《中国康复理论与实践》

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (3): 326-332.doi: 10.3969/j.issn.1006-9771.2024.03.010

• 应用研究 • 上一篇    下一篇

Passy-Muir说话瓣膜对脑卒中气管切开患者吞咽生物力学的作用

梁明, 魏珍(), 祖合热·肉孜, 李金贤   

  1. 新疆维吾尔自治区人民医院，a.康复医学科，b.高血压诊疗研究中心，新疆乌鲁木齐市 830001
  • 收稿日期:2023-11-06 出版日期:2024-03-25 发布日期:2024-04-01
  • 通讯作者: 魏珍 E-mail:wszsydxs@163.com
  • 作者简介:梁明(1985-)，男，汉族，新疆乌鲁木齐市人，博士，副主任医师，主要研究方向：神经康复。
  • 基金资助:
    1.新疆维吾尔自治区人民医院项目(20200102);2.新疆维吾尔自治区自然科学基金项目(2021D01C131);3.自治区卫生健康青年医学科技人才专项科研项目(WJWY-202026)

Effect of Passy-Muir speaking valve on swallowing biomechanics of dysphagia in stroke patientst after tracheotomy

LIANG Ming, WEI Zhen(), Zuhere·ROUZI , LI Jinxian   

  1. a. Department of Rehabilitation Medicine; b. the Center of Hypertension, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, China
  • Received:2023-11-06 Published:2024-03-25 Online:2024-04-01
  • Contact: WEI Zhen E-mail:wszsydxs@163.com
  • Supported by:
    People's Hospital of Xinjiang Uygur Autonomous Region Fund(20200102);Xinjiang Uygur Autonomous Region Natural Science Fund(2021D01C131);Autonomous Region Hygiene and Health Youth Medical Science and Technology Talents Special Fund(WJWY-202026)

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摘要：

目的 应用高分辨率固态测压技术(HRM)检测Passy-Muir说话瓣膜(PMV)对脑卒中气管切开患者吞咽生物力学的作用，探讨利用咽腔与食管上括约肌(UES)压力参数评估PMV治疗效果的应用价值。

方法 2020年1月至2024年1月，新疆维吾尔自治区人民医院100例脑卒中气管切开患者随机分为对照组(n = 50)和PMV组(n = 50)，对照组给予常规吞咽康复，PMV组在此基础上佩戴PMV，共2周。治疗前后，采用改良曼恩吞咽能力评估量表(MMASA)进行临床吞咽功能评估；并进行HRM检查，收集腭咽收缩压力峰值、腭咽收缩时长、UES松弛残余压和UES松弛时间等数据。将PMV组治疗后的MMASA评分与HRM压力参数值进行相关性分析。

结果 两组各脱落4例。治疗后，两组UES松弛残余压显著降低(t > 47.403, P < 0.001)，MMASA评分、腭咽收缩压力峰值、腭咽收缩时长和UES松弛时间均显著增加(t > 19.621, P < 0.001)；PMV组均优于对照组(t > 2.050, P < 0.05)。治疗后PMV组腭咽收缩压力峰值(r = 0.924, P < 0.001)、腭咽收缩时长(r = 0.948, P < 0.001)和UES松弛残余时间(r = 0.954, P < 0.001)与MMASA评分呈正相关，UES松弛残余压与MMASA评分呈负相关(r = -0.939, P < 0.001)。

结论 佩戴PMV治疗能增强脑卒中气管切开患者的吞咽功能，提高咽腔和UES区域的吞咽生物力学水平。利用咽腔和UES区域的压力参数可预测佩戴PMV治疗后患者吞咽功能的改善情况。

关键词: 脑卒中, 气管切开, Passy-Muir说话瓣膜, 生物力学

Abstract:

Objective To explore the effect of Passy-Muir speaking valve (PMV) on swallowing biomechanics of dysphagia by using high resolution manomety (HRM) in stroke patients after tracheotomy, and to evaluate the application value of pressure parameters of pharynx and upper esophageal sphincter (UES) in PMV therapy.

Methods From January, 2020 to January, 2024, 100 patients in People's Hospital of Xinjiang Uygur Autonomous Region were randomly divided into control group (n = 50) and PMV group (n = 50). The control group accepted routine swallowing therapy, and PMV group accepted PMV additionally, for two weeks. Before and after treatment, the clinical swallowing function was evaluated with modified Mann Assessment of Swallowing Ability (MMASA); and then they were observed with HRM, and the velopharynx maximal pressure, velopharynx time, UES residual pressure and duration of UES relaxation were collected. The correlation of the scores of MMASA and pressure parameters of pharynx and UES was analyzed.

Results Four cases dropped down in each group. After treatment, UES residual pressure significantly decreased (t >47.403, P < 0.001), and the score of MMASA, the velopharynx maximal pressure, the velopharynx time and the duration of UES relaxation significantly increased (t > 19.621, P < 0.001); and all the indexes were better in PMV group than in the control group (t > 2.050, P < 0.05). The scores of MMASA were significantly positively correlated with velopharynx maximal pressure (r= 0.924, P < 0.001), velopharynx time (r= 0.948, P < 0.001) and duration of UES relaxation (r= 0.954, P < 0.001), negatively correlated with UES residual pressure (r= -0.939, P < 0.001).

Conclusion PMV could improve the swallow function and biomechanics of pharynx and UES in stroke patients with tracheotomy. The pressure parameters of pharynx and UES may predict the effect of swallow function by using PMV.

Key words: stroke, tracheotomy, Passy-Muir speaking valve, biomechanics

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