Stargazin调节使君子酸受体亚基转运和突触靶向——疼痛治疗的新靶点

背景 使君子酸(α-amino-3 -hydroxy-5 -methy-4-isoxazole propionate,AMPA)受体是中介中枢神经系统兴奋性突触传递的主要受体,参与疼痛信号传递.Stargazin蛋白是一种AMPA受体调节蛋白,在AMPA受体中介的疼痛信号传递中扮演重要角色.目的 对Stargazin蛋白调节AMPA受体亚基在胞浆胞膜中的转运作用及与疼痛的关系作用进行回顾与总结.内容 Stargazin蛋白可调节AMPA受体不同亚基在胞浆胞膜转运,并通过与突触后膜致密蛋白-95 (postsynaptic density-95,PSD-95)的相互作用,促进AMPA受体亚基突触靶向；Stargazin还通过C末端自身磷酸化修饰改变与PSD-95蛋白相互作用的强度,控制AMPA受体的突触靶向.Stargazin通过调节AMPA受体的转运,间接调控AMPA受体中介的疼痛信号传递.趋向 下调Stargazin的表达或干扰其与兴奋性突触后PSD-95蛋白的相互作用,可间接抑制AMPA受体的功能,是未来疼痛治疗研究的新靶点.     

Neuroligin1与突触活动的相互作用

背景 Neuroligin1是突触细胞黏附分子(synaptic cell adhesion molecules,SynCAM)的一种,与Neurexin1β及突触后膜致密蛋白95(postsynaptic density protein 95,PSD-95)相结合形成跨突触复合物,这一跨突触信号可以中介使君子酸(a-amino-3-hydroxy-5-methyl4-isoxazole-propionate,AMPA)受体亚基突触靶向和突触前囊泡释放,在学习、记忆和疼痛中均具有重要作用.目的 对Neuroligin1与突触活动的相互作用进行回顾与总结.内容 Neuroligin1可通过调节AMPA受体、N-甲基-D-天冬氨酸(N-methyl-D-aspartic acid,NMDA)受体的突触靶向来参与到突触活动中;相应的,突触活动也能诱导Neuroligin1的裂解和磷酸化,使突触活动趋于平衡.趋向 通过下调Neuroligin1的表达或干扰其与PSD-95蛋白或Neurexin1β的相互作用,可间接抑制AMPA受体的功能,是未来疼痛治疗的研究方向.     

神经突触中枢神经突触膜相关鸟甘酸激酶锚定蛋白参与疼痛调节的研究进展

背景 中枢神经突触膜相关鸟苷酸激酶(membrane-associated guanylate kinase,MAGUK)蛋白家族包含4种突触相关蛋白:PSD-93、PSD-95、SAP-102、SAP-97,它们参与调节谷氨酸突触信号传递,与学习记忆和疼痛等有关. 目的综述神经突触MAGUK锚定蛋白与疼痛相关受体和分子之间的相互作用及其在疼痛信号调节及传递中的作用. 内容 神经突触MAGUK锚定蛋白可通过与N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体、神经元型一氧化氮合酶(neuronal nitric oxide synthase,nNOS)、使君子酸(α-amino-3-hydroxy-5-methy-4-isoxazole propionate,AMPA)受体以及突触细胞黏附分子(synaptic cell-adhesion molecules,Syn CAM)等相互作用参与调节疼痛信号在突触的传递,影响突触传递强度. 趋向 干扰神经突触MAGUK锚定蛋白与疼痛相关受体和重要分子间的相互作用可影响疼痛信号在突触的传递,是疼痛治疗的新靶点.     

