说话瓣膜配合综合性吞咽康复在气管切开后患儿中的应用1例报道  

Application of Passy- Muir Valve Based on Comprehensive Swallowing Training for Child post Tracheotomy: A Case Report

作　　者：谢纯青[1] 温红梅[1] 万桂芳[1] 武惠香[1] 窦祖林[1] 

机构地区：[1]中山大学附属第三医院康复医学科,广东广州市510630

出　　处：《中国康复理论与实践》2015年第11期1315-1318,共4页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的探讨气管切开后咳嗽反射缺失并环咽肌失弛缓患者吞咽障碍的康复方法及效果。方法回顾1例小脑毛细胞型星形细胞瘤切除术后气管切开后吞咽障碍患儿。患儿无咳嗽反射,环咽肌完全不开放,误吸严重。予安装说话瓣膜,行呼吸训练、球囊扩张术、表面肌电生物反馈吞咽训练、吞咽手法训练及电刺激等康复。结果 7周后,患儿大口进食稀流质时发生误吸,有弱咳嗽反射,进食浓流质和糊状食物无误吸,环咽肌开放正常。于第11周拔除气管套管后拔除胃管,完全经口摄取足够营养。结论气管切开后并发严重误吸的吞咽障碍患者,可通过佩戴说话瓣膜和综合吞咽训练减少误吸,改善咳嗽反射,促进吞咽功能恢复。Objective To explore the rehabilitation for dysphagia in young patient after tracheotomy and cricopharyngeal achalasia with-out cough reflex. Methods A child was reviewed, who accepted tracheotomy after resection of cerebellar pilocytic astrocytoma for dyspha-gia. The features characterized as severe silent aspiration and failure of cricopharyngeus muscle relaxation. Therapies included Passy-Muir valve placement, breathing exercises, balloon dilatation, surface electromyography biofeedback, and electrical stimulation. Results The aspi-ration was observed when she drank thin liquid with weak cough reflex, and disappeared as eating thick liquid and paste food, with complete cricopharyngeus muscle opening, 7 weeks after treatment. She was removed the tracheotomy tube and nasal feeding tube 11 weeks after treatment, and got sufficient nutrition by fully oral intake. Conclusion The application of Passy-Muir valve and comprehensive swallowing training is helpful for patient post tracheotomy with silent aspiration in decreasing the risk of aspiration, improving cough reflex and prompt-ing swallowing function.

关 键 词：气管切开 吞咽障碍 环咽肌失弛缓 说话瓣膜 康复 

分 类 号：R767.92[医药卫生—耳鼻咽喉科]