高流量气道湿化结合进食训练对气管切开合并吞咽障碍患者误吸与残留的影响

Effects of high-flow airway humidification in patients with dysphagia after tracheotomy

目的探索高流量气道湿化对气管切开合并吞咽障碍患者的误吸与残留的影响。方法纳入中山大学附属第三医院康复医学科收治的气管切开伴吞咽障碍患者17例,在气管套管处配接高流量湿化仪并抽空气囊,对照条件为气管套管堵管、抽空气囊、充盈气囊的三种状态,在不同状态下给予患者5 ml中稠食物,使用喉镜吞咽功能评估(FEES)对残留和误吸情况进行评估。结果17例患者在高流量湿化、气管套管堵管、抽空气囊、充盈气囊四种状态下的渗漏-误吸评分和残留评分差异均有统计学意义(P<0.001)。配接高流量湿化仪时,17例患者的渗漏-误吸评分为(3.2±2.0)分,明显低于另三种状态下的渗漏-误吸评分[气管套管堵管(5.2±2.3)分、抽空气囊(5.6±2.3)分、充盈气囊(6.0±2.3)分],差异有统计学意义(P<0.001)。配接高流量湿化仪时,17例患者的残留评分为(2.8±1.1)分,亦明显低于另三种状态下的残留评分[气管套管堵管(3.8±1.2)分、抽空气囊(3.6±1.3)分、充盈气囊(3.9±1.4)分],差异亦有统计学意义(P<0.001)。结论配接高流量湿化仪可以有效改善气管切开患者的吞咽功能状态。

Objective To explore the effect of high-flow airway humidification on aspiration and residues in cases of dysphagia after a tracheotomy.Methods Seventeen persons with dysphagia after a tracheotomy were asked to swallow 5ml of a thick liquid when their tracheal cannula was either connected to a high-flow airway humidification system or blocked,or the cuff was empty or full.Endoscopic evaluation was then used to grade the residue and aspiration in the different conditions.Results There were significant differences in the residuals grading and aspiration among the four conditions.The average penetration-aspiration scale grade was significantly lower when the subject was connected to high-flow airway humidification than in the other three conditions.The grade of residuals was also significantly lower.Conclusion High-flow airway humidification can effectively improve the swallowing of persons with dysphagia after a tracheotomy.