罗哌卡因致幼鼠惊厥对其成年后学习记忆的影响

目的 通过制备幼鼠罗哌卡因毒性惊厥模型,观察其对幼鼠成年后学习记忆能力和突触后致密物蛋白-95( post synaptic density-95protein,PSD-95)表达的影响.方法 选用18日龄Sprague -Dawley (SD)幼鼠20只,采用随机数字表法分为罗哌卡因组(R组)和生理盐水组(N组)2组,每组10只.连续水迷宫训练3d,每天2次,达到标准者纳入实验(潜伏期≤120 s).于21日龄分别经腹腔单次注射罗哌卡因(33.8 mg/kg)和生理盐水(0.1 ml/kg).出现惊厥鼠纳入实验,常规饲养至第55日龄再次行水迷宫测试.前3d为训练学习阶段,每天训练两次.第4天测试记忆能力.测试结束后选取5只取海马组织,采用Weston Blot技术行PSD-95含量测定.另两组各取5只,取右侧海马CA1区于电镜下观察突触后致密物厚度(post synaptic density,PSD)变化.结果 R组和N组水迷宫测试第1天潜伏期分别为(12.6±3.4)、(10.5±4.1)s；第2天潜伏期分别为(6.8±2.8)、(7.1±1.3)s；第3天潜伏期分别为(6.2±0.7)、(6.4±1.1)s；第4天潜伏期分别为(5.0±2.7)、(8.1±4.0)s；训练阶段和第60日龄潜伏期之间差异均无统计学意义(P＞0.05).R组和N组PSD-95蛋白含量基础值和60日龄分别为(0.60±0.08)、(0.61±0.05),两组差异无统计学意义(P＞0.05).R组和N组60日龄PSD厚度分别为(84±6)、(81±7) nm,两组差异无统计学意义(P＞0.05).结论 幼年期单次罗哌卡因毒性惊厥对成年后鼠学习记忆、PSD-95蛋白及PSD厚度无明显影响.     

代谢型谷氨酸受体与吗啡耐受和依赖

谷氨酸通过离子型和代谢型谷氨酸受体(metabotropic Slutmate receptors,mGluRs)发挥作用,其中mGluRs是G蛋白耦联受体,分为3组共8个亚型,通过突触前和突触后作用参与离子通道活动调节、神经递质释放、突触传递和突触町塑性等生理病理过程.研究表明mGluRs与吗啡耐受和依赖密切有关.现就近年来各种类型的mGluRs参与吗啡耐受和依赖的研究进展作一综述.     

线粒体保护剂对异氟醚麻醉老年小鼠海马线粒体功能和突触可塑性的影响

目的观察线粒体保护剂SS-31对异氟醚麻醉老年小鼠线粒体功能和突触可塑性的影响。方法老年雄性C57BL/6小鼠48只随机均分为四组(n=12):氧气+生理盐水组(CN组)、氧气+SS-31组(CS组)、异氟醚+生理盐水组(IN组)和异氟醚+SS-31组(IS组)。根据分组,于氧气或异氟醚吸入前30min腹腔注射等容生理盐水(CN、IN组)或SS-31(5mg/kg,CS、IS组),于气体吸入2h后取小鼠海马组织。提取线粒体检测电子传递链复合物Ⅰ~Ⅳ酶活性、三磷酸腺苷(ATP)和线粒体膜电位(MMP)水平,组织匀浆检测突触可塑性相关蛋白突触蛋白1(synapsin-1)、突触后密度蛋白95(PSD-95)、NMDA受体2A(NMDAR2A)、NMDAR2B、钙调蛋白依赖的蛋白激酶Ⅱα(CaMKⅡα)和CaMKⅡβ的含量。结果与IN组比较,IS组复合物Ⅰ酶活性、ATP和MMP水平升高,synapsin-1和PSD-95含量增加,NMDAR2B、CaMKⅡα和CaMKⅡβ含量降低(P0.05),而复合物Ⅱ~Ⅳ酶活性及NMDAR2A含量差异无统计学意义。结论线粒体保护剂SS-31可改善异氟醚麻醉所致老年小鼠海马线粒体及神经元突触可塑性损伤。     

