史静,吴海婉,支小建,等.声门下增压技术对气管切开患者上气道阻塞的干预疗效观察[J].中华物理医学与康复杂志,2025,47(12):1088-1092
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| 声门下增压技术对气管切开患者上气道阻塞的干预疗效观察 |
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| DOI：10.3760/cma.j.cn421666-20250629-00541 |
| 中文关键词: 声门下增压 气管切开 上气道阻塞 VOTE评分 |
| 英文关键词: Subglottic pressure Tracheotomy Upper airway obstruction VOTE scoring Murray secretion grading |
| 基金项目:广东省康复医学临床医学研究中心项目（2023B110003） |
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| 中文摘要: |
| 目的 通过系统评估声门下增压技术对气管切开患者上气道阻塞的治疗效果，深入分析其对软腭、口咽、舌根及会厌部位气管阻塞的疗效差异。 方法 本研究共纳入符合标准的22例气管切开患者，对所有患者实施标准化声门下增压治疗，通过声门下吸引管持续输注氧气，氧流量设定为2~5 L/min，并根据患者耐受情况动态调整氧流速，每周治疗5 d，连续治疗2周。于干预前、干预后采用电子喉镜检查患者气道阻塞情况，具体分析指标包括VOTE评分、Murray分泌物评级及声带运动情况。 结果 声门下增压干预对气管切开患者不同部位气道阻塞的疗效存在显著差异（P=0.028），以舌根部气道阻塞的治疗效果尤为显著，有效率高达93.8%（15/16），其次是口咽部气道阻塞，有效率为60%（9/15），而软腭部气道阻塞及会厌部气道阻塞的有效率较低，分别为42.9%（6/14）和36.8%（7/19）。在气道阻塞类型方面，入选患者以前后向阻塞最为常见，主要出现在舌根部（占比为72.7%）及会厌部（占比为63.6%），同心圆型阻塞则主要出现在软腭及会厌部，占比均为22.7%；完全阻塞在舌根及会厌部的占比分别为22.7%和27.3%，而部分阻塞在软腭及口咽部更为普遍（占比分别为63.6%和68.2%）。Murray分泌物评级结果显示干预后患者分泌物积聚显著减少(P<0.05)，但声带活动度较干预前无明显变化(P>0.05)。 结论 声门下增压治疗对气管切开患者上气道阻塞具有明显改善作用，且以对舌根部位气道阻塞的疗效尤为显著，提示气道阻塞部位是影响声门下增压治疗效果的重要因素之一。 |
| 英文摘要: |
| Objective To evaluate systematically any therapeutic effect of increased subglottic pressure (SPA) on upper-airway obstruction during tracheotomy, and its effects on the soft palate, oropharynx, tongue base and epiglottis. Methods Twenty-two patients undergoing tracheotomy received standardized SPA at 2-5L/min 5 days per week over 2 weeks. Oxygen flow was dynamically adjusted to adjust subglottic pressure. Before and after the intervention, fiber-optic laryngoscopy was performed to explore airway obstruction. The results were also quantified with VOTE scoring, Murray secretion grading and vocal-cord mobility measurements. Results The effect of SPA differed significantly among anatomical sites. The tongue base showed the highest response rate (93.8%, 15/16), followed by the oropharynx (60%, 9/15), the soft palate (42.9%, 6/14) and the epiglottis (36.8%, 7/19). Antero-posterior obstruction predominated at the tongue base (72.7%) and epiglottis (63.6%), whereas concentric obstruction was mainly seen at the soft palate and epiglottis (22.7% each). There were, however, some cases of complete obstruction at the tongue base (22.7%) and epiglottis (27.3%), while partial obstruction was more common at the soft palate (63.6%) and oropharynx (68.2%). Post-intervention, the average Murray secretion grade had decreased significantly, but vocal-cord mobility remained unchanged. Conclusions SPA markedly relieves upper-airway obstruction in patients undergoing tracheotomy, with the greatest benefit at the tongue base. The obstruction site is thus a key determinant of SPA′s effectiveness. |
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