中国全科医学 ›› 2023, Vol. 26 ›› Issue (18): 2293-2300.DOI: 10.12114/j.issn.1007-9572.2022.0603

• 医学循证 • 上一篇    下一篇

心脏外科术后患者获得性吞咽障碍发病率的Meta分析

刘露1, 蒋运兰2,*(), 彭寒梅1, 卢宇彤1, 刘明婷1, 廖诗沁1   

  1. 1.610072 四川省成都市,成都中医药大学护理学院
    2.610075 四川省成都市,成都中医药大学附属医院
  • 收稿日期:2022-06-10 修回日期:2022-09-10 出版日期:2023-06-20 发布日期:2022-10-27
  • 通讯作者: 蒋运兰
  • PROSPERO注册号:CRD42022336151

    作者贡献:刘露负责文章的构思与设计、论文撰写及修订,并对论文整体负责;蒋运兰负责论文的修订、质量控制与审校;彭寒梅、卢宇彤负责文献搜集及资料整理;刘露、刘明婷、廖诗沁负责文章的统计学分析与结果解释。
  • 基金资助:
    国家重点研发计划项目(2020YFC2003104)——国家科技部"主动健康和老龄化科技应对"重点专项

Dysphagia Incidence after Cardiac Surgery: a Meta-analysis

LIU Lu1, JIANG Yunlan2,*(), PENG Hanmei1, LU Yutong1, LIU Mingting1, LIAO Shiqin1   

  1. 1. School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
    2. Hospital of Chengdu University of TCM, Chengdu 610075, China
  • Received:2022-06-10 Revised:2022-09-10 Published:2023-06-20 Online:2022-10-27
  • Contact: JIANG Yunlan

摘要: 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7 880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。

关键词: 吞咽障碍, 心脏外科手术, 发病率, Meta分析, 病例对照研究, 队列研究

Abstract:

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 7 880 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 region-specific 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 classⅠ or Ⅱ, and was 21.0%〔95%CI (11.0%, 30.9%) 〕 in those with NYHA class Ⅲ or Ⅳ. 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.

Key words: Deglutition disorders, Cardiac surgical procedures, Incidence, Meta-analysis, Case-control study, Cohort study