吞咽障碍患者误吸干预中Chin-Down动作的研究进展

doi:10.3969/j.issn.1006-9771.2022.07.012

Abstract

Abstract:

Objective To identify the appropriate definition, scope of application, the mechanism and the efficacy of the chin-down maneuver in aspiration reduction or prevention.

Methods Literatures about chin-down published before July, 2021 were reviewed.

Results A total of 13 articles were included. Chin-down refered to the action of bending the neck and leaning the chin as far as possible toward the chest. Chin-down maneuver could change the position and pressure of the pharyngeal structure to guide the food safely into the esophagus, to prevent or reduce aspiration. Chin-down maneuver was effctive on dysphagia caused by insufficient laryngeal elevation, delayed pharyngeal reflex, epiglottal defect, lychee cartilage defect, and glottis closure defect. However, this action worked in patients with premature overflow of food clumps, weak pharyngeal contraction muscle strength, and poor oral preservation.

Conclusion Chin-down maneuver is beneficial to aspiration dysphagia after dysphagia.

Key words: dysphagia, chin-down maneuver, aspiration, compensatory measures, review

CLC Number:

R493

CHEN Jinjin,AERKEN Rufeina,WU Silin,MENG Dianhuai,ZHOU Yuntao. Advance in chin-down maneuver in aspiration for dysphagic patients (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(7): 816-821.

Figures/Tables 2

作者	年份	研究对象	n	平均年龄/岁	实验设计	干预周期	干预指标
Shanahan等^[34]	1993	使用chin-down减少误吸的吞咽障碍患者	15	74.3	自身配对设计	即刻	会厌角↑⁺
Shanahan等^[34]	1993	使用chin-down未减少误吸的吞咽障碍患者	15	61.1	自身配对设计	即刻	会厌角↑⁺
Bülow等^[33]	2002	咽期功能障碍的吞咽障碍患者	8	70	自身配对设计	即刻	中立位vs. chin-down下吞咽：咽下缩肌水平的食团内峰值压力、食团内压力(峰值幅度和持续时间)均无显著性差异
Terré等^[29]	2012	脑损伤后继发吞咽障碍的患者	47	43	交叉设计随机对照	即刻	1.相较于chin-down减少或防止了误吸的患者,在chin-down动作下持续误吸患者的咽期延迟时间↑⁺;2.实验组chin-down干预后误吸减少vs.持续存在误吸：咽部残留↓⁺,环咽肌功能障碍↓⁺,咽期延迟时间↓⁺
Terré等^[29]	2012	脑损伤后没有吞咽障碍的患者	25	51	交叉设计随机对照	即刻
Ra等^[13]	2014	用chin-down有效减少误吸的吞咽障碍患者	19	64.1	自身配对设计	-	PAS评分↑⁺,颈椎前凸角↑⁺,AO flexion↑⁺,中立位和chin-down颈椎屈曲角度差↑⁺,脖子总屈曲角度↑⁺
Ra等^[13]	2014	用chin-down对误吸无效的吞咽障碍患者	78	67.8	自身配对设计	-	梨状隐窝残留发生率↑⁺
Saconato等^[35]	2016	用chin-down有效减少误吸的吞咽障碍患者	24	69	自身配对设计	即刻	有效组吞咽触发延迟人数↑⁺,液体误吸人数↑⁺,中度吞咽障碍人数↑⁺
Saconato等^[35]	2016	用chin-down对误吸无效的吞咽障碍患者	11	69	自身配对设计	即刻	有效组吞咽触发延迟人数↑⁺,液体误吸人数↑⁺,中度吞咽障碍人数↑⁺
Kumai等^[36]	2017	三切口食管癌根治术后	14	65.9	自身配对设计	即刻	chin-down动作下咽收缩率↓⁺,梨状隐窝残留量↓⁺,UES开放直径↑⁺,UES开放持续时间↑⁺,喉前庭闭合持续时间↑⁺
Ayres等^[9]	2017	帕金森病伴吞咽障碍	实验组n = 10	62	随机对照试验	每周4次,每次30 min	chin-down干预后固体和液体误吸症状明显改善,SWAL-QOL的症状频率和心理健康领域得分↑⁺
			对照组n = 8	62.8
			定向组 n = 6	64.5
Kumai等^[27]	2019	三切口食管癌根治术后	15	65.3	自身配对设计	即刻	chin-down干预后梨状隐窝残留量↓⁺,PAS评分↑⁺
Matsubara等^[30]	2020	三切口食管癌根治术后	9	67.8	自身配对设计	即刻	chin-down干预后UES处低吞咽压的持续时间↑⁺,鼻孔到下咽和UES之间的距离↓⁺,腭咽处的最大吞咽压↓⁺
Lee等^[37]	2020	健康人+吞咽障碍患者	20+59	65.05	非随机对照	吞咽稀薄液体时chin-down	1.吞咽障碍患者干预后：环咽肌最大压力↑⁺,舌根收缩压↑⁺,下咽部平均压力↓⁺;2.健康人干预后：环咽肌最大压力↑⁺,舌根收缩压↑⁺,吞咽前UES峰值压力↓⁺,咽缩肌最大峰值压↓⁺,UES最低压持续时间↓⁺;3.健康人vs.吞咽障碍患者：健康人吞咽后UES峰值压力↓⁺,UES活动时间↓⁺
Lee等^[37]	2020	健康人+吞咽障碍患者	10+15	40.45	非随机对照	吞咽蜂蜜样液体时chin-down	1.吞咽障碍患者干预后：环咽肌平均最大压力↑⁺,舌根收缩压↑⁺,UES最低压力持续时间↓⁺;2.健康人干预后：舌根收缩压↑⁺,最小UES压力↑⁺
Ko等^[8]	2021	吞咽障碍患者	76	65.62	回顾性队列研究	-	1.chin-down干预后,渗透误吸的深度↓⁺,渗透率↓⁺;2.chin-down有效vs. chin-down无效：有效组PAS评分↓⁺,中立位和chin-down位下会厌谷和梨状隐窝的残留量↓⁺
Ko等^[8]	2021	吞咽障碍患者	76	68.22	回顾性队列研究	-
Miyamoto等^[31]	2021	吞咽障碍患者	64	未提及	回顾性队列研究	即刻	chin-down干预后：PDAI、咽收缩、舌骨前移、喉抬高、UES开放、吞咽启动、咽部清除显著改善
Forbes等^[32]	2021	吞咽障碍患者	15	58	回顾性队列研究	-	chin-down干预vs.中立位下吞咽：食团过早溢出的持续时间↑⁺,STD-early release↑⁺

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作者	年份	国家	相关定义	名称
张俊娣^[20]	2005	中国	使其下颌尽量靠近胸骨柄	低头吞咽法
专家组^[21]	2018	中国	头颈部屈曲	头颈部屈曲
Welch等^[7]	1993	美国	使下颌靠近胸部	chin-down
Lewin^[12]	2001	美国	屈曲头部和颈部,使下颌靠近胸部	chin-down
Logemann等^[22]	2008	美国	使下颌靠近颈前部	chin-down
Kumai等^[23]	2017	日本	颈部屈曲(下颈段屈曲)	chin-down
Ra等^[13]	2014	韩国	尽可能屈曲头部,目标是使下颌碰到胸部	chin-tuck
Leigh等^[15]	2015	韩国	把下颌往下移动	chin-tuck
Logemann等^[24]	1994	美国	低头使下颌碰到颈部	head down

Advance in chin-down maneuver in aspiration for dysphagic patients (review)

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