健康评估II(APACHEII)评分、CSICU停留时间、机械通气时间、带管时间、拔管时心率均显著高于对照组患者(P<0.05)。多因素Logistic回归中APACHEII评分、CSICU停留时间、机械通气时间、拔管时心率和诊断类型都符合多因素Logistic回归拟合方程。ROC曲线分析APACHEⅡ评分、CSICU停留时间、机械通气时间和拔管时心率中,APACHEⅡ评分的预测效能最大,AUC为0.908。CSICU停留时间(AUC=0.889)、机械通气时间(AUC=0.813)和拔管时心率(AUC=0.692)的预测效能依次递减。结论对于CSICU患者,APACHEⅡ评分、CSICU停留时间、机械通气时间和拔管时心率均是CSICU患者出现吞咽困难的危险因素。因此所有需要插管进行机械通气的CSICU患者都应考虑有吞咽困难的风险,应对CSICU患者进行吞咽困难的系统筛查。

Objective To explore the risk factors for dysphagia after extubation in patients in the Cardiovascular Surgical Intensive Care Unit(CSICU),to assess the risk of dysphagia after extubation,and to provide evidence for preventing dysphagia after extubation in patients with tracheal intubation.Methods Patients who underwent tracheal intubation and mechanical ventilation in the CSICU of Jiangsu Provincial People's Hospital from September 2020 to October 2021 were selected,and 274 patients were enrolled as the study subjects after screening and exclusion,of which the observation group was patients with dysphagia after extubation,with a total of 79 cases;the control group was patients without dysphagia,with a total of 195 cases.The general data and clinical characteristics of all patients at admission were collected and analyzed,and all data were subjected to univariate analysis,and the results with statistical significance were included in the Logistic regression analysis for multivariate analysis,and the independent risk factors for dysphagia after extubation in CSICU patients were screened out.Finally,the receiver operating characteristic(ROC)curve and area under curve(AUC)were used to evaluate which variables had predictive value for dysphagia after extubation.Results The SSA score,APACHE Ⅱ score,CSICU stay time,mechanical ventilation time,tube time,and heart rate at extubation of the observation group patients were significantly higher than those of the control group patients(P<0.05).In the multivariate Logistic regression analysis,APACHEⅡscore,CSICU stay time,mechanical ventilation time,heart rate at extubation and diagnosis type all met the multivariate Logistic regression fitting equation.The ROC curve analysis showed that APACHEⅡscore had the highest predictive efficacy among APACHEⅡscore,CSICU stay time,mechanical ventilation time and heart rate at extubation,with AUC of 0.908.The predictive efficacy of CSICU stay time(AUC=0.889),mechanical ventilation time(AUC=0.813)and heart rate at extubation(AUC=0.692)decreased successively.Conclusion For CSICU patients,APACHEⅡscore,CSICU stay time,mechanical ventilation time and heart rate at extubation were all risk factors for dysphagia in CSICU patients.Since all CSICU patients who need intubation for mechanical ventilation should consider the risk of dysphagia,systematic screening for dysphagia should be performed for CSICU patients.