Article record

非插管COVID-19肺炎患者与非COVID肺炎患者经口进食恢复的比较：一项使用功能性经口进食量表的回顾性队列研究

Oral Intake Recovery in Non-Intubated Patients With COVID-19 Pneumonia Compared With Non-COVID Pneumonia: A Retrospective Cohort Study Using the Functional Oral Intake Scale.

临床研究咽喉科IF 3.1Q1

文献信息

PMID	42726278
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Shinichi Watanabe 查看其他 8 位作者 Takaaki Sakurai；Takahiro Kanaya；Takumi Iwasaki；Hyosuke Oshima；Tetsuya Furukawa；Tomohiro Yoshikawa；Seichi Nakahashi；Yasunari Morita
作者单位	Department of Rehabilitation, National Hospital Organization, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan. s-watanabe@gifuhoken.ac.jp. 查看其他 5 条单位信息 Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health science, 2-92 Higashiuzura, Gifu, 500-8281, Japan. s-watanabe@gifuhoken.ac.jp.；Department of Rehabilitation, National Hospital Organization, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.；Shibetsu Town Health and Welfare Center Health Promotion Division, 1-2-6 North 1 West 5, Shibetsu-cho, Shibetsu District, Hokkaido, 086-1631, Japan.；Department of Rehabilitation Medicine, National Hospital Organization, Hokkaido Medical Center, 5-7-1-1, Yamanote, Nishi-ku, Hokkaido, 063-0005, Japan.；Department of Emergency and Intensive Care Medicine, National Hospital Organization, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan.
期刊	Dysphagia
SCI 分区	Q1
IF	3.1
研究类型	临床研究 · 临床
所属专科	咽喉科

中文摘要

吞咽困难是2019冠状病毒病（COVID-19）的并发症，常归因于插管和危重疾病。然而，非插管COVID-19患者与其他肺炎类型患者相比的恢复轨迹仍不清楚。这项回顾性队列研究纳入2022年5月至2023年12月期间因肺炎住院的非插管成人，比较COVID-19与非COVID肺炎患者在达到功能性经口进食（功能性经口进食量表[FOIS]≥4）的时间及纵向FOIS变化。拟合了两个Cox比例风险模型：模型1估计总效应（仅暴露前变量），模型2在进一步调整暴露后康复变量后估计条件关联。采用线性混合效应模型进行纵向分析。在431例患者（168例COVID-19，263例非COVID）中，COVID-19组开始经口进食和言语治疗的启动显著延迟。在模型1中，COVID-19与达到FOIS≥4的风险降低44%相关（HR 0.56；95% CI，0.42-0.76；p=0.0001）。在模型2中，该关联减弱至无统计学意义（HR 1.03；95% CI，0.73-1.46；p=0.876），时间依赖性Cox敏感性分析结果一致（HR 0.88；95% CI，0.63-1.23；p=0.465）。较高的院前衰弱、延迟经口进食和缺乏直接吞咽训练独立预测恢复较慢。这些发现表明，COVID-19患者中观察到的恢复较慢主要归因于经口进食和康复的延迟，而非COVID-19本身，支持在感染控制限制下早期经口进食和公平的直接吞咽训练。

英文摘要

Dysphagia is a complication of coronavirus disease 2019 (COVID-19), often attributed to intubation and critical illness. However, the recovery trajectory in non-intubated patients with COVID-19 compared with that in patients with other pneumonia types remains unclear. This retrospective cohort study included non-intubated adults hospitalized with pneumonia between May 2022 and December 2023, comparing COVID-19 and non-COVID pneumonia patients regarding time to functional oral intake (Functional Oral Intake Scale [FOIS] ≥ 4) and longitudinal FOIS changes. Two Cox proportional hazards models were fitted: Model 1 estimated the total effect (pre-exposure variables only), and Model 2 estimated a conditional association after further adjustment for post-exposure rehabilitation variables. A linear mixed-effects model was used for the longitudinal analysis. Of the 431 patients (168 COVID-19, 263 non-COVID), the COVID-19 group had significantly delayed initiation of oral intake and speech therapy. In Model 1, COVID-19 was associated with a 44% lower hazard of achieving FOIS ≥ 4 (HR 0.56; 95% CI, 0.42-0.76; p = 0.0001). In Model 2, this attenuated to null (HR 1.03; 95% CI, 0.73-1.46; p = 0.876), and a time-dependent Cox sensitivity analysis was concordant (HR 0.88; 95% CI, 0.63-1.23; p = 0.465). Higher pre-hospital frailty, delayed oral intake, and lack of direct swallowing training independently predicted slower recovery. These findings indicate that the slower recovery observed in patients with COVID-19 was largely attributable to delays in oral intake and rehabilitation rather than to COVID-19 itself, supporting early oral intake and equitable direct swallowing training under infection control constraints.