脑卒中后吞咽障碍患者和健康志愿者咳嗽反射的比较  

Cough Reflex Induced with Citric Acid in Post-stroke Dysphagia Patients and Healthy Adults

作　　者：招少枫[1] 何怀[1] 窦祖林[2] 张涵君[1] 欧阳睿智 昝云强[1] 胡凤娟[1] 徐红星[1] 

机构地区：[1]苏州大学附属第一医院康复医学科,江苏苏州市215006 [2]中山大学附属第三医院康复医学科,广东广州市510630 [3]苏州市相城人民医院康复医学科,江苏苏州市215131

出　　处：《中国康复理论与实践》2015年第5期567-571,共5页Chinese Journal of Rehabilitation Theory and Practice

基　　金：江苏省临床医学科技专项(No.BL2014047)

摘　　要：目的评估脑卒中后吞咽障碍患者及正常人上气道咳嗽防御反射功能的差异。方法脑卒中患者根据洼田饮水试验结合吞咽造影检查,分为卒中后无吞咽障碍组(SND,n=20)和卒中后吞咽障碍组(SD,n=20);另选择正常人20名为对照组(NC)。所有受试者完成4种不同浓度柠檬酸(0.2 mol/L、0.4 mol/L、0.6 mol/L、0.8 mol/L)吸入,计算不同浓度下咳嗽反射通过率。结果与NC组相比,SD组吸入0.2 mol/L、0.4 mol/L柠檬酸通过率下降(P<0.05);与SND组相比,SD组吸入0.4 mol/L柠檬酸通过率下降(P<0.05)。SNC组通过率与NC组无显著性差异(P>0.05)。NC组90%通过0.4 mol/L柠檬酸试验;SD组0.2 mol/L、0.4 mol/L通过率无显著差异(P>0.05),均低于0.6 mol/L、0.8 mol/L通过率(P<0.05);SND组0.4 mol/L通过率为85%,高于0.2 mol/L通过率(P<0.05)。柠檬酸咳嗽反射试验的评价者间信度κ=0.97。同一浓度两次测试,一致率96.8%。受试者无哮喘、窒息等症状发生。结论中低浓度柠檬酸咳嗽反射试验可以评估脑卒中后吞咽障碍患者上气道的咳嗽保护能力,可以作为吞咽障碍呼吸道功能筛查指标之一。Objective To evaluate the application of cough reflex testing with various concentrations of citric acid for dysphagia post stroke. Methods 20 normal controls （NC）, 20 stroke patients with dysphagia （SD） and 20 stroke patients without dysphagia （SND） were test-ed with cough reflex inhalated 4 kinds of dosage of citric acid：0.2 mol/L, 0.4 mol/L, 0.6 mol/L and 0.8 mol/L. Results The incidence of pass （coughed twice or more） decreased in the SD compared with those in the NC as inhalated citric acid of 0.2 mol/L and 0.4 mol/L （P〈0.05）, and decreased under 0.4 mol/L compared with the SND （P〈0.05）. There was no significant difference between the SND and the NC （P〉0.05）. 90%of the NC passed as inhalated citric acid of 0.4 mol/L;however, it was 45%in the SD, and increased when they inhalated more dosage of citric acid （P〈0.05）. The incidence of pass decreased under 0.2 mol/L citric acid in the SND compared with other concentra-tion （P〈0.05）. The result of the test was reliable interrater （κ=0.97）. The incidence of cough was consistent of 96.8%with the same concen-tration. No asthma and asphyxia was observed. Conclusion Cough reflex testing with citric acid inhalation can be used to assess the defen-sive function of airway in lower concentration for dysphagia after stroke.

关 键 词：脑卒中 吞咽障碍 咳嗽反射 柠檬酸 

分 类 号：R743.3[医药卫生—神经病学与精神病学]