摘要
目的:探讨Passy-Muir说话瓣膜(PMV)对脑损伤气管切开术后患者吞咽生物力学和误吸的影响。方法:选取符合纳入标准的脑损伤气管切开术后伴误吸的患者20例,按随机数字表法分为非PMV干预组(10例)和PMV干预组(10例)。非PMV干预组给予常规吞咽康复训练,PMV干预组在此基础上给予佩戴PMV治疗,治疗结束时间为治疗2周后或拔除气管套管时。分别于治疗前和治疗结束后(治疗后),采用高分辨率测压检查和吞咽造影检查评估2组患者吞咽过程中的颚咽收缩压力峰值(VP-Max)、食管上括约肌松弛后压力峰值(UES-Max)及渗漏-误吸(PAS)评分。结果:治疗前,2组患者的VP-Max、UES-Max及PAS评分组间比较,差异均无统计学意义(P>0.05)。治疗后,2组患者的VP-Max和UES-Max较组内治疗前均有明显改善(P<0.05);PMV干预组的PAS评分亦较组内训练前明显改善(P<0.05)。治疗2周后,PMV干预组的VP-Max和UES-Max分别为(150.87±65.51)mmHg和(206.00±42.28)mmHg,明显高于非PMV干预组(122.45±74.45)mmHg和(190.17±79.56)mmHg,差异有统计学意义(P<0.05)。且VP-Max的增高与PAS评分的改善之间呈正相关(P<0.05)。结论:PMV干预能够改善脑损伤气管切开术后患者腭咽收缩功能和UES松弛后收缩功能,腭咽收缩压力峰值的增高与误吸情况的改善呈正相关。
Objective To investigate the effect of a Passy-Muir speaking valve(PMV)on the biomechanics of swallowing and on aspiration among persons tracheotomized after brain damage.Methods Twenty tracheotomized patients with aspiration after brain injury were selected and randomly divided into a non-PMV intervention group and a PMV intervention group,each of 10.Both groups were given routine swallowing training,while the PMV intervention group was additionally provided with a PMV and trained to use it.The treatment ended when the tracheal tube was removed or after 2 weeks.High-resolution manometry and videofluoroscopy were used to evaluate the maximum pressure in the velopharynx(VP-Max),the maximum post-deglutitive upper esophageal sphincter(UES)pressure(UES-Max)and Rosenbek penetration aspiration(PAS)scores for both groups before and after the treatment.Results Before the treatment there was no significant difference between the two groups in terms of average VP-Max,UES-Max or PAS score.After the treatment,the average VP-Max and UES-Max had increased significantly in both groups,and the average PAS score of the PMV intervention group had decreased significantly.There was a significant positive correlation between the increases in VP-Max and the decrease in PAS scores.Conclusion Inserting a PMV can improve velopharynx contraction and post-deglutitive UES among persons tracheotomized after a brain injury.The increase in maximum velopharynx pressure is positively correlated with decreases in aspiration.
作者
韩晓晓
张可
杨清露
孟占鳌
窦祖林
张耀文
Han Xiaoxiao;Zhang Ke;Yang Qinglu;Meng Zhanao;Dou Zulin;Zhang Yaoiven(The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;The Affiliated Bao'an Hospital of Southern Medical University Shenzhen 518101,China;The Eighth Affiliated Hospital of Sun Yat-sen University,Shenzhen 518033,China)
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2020年第1期24-28,共5页
Chinese Journal of Physical Medicine and Rehabilitation
基金
国家自然科学基金面上项目(81472153)。
