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

doi:10.3969/j.issn.1006-9771.2024.03.010

Abstract

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

CLC Number:

R743.3

LIANG Ming, WEI Zhen, Zuhere·ROUZI , LI Jinxian. Effect of Passy-Muir speaking valve on swallowing biomechanics of dysphagia in stroke patientst after tracheotomy[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 326-332.

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References 30

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项目	对照组 (n = 46)	PMV组 (n = 46)	χ²/t值	P值
性别(男/女)/n	25/21	27/19	0.177	0.674
年龄/岁	60.67±5.17	59.78±5.75	0.781	0.437
病程/月	2.02±0.40	2.05±0.41	0.462	0.645
发病类型(脑梗死/ 脑出血)/n	32/14	33/13	0.052	0.819
GCS评分	13.57±1.11	13.35±1.04	0.971	0.334
血氧饱和度/%	94.90±2.17	94.50±2.58	0.787	0.433
气管套管在位时间/d	12.20±3.70	11.70±4.00	0.623	0.535
高血压病(有/无)/n	39/7	37/9	0.303	0.582
糖尿病(有/无)/n	29/17	32/14	0.438	0.508

组别	n	治疗前	治疗后	t值	P值
对照组	46	28.74±7.30	36.83±8.83	19.621	< 0.001
PMV组	46	27.24±7.12	40.52±8.46	39.906	< 0.001
t值		0.998	2.050
P值		0.321	0.043

组别	n	治疗前	治疗后	t值	P值
对照组	46	71.76±4.99	105.46±5.43	199.943	< 0.001
PMV组	46	73.28±7.06	110.68±11.14	48.387	< 0.001
t值		1.195	2.856
P值		0.235	0.005

组别	n	治疗前	治疗后	t值	P值
对照组	46	439.67±50.18	530.37±61.69	36.039	< 0.001
PMV组	46	446.20±53.69	559.72±66.75	105.042	< 0.001
t值		0.602	2.190
P值		0.549	0.031

组别	n	治疗前	治疗后	t值	P值
对照组	46	13.69±2.27	7.76±2.51	96.079	< 0.001
PMV组	46	12.95±2.77	6.76±1.96	47.403	< 0.001
t值		1.399	2.131
P值		0.165	0.036

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

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组别	n	治疗前	治疗后	t值	P值
对照组	46	458.28±63.66	594.80±66.96	67.097	< 0.001
PMV组	46	447.85±54.99	620.89±51.71	105.040	< 0.001
t值		0.841	2.091
P值		0.402	0.039

参数	MMASA评分
参数	r值	P值
腭咽收缩压力峰值	0.924	< 0.001
腭咽收缩时长	0.948	< 0.001

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