心脏外科术后患者获得性吞咽障碍的发病率：系统评价和meta分析
he incidence of acquired dysphagia after cardiac surgery: a systematic review and meta-analysis
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的发生率。方法 计算机检索CNKI、CBM、VIP、WanFang、PubMed、EMbase、The Cochrane Library、CINAHL、Web of Science等中外文数据库或搜索引擎，查找有关心脏外科术后患者获得性吞咽障碍发生情况的临床研究，研究结局为发生获得性吞咽障碍，检索时限均为自建库到2022年5月。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Stata15.0进行发病率的Meta分析。结果 本文共纳入15篇文献，研究包含7880名患者。Meta分析结果显示，心脏外科术后患者吞咽障碍的总体发病率为13.3%〔95%CI（10.1%，16.5%）〕。亚组分析结果显示，亚洲、北美洲心脏外科术后患者获得性吞咽障碍发病率分别为：〔16.6%（10.4%，22.8%）〕，〔10.0%（6.1%，13.8%）〕；男性〔16.9%（11.8%，21.9%）〕和女性〔16.4%（11.1%，21.8%）〕发病率差异无统计学意义（c2=1.843, P＞0.05）；70岁以下和70岁以上心脏外科术后患者吞咽障碍发病率分别为〔10.9%（8.6%，13.5%）〕，〔28.4%（19.7%，37.9%）〕；美国纽约心脏病学会心功能分级 (American New York Heart Association classification，NYHA)为Ⅰ~Ⅱ级、Ⅲ~Ⅳ级的患者发病率分别为〔11.8%（7.4%，16.3%）〕，〔21.0%（11.0%，30.9%）〕；围术期气管插管时间在12h以内、12~24h、25~48h和48h以上的发病率分别为〔1.0%（0.3%，1.8%）〕，〔6.4%（4.4%，8.3%）〕，〔16.8%（9.5%，24.1%）〕，〔55.0%（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、房颤史、心衰史以及术中使用经食管超声心动图（transesophageal echocardiography，TEE）、患有围术期脑卒中、围术期败血症的患者，心脏外科术后获得性吞咽障碍的发病率更高。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，需及时对术后患者进行早期筛查与有效处理。
Objective To analyze the incidence of acquired dysphagia after cardiac surgery based on previous evidence. Methods Use computers to search CNKI, CBM, VIP, WanFang, PubMed, EMbase, The Cochrane Library, CINAHL, Web of Science and other Chinese and foreign databases or search engines. To find clinical studies on the occurrence of acquired dysphagia after cardiac surgery. The outcome of the study was whether acquired dysphagia occurred . The retrieval time is from built database to May 2022. Literature screening, quality evaluation and information extraction were carried out by 2 researchers independently, and meta-analysis of incidence was conducted by Stata15.0. Results A total of 15 articles were included, including 7880 patients. Meta-analysis showed that the overall incidence of dysphagia after cardiac surgery was [13.3% (10.1%, 16.5%)]. The prevalence of acquired dysphagia in Asia, North America was [16.6%[ (10.4%, 22.8%)], [10.0% (6.1%, 13.8%)], respectively. There was no significant difference between male [ 16.9% (11.8%, 21.9%)] and female[16.4% (11.1%, 21.8%)] (c2=1.843, P0.05).The prevalence of dysphagia was [10.9% (8.6%, 13.5%) ] and [28.4% (19.7%, 37.9%) ]in patients under 70 years old and over 70 years old, respectively. The incidence of dysphagia in patients with NYHA grade ~ and ~ was [11.8% (7.4%, 16.3%)], [21.0% (11.0%, 30.9%)], respectively; The incidence of dysphagia was [1.0% (0.3%, 1.8%)], [6.4% (4.4%, 8.3%)], [16.8% (9.5%, 24.1%)], [55.0% (28.0%, 82.0%)] in patients with perioperative endotracheal intubation within 12h, 12-24h, 25-48h, and more than 48h, respectively; In addition, those patients with chronic kidney disease, chronic lung disease, preoperative history of cerebrovascular accident, history of atrial fibrillation, history of heart failure, intraoperative use of transesophageal echocardiography (TEE), perioperative stroke, perioperative septicemia, dysphagia is more common after heart surgery. Conclusion Current evidence suggests that the incidence of dysphagia after cardiac surgery is high, and early screening is necessary to ensure early identification and effective management of patients at risk.
刘露, 蒋运兰, 彭寒梅, 卢宇彤, 刘明婷, 廖诗沁
10.12114/j.issn.1007-9572.2022.0603
外科学临床医学医学研究方法
心脏术后吞咽障碍发病率meta分析
刘露, 蒋运兰, 彭寒梅, 卢宇彤, 刘明婷, 廖诗沁.心脏外科术后患者获得性吞咽障碍的发病率：系统评价和meta分析[EB/OL].(2022-08-23)[2025-08-02].https://chinaxiv.org/abs/202208.00135.点此复制
评论