全身麻醉后因术后声音嘶哑转诊耳鼻咽喉科会诊：一项10年回顾性研究。

文献信息

中文摘要

背景： 因术后声音嘶哑转诊至耳鼻咽喉科医师的患者常需进一步治疗，从而延长住院时间并损害其生活质量；然而，这种不常见的并发症仍研究不足。我们回顾性分析了转诊至我院耳鼻咽喉科的患者数据，以确定其发生率、相关因素及预后。
方法： 2015年10月至2025年9月期间，我院共有676,641例患者接受全身麻醉。其中，1,185例因术后咽喉部主诉转诊至耳鼻咽喉科，958例被诊断为声音嘶哑。因术后声音嘶哑转诊耳鼻咽喉科会诊是我们研究的主要结局。我们确定了其发生率，并使用多变量logistic回归识别区分声音嘶哑与其他转诊主诉的因素。次要结局包括会诊期间发现的声音嘶哑相关声带损伤以及患者预后。前者使用有序logistic回归分析以确定相关因素。对于后者，使用Kaplan-Meier曲线和log-rank检验比较术后声音嘶哑患者的恢复轨迹，并使用Cox回归识别相关因素。扩展队列敏感性分析（n = 1438；480例对照）评估了主要发现的稳健性。
结果： 因术后声音嘶哑转诊耳鼻咽喉科会诊的发生率为958/676,641（0.142%）。在转诊队列中，鼻胃管置入（比值比[OR] = 2.34，95%置信区间[CI]，1.63-3.38，P < .001）和经食管超声心动图（TEE）（OR = 1.84，95% CI，1.15-3.02，P = .014）与声音嘶哑而非其他咽喉部主诉独立相关。在该队列中，更严重的声带损伤与鼻胃管置入（OR = 2.11，95% CI，1.61-2.78，P < .001）、TEE（OR = 1.61，95% CI，1.15-2.25，P = .006）、更长的手术时间（OR = 1.10/小时，95% CI，1.03-1.18，P = .003）、双腔管（OR = 1.55，95% CI，1.04-2.31，P = .033）和女性性别（OR = 1.41，95% CI，1.11-1.80，P = .005）相关。在转诊的声音嘶哑患者中，首次会诊延迟（症状出现后≥6天）和更严重的声带损伤与恢复较慢相关（均P < .001）。鼻胃管置入与声音嘶哑之间的主要关联在扩展队列敏感性分析中持续存在（OR = 4.20，95% CI，3.00-5.95，P < .001）。
结论： 因术后声音嘶哑转诊耳鼻咽喉科会诊的发生率约为1.5/1000。在转诊队列中，鼻胃管置入与声音嘶哑而非其他咽喉部主诉的关联最强，并且与TEE、更长的手术时间、双腔管插入和女性性别一起，与更严重的声带损伤相关。

英文摘要

BACKGROUND: Patients referred to otolaryngologists due to postoperative hoarseness often require further treatment, prolonging hospitalization and impairing their quality of life; however, this uncommon complication remains understudied. We retrospectively examined the data from patients referred to our Otolaryngology Department to determine its incidence, associated factors, and prognosis.
METHODS: At our hospital, 676,641 patients underwent general anesthesia between October 2015 and September 2025. Of these, 1185 were referred to the Otolaryngology Department with postoperative laryngopharyngeal complaints, 958 of whom were diagnosed with hoarseness. Postoperative hoarseness referred for otolaryngological consultation was the primary outcome of our study. We determined its incidence and used multivariable logistic regression to identify factors distinguishing hoarseness from other referred complaints. Secondary outcomes included hoarseness-related vocal fold injury identified during consultation and patient prognosis. The former was analyzed using ordinal logistic regression to determine associated factors. For the latter, recovery trajectories among patients with postoperative hoarseness were compared using Kaplan-Meier curves and log-rank tests, and associated factors were identified using Cox regression. An expanded-cohort sensitivity analysis (n = 1438; 480 controls) assessed the primary finding's robustness.
RESULTS: The incidence of postoperative hoarseness referred for otolaryngological consultation was 958/676,641 (0.142%). Within the referral cohort, nasogastric tube placement (odds ratio [OR] = 2.34, 95% confidence interval [CI], 1.63-3.38, P < .001) and transesophageal echocardiography (TEE) (OR = 1.84, 95% CI, 1.15-3.02, P = .014) were independently associated with hoarseness versus other laryngopharyngeal complaints. In this cohort, greater vocal fold injury severity was associated with nasogastric tube placement (OR = 2.11, 95% CI, 1.61-2.78, P < .001), TEE (OR = 1.61, 95% CI, 1.15-2.25, P = .006), longer surgical duration (OR = 1.10/h, 95% CI, 1.03-1.18, P = .003), double-lumen tube (OR = 1.55, 95% CI, 1.04-2.31, P = .033), and female sex (OR = 1.41, 95% CI, 1.11-1.80, P = .005). Among referred patients with hoarseness, delayed first consultation (≥6 days after symptom onset) and greater vocal fold injury severity were associated with slower recovery (both P < .001). The primary association between nasogastric tube placement and hoarseness persisted in the expanded-cohort sensitivity analysis (OR = 4.20, 95% CI, 3.00-5.95, P < .001).
CONCLUSIONS: The incidence of postoperative hoarseness referred for otolaryngological consultation was ~1.5/1000. Within the referral cohort, nasogastric tube placement was most strongly associated with hoarseness versus other laryngopharyngeal complaints and, together with TEE, longer surgical duration, double-lumen tube insertion, and female sex, was associated with greater vocal fold injury severity.