改良气脉冲治疗脑卒中气管切开伴吞咽障碍患者的研究进展
赵潇潇 姜永梅 郭启程 王亚娟 周笑涵
大连医科大学附属第二医院，辽宁 大连 116000
通信作者：姜永梅
【摘要】 吞咽障碍是脑卒中患者最常伴有的并发症之一，且吞咽障碍会增加不良预后和病死率。脑卒中伴吞咽障碍不仅影响患者吞咽安全，还会增加吸入性肺炎的发生风险，以及由于无法经口进食而导致的营养不良而出现其他并发症的相关风险。重症脑卒中会因为各种原因并发不同程度的呼吸功能障碍及吞咽障碍，当吞咽障碍较严重且气道保护不充分或需要长期通气时，则需进行气管切开术。但气管切开会使吞咽时无法形成声门下压力、口咽部敏感度降低，这在一定程度上加重患者原有的吞咽功能障碍。及时改善脑卒中气管切开患者吞咽功能对于帮助患者预防相关并发症的发生、发展尤为重要。但目前国内外针对脑卒中伴吞咽障碍的气管切开患者吞咽障碍治疗还缺乏特异性的针对手段。在临床工作中，对改善脑卒中气管切开患者吞咽障碍进行研究发现，喉部感觉减退是导致患者吞咽反射延迟及咳嗽反射不敏感的重要原因之一。改良气脉冲是一种将气流运送到咽喉的特殊装置，可使气脉冲反复刺激吞咽反射相关感受区，应用于喉部结构的气脉冲刺激可以直接作用于外周感觉传入系统，间接作用于喉部运动和感觉的大脑皮层及相关区域。本文主要探讨改良气脉冲改善由于喉部感觉减退造成的吞咽障碍的可行性。
【关键词】 脑卒中；气管切开；吞咽障碍；改良气脉冲
【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1673-5110 （2022） 07-0920-05
基金项目：中国卒中学会脑血管病全程管理项目启航基金（编号：2020017）
DOI：10.12083/SYSJ.220431
Research progress of modified air-pulse therapy for stroke patients with tracheotomy and dysphagia
ZHAO Xiaoxiao，JIANG Yongmei，GUO Qicheng，WANG Yajuan，ZHOU Xiaohan
The Second Hospitai of Dalian Medical University，Dalian 116000，China
Corresponding author：JIANG Yongmei
【Abstract】 prognosis and mortality. Stroke with dysphagia not only affects safe swallowing Dysphagia is one of the most common complications of stroke and is associated with poor ，but also increases the risk of aspiration pneumonia and other complications associated with malnutrition due to the inability to eat through the mouth. Severe stroke can be complicated by respiratory dysfunction and dysphagia to varying degrees for various reasons. When dysphagia is more serious and the airway protection is inadequate or long-term ventilation is required，tracheotomy is needed. However，tracheotomy can not form subglottic pressure during swallowing and reduce oropharyngeal sensitivity，which aggravates the original dysphagia to a certain extent. Timely improvement of swallowing function in stroke patients with tracheotomy is particularly important to help patients prevent the occurrence and development of related complications. However，there is still a lack of specific treatment for dysphagia in stroke patients with tracheotomy at home and abroad. In clinical work，we studied the improvement of dysphagia in stroke patients with tracheotomy，and found that laryngeal hypoesthesia is one of the important reasons leading to delayed swallowing reflex and insensitive cough reflex. Modified air-pulse is a special device for transporting air to the larynx，which can make the air pulse repeatedly stimulate the relevant sensory area of swallowing reflex. The air pulse stimulation applied to larynx structure can directly act on the peripheral sensory afferent system，and indirectly act on the cerebral cortex and related areas of larynx movement and sensation. This paper mainly discusses the feasibility of improving swallowing disorders caused by laryngeal hypoesthesia with modified air-pulse.
【Key words】Stroke；Tracheotomy；Dysphagia；Modified；Air-pules