突触后致密物质-95多肽疫苗对神经病理性痛大鼠脊髓脑源性神经营养因子mRNA表达的影响

目的 观察突触后致密物质-95(PSD-95)多肽疫苗对大鼠神经病理性痛的影响.方法 成年雌性SD大鼠,制备保留性神经损伤(SNI)模型,7d后选取SNI模型成功的大鼠24只,随机分为4组(n=6):NP组、磷酸盐缓冲液(PBS)组、匙孔虫戚血蓝蛋白(KLH)组及PSD-95组.PSD-95组沿背部两侧皮下多点注射PSD-95多肽疫苗3次,每隔2周注射1次;PBS、KLH组分别给予PBS和KLH.分别于制备SNI前1 d(基础值)、第1次免疫前1d及第3次免疫后7d和14 d(T0-3)时测定机械痛阈;于T3时处死大鼠,取脊髓腰膨大组织,采用逆转录-聚合酶链反应(RT-PCR)法测定脑源性神经营养因子(BDNF) mRNA表达.结果 与T0时比较,T1时各组机械痛阈均降低(13.2±1.1比1.9±0.5:12.9±0.9比1.9 ±0.7;13.5±1.0比1.8±0.5;13.1±1.1比1.7±0.6);T2、T3时NP、PBS和KLH组机械痛阈降低(2.4±0.6、2.5±0.6;3.2±0.9、3.4±0.8;3.3±0.8、3.5±1.1)(P＜0.05).与T1时比较,PSD-95组T2、T3时机械痛阈升高(1.7±0.6比10.5 ±2.1、11.2±1.9),BDNF mRNA表达下调(1.48±0.21比0.92±0.13、0.88 ±0.12)(P＜0.05);PBS组和KLH组其余时点各指标差异无统计学意义(P＞0.05).与NP组比较,T2、T3时PSD-95组机械痛阈升高(2.4±0.6比10.5±2.1;2.5±0.6比11.2±1.9),BDNF mRNA表达下调(1.48±0.17比0.92 ±0.13;1.52±0.23比0.88±0.12)(P ＜0.05);PBS组和KLH组各指标差异无统计学意义(P＞0.05).结论 PSD-95多肽疫苗对神经病理性痛大鼠具有镇痛作用,其机制可能与下调脊髓BDNF mRNA的表达有关.     

β阻滞剂与肾功能

文章综述了各种β阻滞剂对肾功能的影响,同时又综述了肾功能损伤对各种β阻滞剂药物动力学的影响。一、受体与肾功能 1.α和β肾上腺素能受体:现存在两种α受体,即突触前(α_2)和突触后(α_1)受体。β受体位于某些血管(包括骨骼肌血管),可能在冠状血管和肾血管,它位于支气管,兴奋引起气管扩张。位于心脏的为β_1受体,位于血管、支气管的为β_2受体。β_2受体在血管内已被证明,它调节血管扩张,兴奋使肾血流增加,     

成年和老龄大鼠神经肌肉接头处突触后膜乙酰胆碱受体表达和分布的比较

目的 比较成年和老龄大鼠神经肌肉接头处突触后膜乙酰胆碱受体表达和空间分布的差异.方法 健康雄性Wistar大鼠10只,按月龄分为成年组(4～6月龄,n=5)和老龄组(24～28月龄,n=5),提取大鼠腓肠肌总RNA.根据编码大鼠烟碱型乙酰胆碱受体ε亚单位的mRNA序列,设计引物并合成引物对,采用实时定量PCR技术测定腓肠肌组织烟碱型乙酰胆碱受体ε亚单位mRNA表达量.用四甲基罗丹明-α-银环蛇毒标记大鼠神经肌肉接头处突触后膜乙酰胆碱受体,采用激光共聚焦显微镜激发标记物发光,观察受体分布情况,并测定受体分布区的面积、长度和宽度.结果 与成年组比较,老龄组大鼠腓肠肌烟碱型乙酰胆碱受体ε亚单位mRNA表达量降低(P＜0.05),突触后膜乙酰胆碱受体分布区面积、长度和宽度差异无统计学意义(P＞0.05).两组大鼠突触后膜乙酰胆碱受体分布形态存在明显差异.结论 老龄可下调大鼠神经肌肉接头处突触后膜乙酰胆碱受体表达,但并不改变运动神经轴突末梢与骨骼肌纤维的接触面积.     

NMDA受体介导的体外循环缺血缺氧性脑损伤的研究进展

NMDA受体是兴奋性氨基酸的一种特异性受体,不仅参与突触兴奋性的传递,而且还与突触的可塑性及发育[1]、神经元变性和某些神经精神病的发展有关。NMDA介导的神经兴奋毒性在缺血缺氧性脑病损伤中起关键性作用。在体外循环手术尤以深     

Influence of paradoxical sleep deprivation and sleep recovery on testosterone level in rats of different ages

