COVID-19后持续性危重症成人长期沟通与吞咽障碍：一项混合方法观察性研究
Long-term communication and swallowing disability in adults with persistent critical illness following COVID-19: A mixed-methods observational study.
文献信息
| PMID | 42914789 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Amy Freeman-Sanderson |
| 作者单位 | Faculty of Health, University of Technology Sydney, NSW, Australia; Speech Pathology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: amy.freeman-sanderson@uts.edu.au. |
| 期刊 | Intensive & critical care nursing |
| SCI 分区 | Q1 |
| IF | 5.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 描述COVID-19后持续性危重症成人沟通与吞咽障碍的生活体验。
方法： 混合方法研究。在患者报告的沟通与吞咽结局测量之外，同时进行半结构化访谈。
地点： 参与者从一项嵌入注册库的COVID康复研究中招募。所有患者若年龄≥18岁、SARS-CoV-2 PCR阳性且患有持续性危重症，均符合条件。持续性危重症定义为连续入住ICU>10天，并接受有创机械通气至少24小时。
主要结局指标： 采用半结构化访谈探讨沟通与吞咽障碍。额外患者报告结局采用吞咽困难严重程度评定量表和La Trobe沟通问卷评估。一般功能结局采用WHODAS 2.0、EQ-5D-5L、HADS、MoCA-Blind、IADL和IES-6评估。
结果： 在随访的113名参与者中，29/113（26%）报告沟通或吞咽障碍，其中17/29（59%）同意接受半结构化访谈。在回答沟通功能问题的16名参与者中，100%自报至少一个沟通领域存在困难，包括表达性语言13/16（81%）、嗓音13/16（81%）、接受性语言9/16（56%）和言语5/16（31%）。尽管所有参与者均经口进食，且多数无质地限制（13/17，76%），许多人报告持续存在关于安全性和效率的吞咽担忧。这些新发障碍的影响超出身体功能，并影响其活动和参与。恢复情况不明确、漫长，并因他人的评判而加重。参与者自行应对康复历程，部分人获得良好支持，另一些人则描述了关键的医疗照护缺口。
结论： 我们发现，因COVID-19相关危重症入住ICU且住院时间≥10天的人群中，约四分之一在6个月时报告持续沟通和吞咽障碍。其影响远超出出院之后，并突出表明需要在康复路径中专门处理吞咽和沟通问题。
临床实践意义： 对经历持续性危重症的个体进行沟通和吞咽功能的专门评估至关重要。
英文摘要
OBJECTIVES: To describe the lived experience of communication and swallowing disability in adults with persistent critical illness following COVID-19.
METHODS: A mixed-methods study. Semi-structured interviews were conducted alongside patient-reported communication and swallowing outcome measures.
SETTING: Participants were recruited from a registry-embedded COVID-Recovery study. All patients were eligible if they were ≥ 18 years, positive PCR for SARS-CoV-2 and had persistent critical illness. This was defined as admission to ICU for >10 consecutive days with invasive mechanical ventilation for at least 24 h.
MAIN OUTCOME MEASURES: Semi-structured interviews were used to explore communication and swallowing disability. Additional patient-reported outcomes were assessed with the Dysphagia Severity Rating Scale and the La Trobe Communication Questionnaire. General function outcomes were evaluated with the WHODAS 2.0, EQ-5D-5L, HADS, MoCA-Blind, IADL and IES-6.
FINDINGS: Of the 113 participants followed up, 29/113 (26%) reported communication or swallowing disability, and of these 17/29 (59%) consented to semi-structured interviews. From the 16 participants who answered questions about communication function 100% self-reported difficulty in ≥1 communication domain, including expressive language 13/16 (81%), voice 13/16 (81%), receptive language 9/16 (56%) and speech 5/16 (31%). Although all participants were consuming an oral diet and most with nil texture restrictions (13/17,76%), many reported ongoing swallowing concerns regarding safety and efficiency. Impacts of these new disabilities were beyond physical function and impacted on their activities and participation. Recovery was unclear, prolonged and compounded by judgement from others. Participants navigated their own recovery journey and whilst some were well supported, others described critical healthcare gaps.
CONCLUSIONS: We identified approximately one quarter of people admitted to ICU for COVID-19 related critical illness with a length of stay of 10 days or more report ongoing communication and swallowing disability at 6 months. The impacts continued well beyond hospital discharge and highlight a need to specifically address swallowing and communication in recovery pathways.
IMPLICATIONS FOR CLINICAL PRACTICE: Specific assessment of communication and swallowing function is essential for individuals who experience persistent critical illness.