陈文斌,张禄晗,徐蕊,等.声门下外部气流对脑卒中后气管切开合并吞咽障碍患者咽腔压力的影响[J].中华物理医学与康复杂志,2026,48(3):254-258
扫码阅读全文
|
| 声门下外部气流对脑卒中后气管切开合并吞咽障碍患者咽腔压力的影响 |
|
| |
| DOI：10.3760/cma.j.cn421666-20250629-00542 |
| 中文关键词: 气管切开术 吞咽障碍 高分辨率测压 声门下外部气流 |
| 英文关键词: Tracheotomy Deglutition disorders High resolution manometry External subglottic airflow |
| 基金项目:金华市科技局公益类重点项目（2023-3-093）；金华市科技局公益类一般项目（2023-4-086） |
|
| 摘要点击次数: 101 |
| 全文下载次数: 37 |
| 中文摘要: |
| 目的 采用高分辨率测压（HRM）技术，动态监测不同流速的声门下外部气流（ESAF）对脑卒中后气管切开合并吞咽障碍患者咽腔压力的影响。方法 募集脑卒中后气管切开合并吞咽障碍患者 20 例，采用随机交叉设计，每例患者均依次接受四种流速（0L/min、2L/min、4L/min、6L/min）的 ESAF 治疗，治疗过程中，患者在每种流速下均进食 3 次 5mL 的中稠食物，每次进食间歇 1min。采用 HRM 测量四种流速的 ESAF 下咽腔的压力参数，包括腭咽、下咽的收缩压力峰值、上食管括约肌（UES）静息压和 UES 松弛残余压、UES 松弛前最高压、UES 松弛后最高压、UES 松弛持续时间，并进行统计学分析。结果 0L/min、2L/min、4L/min、6L/min 流速 ESAF 间的 UES 静息压两两比较，差异均有统计学意义（P<0.05），且 6L/min 流速 ESAF 下的 UES 松弛后最高压均显著高于 0L/min、2L/min、4L/min 流速 ESAF（P<0.05）。0L/min、2L/min、4L/min、6L/min 流速 ESAF 下，患者的腭咽部收缩峰值、下咽部收缩峰值、UES 松弛残余压、UES 松弛前最高压、UES 松弛后最高压、UES 松弛持续时间两两比较差异均无统计学意义（P>0.05）。结论 虽然不同流速的 ESAF 均可提升脑卒中后气管切开合并吞咽障碍患者 UES 静息压，且 6L/min 流速的 ESAF 可更为显著地改善其 UES 松弛后最高压；然而不同流速的 ESAF 对患者咽缩肌峰值、UES 松弛残余压和持续时间等参数的影响并不显著，因此 ESAF 对脑卒中后气管切开合并吞咽障碍患者吞咽功能的即时改善效果还有待进一步研究去验证。 |
| 英文摘要: |
| Objective This study employed high-resolution manometry (HRM) to dynamically monitor the effects of external subglottic airflow (ESAF) interventions at different flow rates on pharyngeal pressure in post-stroke tracheotomized patients with dysphagia. Methods Twenty post-stroke patients with tracheostomy and dysphagia were enrolled in a randomized crossover study. Each participant sequentially received four different ESAF flow rates (0L/min, 2L/min, 4L/min, and 6L/min). During each ESAF condition, patients were given three 5-mL boluses of moderately thick liquid to swallow, with a 1-minute interval between each swallow. High-Resolution Manometry (HRM) was employed to measure pharyngeal pressure parameters under all four flow rates. The measured parameters included: peak contraction pressure in the velopharynx and hypopharynx; upper esophageal sphincter (UES) resting pressure; UES residual pressure during relaxation; pre-relaxation and post-relaxation maximum UES pressure; and UES relaxation duration. Statistical analysis was subsequently performed on the collected data. Results Pairwise comparisons of UES resting pressure among the four ESAF flow rates (0L/min, 2L/min, 4L/min, and 6L/min) revealed statistically significant differences (P<0.05). Furthermore, the post-relaxation maximum UES pressure under the 6L/min flow rate was significantly higher than that under the 0L/min, 2L/min, and 4L/min flow rates (P<0.05). However, no statistically significant differences were found in the following parameters across the different flow rates (P>0.05): peak contraction pressure of the velopharynx and hypopharynx, UES residual pressure during relaxation, pre-relaxation maximum UES pressure, and UES relaxation duration. Conclusions Although ESAF at various flow rates increased UES resting pressure, and the 6L/min flow rate furthermore significantly elevated the post-relaxation maximum UES pressure in post-stroke tracheotomized patients with dysphagia, its effects on pharyngeal constrictor peak pressure, UES residual pressure, and relaxation duration were not significant. Therefore, the immediate therapeutic effects of ESAF on swallowing function in this patient population warrant further investigation. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|