This study was performed to assess serum testosterone alterations induced by paradoxical sleep deprivation (PSD) and to verify their attenuation during sleep recovery (SR) based on different durations and ages. Wistar male rats aged 12 weeks for the younger group and 20 weeks for the elder group were randomly distributed into one of the following groups: a control group (cage and platform), 3-day SD, 5-day SD, 7-day SD, 1-day SR, 3-day SR and 5-day SR groups. For PSD, the modified multiple platform method was used to specifically limit rapid eye movement (REM) sleep. Differences in the testosterone and luteinizing hormone levels between the younger group and the elder group according to duration of PSD and SR recovery were analysed. Testosterone continued to fall during the sleep deprivation period in a time-dependent manner in both the younger (P=0.001, correlation coefficient r=-0.651) and elder groups (P=0.001, correlation coefficient r=-0.840). The elder group showed a significantly lower level of testosterone compared with the younger group after PSD. Upon SR after 3 days of PSD, the testosterone level continued to rise for 5 days after sleep recovery in the younger group (P=0.013), whereas testosterone concentrations failed to recover until day 5 in the elder group. PSD caused a more detrimental effect on serum testosterone in the elder group compared to the younger group with respect to decreases in luteinizing hormone (LH) levels. The replenishment of serum testosterone level was prohibited in the elder group suggesting that the effects of SD/SR may be age-dependent. The mechanism by which SD affects serum testosterone and how age may modify the process are still unclear.     

深Ⅱ度烫伤大鼠创缘皮肤组织中表皮细胞增殖的研究

目的观察大鼠深Ⅱ度烫伤后创缘皮肤组织中表皮细胞的增殖活动规律,探讨其可能机制. 方法将24只SD大鼠随机分为正常组(未烫伤)、烫伤后3 d组、7 d组及14 d组,每组6只.采集正常组大鼠皮肤及烫伤大鼠创缘皮肤,观察其表皮组织学特征;用流式细胞仪检测表皮细胞的细胞周期;蛋白印迹法检测表皮细胞增殖调节因子细胞周期素(cyclinD1、cyclinB1)和细胞周期素依赖性激酶(CDK)4的表达水平,并测定M期促进因子(MPF)的组蛋白激酶活性. 结果组织学观察显示,伤后3 d组大鼠创缘表皮细胞核及核仁较正常组增大;伤后14 d组胞核及核仁增大明显,细胞数显著增多.伤后14 d组S期表皮细胞百分比出现上升趋势;G2/M期百分比自伤后3 d起逐渐升高,伤后7、14 d组(4.5±0.6、5.4±1.0)显著高于正常组(2.9±1.1,P<0.05).cyclinD1表达量伤后3 d即明显增高;cyclinB1表达无显著波动.伤后3 d组的CDK4表达水平较低,14 d组开始回升.伤后14 d组表皮细胞MPF活性显著增强. 结论在细胞周期调控因子作用下,大鼠深Ⅱ度烫伤后皮肤组织中表皮细胞在伤后早期即出现DNA合成及有丝分裂的增加,伤后14 d增殖明显活跃.cyclinD1/CDK4复合物的表达及MPF的活性在伤后早期并未同步增高,但自伤后14 d起其表达显著增多,提示创面愈合过程中细胞周期调控因子的调控规律具有特殊性.     

β内啡肽与μ型-阿片受体在深Ⅱ度烫伤大鼠创面愈合过程中的表达

目的观察β内啡肽和μ型-阿片受体（MOR）在深Ⅱ度烫伤大鼠创面愈合过程中的表达。方法将36只Wistar大鼠随机分为对照组（6只）、烫伤组（30只）。烫伤组大鼠被造成5％TBSA深Ⅱ度烫伤，对照组仅模拟烫伤。于伤后即刻及伤后3、7、14、21d取创面组织，采用免疫荧光标记法检测B内啡肽和MOR的表达情况。结果对照组大鼠皮肤组织内β内啡肽和MOR主要分布于表皮、真皮交界的周围神经纤维、表皮的角质形成细胞、真皮的成纤维细胞中，强度较弱。伤后3d，烫伤组B内啡肽表达达峰值（196±16，P＜0．01），在皮肤全层均有表达；MOR集中表达在基底层和基底上的角质形成细胞。伤后7、14d烫伤组B内啡肽仍大量表达。伤后7d，烫伤组MOR的表达进一步增强，胶原排列紊乱；14d时部分创面再上皮化，MOR表达达高峰（306±23，P＜0．01）。伤后21d，烫伤组创面完全再上皮化，周围神经末梢接近并抵达表皮、真皮交界，胶原排列较整齐，β内啡肽的表达（31±24）与对照组（30±18）接近；但MOR的表达（56±16）仍然高于对照组（28±15）。结论烫伤后β内啡肽和MOR的表达具有一定的时效性，这种变化可能影响了创面愈合。     

