普通病房入院时吞咽困难筛查与医院获得性吸入性肺炎：一项回顾性队列研究
Admission Dysphagia Screening and Hospital-Acquired Aspiration Pneumonia in General Wards: A Retrospective Cohort Study.
文献信息
| PMID | 42934351 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Takeshi Yamauchi |
| 作者单位 | Department of Medical Education and General Practice, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan. |
| 期刊 | Journal of general internal medicine |
| 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
背景： 随着人口老龄化，吸入性肺炎的发病率不断上升。由于吸入性肺炎具有潜在可预防性，入院时进行系统性吞咽评估可能有助于识别吸入性肺炎高风险患者。我院在普通病房实施了一项由护士主导的吞咽困难筛查方案（进食评估工具-10（EAT-10），随后进行反复唾液吞咽试验（RSST）和进餐观察）。
目的： 评估入院时吞咽困难筛查与医院获得性吸入性肺炎（HA-AP）发病率之间的关联。
设计： 回顾性队列研究。
参与者： 2022年3月至2023年2月期间入住普通病房的共12,374例成年患者，包括10,947例方案依从患者和1,427例非方案依从患者。
主要测量指标： HA-AP最初根据日本常规临床实践中用于报销目的的ICD-10编码J69.0-J69.9进行识别，随后所有识别病例均由研究者通过病历审查进行核实。在调整年龄、性别、体重指数、吞咽困难相关合并症、恶性肿瘤疾病、手术、内镜操作、放疗、化疗和入院月份后，使用改良Poisson回归估计风险比（RR）。
关键结果： 方案依从组的HA-AP发病率低于非方案依从组（0.8% vs. 2.1%）。脑血管疾病、痴呆和呼吸系统疾病与较高的HA-AP发病率相关。经过多变量调整后，方案依从性与HA-AP风险降低独立相关（RR，0.424；95% CI，0.272-0.663；p < 0.001）。这种降低风险的关联在各疾病类别中均观察到，并且在无恶性肿瘤患者和接受手术的患者中尤为明显。
结论： 在普通病房中，遵守入院时吞咽困难筛查方案与医院获得性吸入性肺炎风险显著降低相关。入院时进行系统性吞咽评估可能是预防医院获得性吸入性肺炎策略的有用组成部分。
英文摘要
BACKGROUND: With the aging population, the incidence of aspiration pneumonia is increasing. Since aspiration pneumonia is potentially preventable, systematic swallowing assessment at hospital admission may help identify patients at a higher risk of aspiration pneumonia. Our hospital implemented a nurse-led dysphagia screening protocol (Eating Assessment Tool-10 (EAT-10), followed by the repetitive saliva swallowing test (RSST) and mealtime observation) in general wards.
OBJECTIVE: To evaluate the association between dysphagia screening on admission and the incidence of hospital-acquired aspiration pneumonia (HA-AP).
DESIGN: Retrospective cohort study.
PARTICIPANTS: A total of 12,374 adult patients admitted to general wards between March 2022 and February 2023, including 10,947 protocol-adherent patients and 1427 non-protocol-adherent patients.
MAIN MEASURES: HA-AP was initially identified based on ICD-10 codes J69.0-J69.9 recorded for reimbursement purposes in routine clinical practice in Japan, and all identified cases were subsequently verified by the researcher through medical chart review. Modified Poisson regression was used to estimate risk ratios (RRs) after adjustment for age, sex, body mass index, dysphagia-related comorbidities, malignant disease, surgery, endoscopic procedures, radiotherapy, chemotherapy, and month of admission.
KEY RESULTS: The incidence of HA-AP was lower in the protocol-adherent group than in the non-protocol-adherent group (0.8% vs. 2.1%). Cerebrovascular disease, dementia, and respiratory disease were associated with a higher incidence of HA-AP. After multivariable adjustment, protocol adherence was independently associated with a reduced risk of HA-AP (RR, 0.424; 95% CI, 0.272-0.663; p < 0.001). The risk-reducing association was observed across disease categories and was particularly evident among patients without malignancy and those undergoing surgery.
CONCLUSIONS: Adherence to an admission dysphagia screening protocol was associated with a significantly lower risk of hospital-acquired aspiration pneumonia in general wards. Systematic swallowing assessment at admission may represent a useful component of strategies aimed at preventing hospital-acquired aspiration pneumonia.