应用气管单向阀对脑出血气管切开术后吞咽障碍患者误吸的疗效

doi:10.3969/j.issn.1006-9771.2020.11.008

摘要/Abstract

摘要：

目的探讨气管单向阀联合神经肌肉电刺激改善脑出血气管切开术后吞咽障碍患者误吸的临床疗效。方法 2018年1月至12月,本院脑出血气管切开术后吞咽障碍患者37例,随机分为对照组(n = 21)和综合组(n = 16)。两组均接受神经肌肉电刺激,综合组佩戴气管单向阀进行训练,共3周。治疗前后,采用功能性经口摄食量表(FOIS)和渗漏-误吸量表(PAS)进行评定。结果治疗后,两组FOIS和PAS评分均显著改善(|Z| > 3.544, P < 0.001),综合组优于对照组(| Z| > 2.094, P < 0.05)。结论在神经肌肉电刺激的基础上联合气管单向阀训练可进一步改善脑出血气管切开术后吞咽障碍患者的误吸。

关键词: 脑出血, 气管切开, 吞咽障碍, 气管单向阀, 误吸

Abstract:

Objective To investigate the effects of a one-way tracheostomy speaking valve based on neuromuscular electrical stimulation on aspiration in patients with dysphagia after tracheotomy for cerebral hemorrhage.Methods From January to December, 2018, 37 patients with dysphagia after tracheotomy for cerebral hemorrhage were randomly divided into control group (n = 21) and experimental group (n = 16). Both groups accepted neuromuscular electrical stimulation, while the experimental group was trained to use one-way tracheostomy speaking valve additionally, for three weeks. They were assessed with Functional Oral Food Intake Scale (FOIS) and Penetration-Aspiration Scale (PAS) before and after treatment. Results The scores of FOIS and PAS improved in both groups after treatment (|Z| > 3.544, P < 0.001), and was better in the experimental group than in the control group (| Z| > 2.094, P < 0.05). Conclusion One-way tracheostomy speaking valve training based on neuromuscular electrical stimulation could improve swallowing and reduce aspiration of patients with dysphagia after tracheotomy.

Key words: cerebral hemorrhage, tracheotomy, dysphagia, one-way tracheostomy speaking valve, aspiration

中图分类号:

R743.34

周惠嫦,张盘德,卫小梅,窦祖林. 应用气管单向阀对脑出血气管切开术后吞咽障碍患者误吸的疗效[J]. 《中国康复理论与实践》, 2020, 26(11): 1292-1296.

ZHOU Hui-chang,ZHANG Pan-de,WEI Xiao-mei,DOU Zu-lin. Effect of One-way Tracheostomy Speaking Valve on Aspiration of Dysphagia Patients after Tracheotomy for Cerebral Hemorrhage[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(11): 1292-1296.

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组别	n	性别(n)		年龄(岁)	病程(d)	GCS	MMSE
组别	n	男	女	年龄(岁)	病程(d)	GCS	MMSE
对照组	21	13	8	57.905±11.405	15.429±2.521	12.762±0.831	17.429±4.812
综合组	16	12	4	53.813±12.172	15.375±2.363	12.813±0.750	17.000±4.147
χ²/t值		0.711		1.050	0.066	-0.191	0.285
P值		0.491		0.301	0.948	0.849	0.778

组别	n	破入脑室		基底节区		大脑皮质
组别	n	左侧	右侧	左侧	右侧	左侧	右侧
对照组	21	4	1	2	3	6	5
综合组	16	2	2	2	2	3	5
χ²值		0.900		0.090		0.540
P值		0.343		0.764		0.463

次数	佩戴时长	时间	呼吸急促 (有/无)	口唇紫绀 (有/无)	甲床颜色 (红润/苍白)	呼吸频率 (次/min)	心率 (次/min)	血氧饱和度
1	1 min
2	5 min
3	10 min
4	15 min
5	30 min
6	1 h
7	2 h
8	3 h
9	4 h
10	5 h
11	6 h
12	12 h
13	24 h
.	24 h

组别	n	治疗前							治疗后							Z值	P值
组别	n	1级	2级	3级	4级	5级	6级	7级	1级	2级	3级	4级	5级	6级	7级	Z值	P值
对照组	21	10	10	1	0	0	0	0	0	0	3	4	3	10	1	-4.062	< 0.001
综合组	16	9	6	1	0	0	0	0	0	0	1	3	1	3	8	-3.592	< 0.001
Z值		-0.433							-2.094
P值		0.705							0.044

组别	n	治疗前								治疗后								Z值	P值
组别	n	1级	2级	3级	4级	5级	6级	7级	8级	1级	2级	3级	4级	5级	6级	7级	8级	Z值	P值
对照组	21	0	0	0	8	4	2	4	3	2	11	6	2	0	0	0	0	-4.045	< 0.001
综合组	16	0	0	0	5	4	1	3	3	8	6	2	0	0	0	0	0	-3.544	< 0.001
Z值		-0.364								-2.722
P值		0.728								0.010