Factors influencing surgical decisions in chronic pilonidal sinus disease

Summary  BACKGROUND: Pilonidal sinus disease (PSD) may be present as chronic PSD, which may eventually exacerbate. Factors associated with the progression of chronic PSD to acute abscess-forming PSD were investigated. METHODS: Records of 1962 patients admitted to the surgical departments of three hospitals of the German Armed Forces between 1980 and 1996 with PSD were analyzed. RESULTS: Patients with chronic PSD showed higher sinus numbers (p < 0.001) and longer disease history (p < 0.001), while acute abscess-forming PSD was associated with smoking (p < 0.001). Surgeons were more likely to opt for primary wound closure when fewer sinus were present. Primary wound closure was similarly successful in chronic (67.2%) and acute (66.9%) PSD. Primary wound healing rate was negatively influenced by a high BMI in chronic PSD (p = 0.012). CONCLUSIONS: Early elective surgery in chronic PSD seems justified in patients presenting with a short duration of disease, low sinus number and smoking history.      

Is conservative treatment an effective option for pilonidal sinus disease in children?

Pilonidal sinus disease (PSD) is associated with a complex disease process in children, and its management remains controversial. There are a few published studies on PSD in the paediatric literature; therefore, we present our experience of conservatively treating PSD in children. This study involved a retrospective review with telephone follow up. All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery. All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess). Data collection included demographics, type of management, recurrence, presence of infection, and total healing time. In the study period, 29 children were identified. Their mean age was 14.94 ± 1.09 (range: 12‐16) years, and 51.7% were girls. The mean length of follow up was 8.34 ± 6.36 (range: 1‐25) months. Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery. PSD is being seen in children more frequently in recent years. Conservative treatment may be the recommended initial approach for PSD in children.     

High Body Mass Index as a Possible Risk Factor for Pilonidal Sinus Disease in Adolescents

Pilonidal sinus disease (PSD) is common in adults, but it may also develop in adolescents. The intergluteal groove is a deep moist area in which broken hairs and foreign bodies can collect, often leading to infection. Only a few papers have been published considering PSD in children. For the present study, we retrospectively examined the data of operated patients with PSD. From that review, it appears that high body mass index (BMI) might be a risk factor for the development of PSD and its complications in older children. Fourteen young patients (12 males, 2 females, 12–18 years of age) underwent surgery for PSD. According to the BMI-for-age, eight of these patients (57, 1%) were overweight or obese. Five of them (35.8%) developed mild to moderate postoperative complications. Symptoms recurred in one patient (7.1%) whose BMI was considered as overweight. In patients with normal weight no early or late complications developed. Our findings suggest that high BMI in adolescents is a significant risk factor in the development of both symptoms and complications of PSD after surgical treatment.     

外固定支架和缆线渐进牵拉装置的设计及其动物实验的初步研究

目的 介绍自行研究设计的治疗膝关节僵直的外固定支架和缆线渐进牵拉装置（PSD）,探讨其用于动物实验的疗效.方法 PSD包括3个部分：大腿双边平面外固定支架、小腿双边平面外固定支架和缆线系统.3只成年左膝关节僵直山羊采用PSD（4次/d,每次紧缩2～4 mm）进行左膝关节的逐步牵拉3周.3周后拆除山羊左下肢PSD.分别记录术前、拆除PSD当天、拆除PSD 1周后左膝关节最大屈曲度数.结果 3只山羊术前、拆除PSD当天及拆除PSD 1周后的膝关节屈曲角度平均分别为9.0°±3.6°、112.2°±17.7°和110.1°±15.5°.PSD治疗3周后左膝关节屈曲度数较术前明显改善,平均矫正103.2°.结论 PSD用于实验山羊左膝关节僵直牵拉效果肯定,具有较好的临床应用价值.     

Direct and indirect measurement of patient radiation exposure during endovascular aortic aneurysm repair

