获得性脑损伤气管切开患者上气道压力重塑对其吞咽功能的影响

Effects of remodeling pressure in upper airway on swallowing function of patients with tracheostomy after acquired brain damage

目的应用高分辨率固态测压技术动态监测脑损伤后行气管切开术患者佩戴吞咽-说话瓣膜对其吞咽功能的即时影响。方法共选取脑损伤后行气管切开术患者12例，分别在吞咽-说话瓣膜干预和非干预状态下吞咽5ml的300mg I／ml碘海醇溶液各3次。采用高分辨率固态测压系统采集患者咽部、食管上括约肌压力及时间参数，包括咽腔收缩压力峰值、咽腔收缩速率、咽腔收缩持续时间、上食管括约肌（UES）松弛残余压及UES松弛持续时间等。结果应用吞咽-说话瓣膜后，发现患者咽腔收缩压力峰值、咽腔收缩速率、咽腔收缩持续时间、UES松弛残余压及UES松弛持续时间均有变化，但发生的即时效应在佩戴吞咽-说话瓣膜前、后差异无统计学意义（P〉0．05）。结论吞咽-说话瓣膜的应用并不能即时明显改善脑损伤后气管切开状态患者的咽部及UES功能。

Objective To monitor the immediate effect of Passi-Muir speaking valve （PMV） on patients with tracheostomy after acquired brain damage. Methods Twelve patients with traeheostomy after acquired brain damage were recruited. All of them underwent the high resolution manometry to measure the pressure in pharynx and upper esophagus during swallowing before and immediately after wearing PMV. The parameters ineluding the pharyngeal peak pressure, increasing rate of the pharyngeal pressure, pharyngeal pressure du- ration, upper esophageal sphincter （UES） residual pressure and UES relaxation duration were recorded. Results No significant differences were found in all the measurements before and immediately after wearing PMV （ P〉0.05）. Conclusion PMV has no instant impact on the swallowing function of patients with trachcostomy after acquired brain damage.