儿科重症监护室患者的吞咽困难(综述)

I. Lisitsa, Y. Aleksandrovich, A. N. Zav’yalova, O. V. Lisovskii, S. A. Razumov
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摘要

众所周知,重症监护室住院的负面影响被概括为重症监护后综合征(PICS),包括吞咽障碍(吞咽困难),在儿科临床中也会遇到。对文献资料进行了非系统性回顾。在 elibrary 网站的数据库中搜索了 1990-2023 年期间的国内出版物,在 PubMed、Google Scholar、Cichrane Library、Cyberleninka、ResearchGate 数据库中搜索了国外出版物。在对 "儿童吞咽困难 "这一查询进行分析时,发现了 1,496 条结果,"儿童重症监护后综合征"--82 条结果。我们分析了 142 篇描述儿童吞咽困难的原因、机制和临床表现的全文文献,这些儿童在重症监护病房住院后出现吞咽困难或与严重躯体疾病相关。综述分析了PIСS儿科患者吞咽困难的原因、诊断和治疗特点。研究考虑了颅内压增高症结构中可导致吞咽困难发生的五类原因:感染-营养性、植物-代谢性、神经肌肉、情绪-认知并发症以及生活质量与病前水平相比下降。与吞咽困难相关的并发症会导致重症监护和住院时间延长,导致营养不良、吸入性肺炎和其他并发症的发生。本文分析了重症监护室儿童吞咽困难的发生机制。确定了儿科实践中吞咽困难发展的主要途径。明确吞咽困难发生的原因,了解吞咽困难发生的机制,并结合康复计划的实施,有助于改善危重症患儿出院后及未来的临床疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dysphagia in pediatric intensive care unit patients (review)
The known negative consequences of intensive care unit stays, summarized as the post-intensive care syndrome (PICS) and including swallowing disorders (dysphagia) are also encountered in pediatric practice.Materials and methods. The non-systematic review of literature sources was carried out. Domestic publications were searched in the database on the elibrary website, foreign publications – in PubMed, Google Scholar, Cichrane Library, Cyberleninka, ResearchGate databases in the period of 1990–2023. When analyzed for the query «Dysphagia in Children», 1,496 results were found, «Post-intensive care syndrome in children» – 82 results. We analyzed 142 full-text publications describing the causes, mechanisms, and clinical presentation of dysphagia in children whose swallowing disorders occurred after hospitalization in intensive care units or were associated with severe somatic diseases.Results. The review analyzes the causes, features of diagnosis and treatment of dysphagia in pediatric patients with PIСS. 5 groups of causes in the structure of PIСS that can lead to the development of dysphagia were considered: infectious-trophic, vegetative-metabolic, neuromuscular, emotional-cognitivecomplications and decreased quality of life compared to the premorbid level. Complications associated with the development of dysphagia lead to increased length of stay in intensive care and hospitalization, lead to the development of malnutrition, aspiration pneumonia and other complications. The mechanisms of dysphagia development in children in intensive care units were analyzed. The main ways of dysphagia progression in pediatric practice are determined.Conclusion. Clarification of the causes and understanding of the mechanisms of dysphagia development in conjunction with the implementation of rehabilitation programs can contribute to the improvement of clinical outcomes in children who have undergone a critical condition in the immediate post-discharge period and in the future.
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