With the increasing complexity of endovascular procedures, concern has grown regarding patient radiation exposure. Abdominal aortic aneurysm (AAA) repair represents the most common complex endovascular procedure currently performed by vascular specialists. Our study evaluates the patient radiation dose received during endovascular AAA repair. Over a 3-month period we prospectively monitored the radiation dose in a series of consecutive patients undergoing endovascular AAA repair. All patients underwent standard endovascular AAA repair with one of two commercially available grafts using the GE OEC 9800 unit. Direct measurement of maximum radiation dose at skin level (peak skin dose, PSD) was recorded using GAFCHROMIC radiographic dosimetry film. Indirect measurements of radiation dose (fluoroscopy time and dose-area-product [DAP]) were recorded with the C-arm dosimeter. A total of 12 consecutive patients undergoing standard endovascular AAA repair were evaluated. Mean PSD was 0.75 Gy (range 0.27-1.25). Mean total fluoroscopy time was 20.6 min (range 12.6-34.2) with an average of 92% spent in standard fluoroscopy and 8% spent in cinefluoroscopy. Regarding total fluoroscopy time, 49% was spent in normal field of view and 51% in magnified view. Mean DAP was 15,166 cGy x cm(2) (range 5,207-24,536). PSD correlated with DAP (r = 0.9, p < 0.05) but not total fluoroscopy time (r = 0.18, p > 0.05). PSD also correlated with body mass index (BMI; r = 0.82, p < 0.05). Obese patients had a mean PSD of 1.1 Gy compared to 0.5 Gy in nonobese patients. PSD of all patients was well below the accepted 2.0 Gy threshold for skin injury. PSD correlated with DAP but not total fluoroscopy time. PSD also correlated with BMI, and the mean PSD was significantly increased in obese compared to nonobese patients. Despite the complexity and duration of endovascular AAA repair, the procedure can be performed safely without excessive radiation exposure.     

局部应用胰岛素对大鼠烫伤创面基底膜形成的影响

目的观察胰岛素对大鼠深Ⅱ度烫伤再上皮化创面基底膜(BM)形成的影响。方法将96只SD大鼠背部造成45cm2深Ⅱ度烫伤,根据创面皮下注射药物的不同分为对照组(创面皮下浸润注射2ml等渗盐水,48只)和胰岛素组(创面皮下浸润注射0.1U长效混悬锌胰岛素 等渗盐水2ml,48只)。两组大鼠均在伤后第1天开始注射,1次/2d,直至创面完全上皮化。于伤后2、3、4、5、6、10、14d及创面完全再上皮化时,每组每时相点处死6只大鼠,取创缘1cm宽皮肤,利用网状纤维染色及透射电镜观察创面BM形态,用蛋白印迹法测定角质形成细胞(KC)层粘连蛋白(LN)5mRNA表达水平和LN含量。结果胰岛素大鼠组再上皮化创面BM结构清晰完整。伤后10、14d胰岛素组LN-5mRNA表达水平高于对照组(P<0.05或0.01)。创面完全再上皮化时两组大鼠LN-5mRNA表达水平均减弱。伤后14d及创面完全再上皮化时胰岛素组LN的蛋白表达量各为56±8、101±13,显著高于对照组39±5、73±16(P<0·05).结论烫伤创面皮下浸润注射0.1U胰岛素可以加速创面再上皮化,改善再上皮化创面质量。     

Swallowing dysfunction after prolonged intubation: analysis of risk factors in trauma patients

Background

The clinical significance of post-extubation swallowing dysfunction (PSD) is profound, resulting in both increased morbidity and mortality. Specific risk factors have not been described in an injured patient cohort. The purpose of this pilot study was to elucidate independent factors that predict PSD in this population.

Methods

A retrospective cohort analysis was performed on 150 consecutive trauma patients intubated for more than 48 hours. Assessment of swallowing function after extubation was performed by a simple bedside speech pathology evaluation. Patients then were divided into 2 groups: those with and those without PSD. Backwards stepwise logistic regression analysis then was used to determine independent predictors of PSD after controlling for important injury characteristics and patient demographics.

Results

The incidence of PSD in our study cohort was 41%. Patients with PSD, although older than non-PSD patients (48 vs 37.5 y; P = .001), were similar with respect to admission Glasgow coma score (GCS) and injury severity score. Regression analysis revealed that age older than 55 years (odds ratio, 2.60; P = .037; 95% confidence interval, 1.1–6.4) and ventilator days (odds ratio, 1.14; P = .001; 95% confidence interval, 1.1–1.2) were significant independent risk factors for PSD. Interpretation of these odds ratios revealed that those patients older than age 55 had more than a 2.5-fold greater risk of PSD. The risk increased by 14% for every day a patient required intubation. There was no significant association between PSD and injury severity score, GCS, presence of medical comorbidities, or development of nosocomial pneumonia.

Conclusions

PSD is a common occurrence in trauma patients. Age older than 55 years and ventilator days are independent risk factors for PSD. Injury severity, altered GCS upon arrival, comorbidities, and nosocomial pneumonia were not independent risk factors for PSD in our cohort. These results suggest that older patients with extended intensive care unit stays and ventilator requirements may benefit from early swallowing evaluation.