改良悬雍垂腭咽成形术后吞咽困难的特征、危险因素及长期结局：一项混合方法研究

文献信息

中文摘要

目的与设计： 改良悬雍垂腭咽成形术（mUPPP）是阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的标准手术干预，但由于缺乏标准化评估方案，术后吞咽困难仍是一种诊断不足且管理不佳的并发症。这项前瞻性混合方法观察性研究旨在探讨mUPPP术后吞咽困难的临床特征、独立危险因素及长期结局。
主要结局指标： 对120例接受mUPPP的OSAHS患者进行了前瞻性观察性研究。在术后2周、1个月、6个月和12个月时进行了混合方法评估（EAT-10、访谈和FEES）。采用单因素和多因素logistic回归分析来识别独立危险因素。
结果： 术后2周时，筛查出具有临床显著吞咽困难症状（EAT-10≥3，患者报告的筛查阈值）的患者比例为63.3%。FEES在超过94%的EAT-10阳性患者中证实了病理性吞咽异常，如咽部反应延迟和误吸风险。确定了四个独立危险因素：女性、胃食管反流病（GERD）、焦虑/抑郁以及日间过度嗜睡（ESS≥10）。约19.2%的患者在6个月时症状持续，9.2%在12个月时症状持续，具有多个危险因素的患者长期持续风险显著更高。
结论： 吞咽困难是mUPPP术后常见且持续的后遗症。推荐联合使用EAT-10和FEES进行全面的术后监测。术前识别和管理危险因素（性别、GERD、心理状态和嗜睡）对于风险分层和实施个性化干预以减轻持续性吞咽困难负担至关重要。

英文摘要

OBJECTIVE AND DESIGN: Modified Uvulopalatopharyngoplasty (mUPPP) is a standard surgical intervention for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), but postoperative dysphagia remains an underdiagnosed and poorly managed complication due to the lack of standardised assessment protocols. This prospective mixed-methods observational study aimed to investigate the clinical characteristics, independent risk factors, and long-term outcomes of dysphagia following mUPPP.
MAIN OUTCOME MEASURES: A prospective observational study was conducted on 120 OSAHS patients undergoing mUPPP. A mixed-methods assessment (EAT-10, interviews, and FEES) was performed at 2 weeks, 1, 6, and 12 months postoperatively. Univariate and multivariate logistic regression analyses were used to identify independent risk factors.
RESULTS: The rate of patients screening positive for clinically significant dysphagia symptoms (EAT-10 ≥ 3, patient-reported screening threshold) was 63.3% at 2 weeks postoperatively. FEES confirmed pathological swallowing abnormalities, such as delayed pharyngeal response and aspiration risk, in over 94% of EAT-10-positive patients. Four independent risk factors were identified: female gender, gastroesophageal reflux disease (GERD), anxiety/depression, and excessive daytime sleepiness (ESS ≥ 10). Symptoms persisted in approximately 19.2% of patients at 6 months and 9.2% at 12 months, with patients having multiple risk factors showing a significantly higher risk of long-term persistence.
CONCLUSION: Dysphagia is a common and persistent sequela following mUPPP. The combination of EAT-10 and FEES is recommended for comprehensive postoperative monitoring. Preoperative identification and management of risk factors (gender, GERD, psychological status, and sleepiness) are crucial for risk stratification and implementing personalised interventions to reduce the burden of persistent dysphagia.