Assessment of aspiration risk in stroke patients with quantification of voluntary cough
Assessment of aspiration risk in stroke patients with quantification of voluntary cough
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DOI：
10.1212/wnl.56.4.502
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发表时间：
2001-02-27
期刊：
影响因子：
9.9
通讯作者：
Bolser, DC
中科院分区：
文献类型：
--
作者：
Hammond, CAS;Goldstein, LB;Bolser, DC
背景：吞咽困难和随后的误吸是急性卒中的严重并发症，可能与咳嗽反射受损有关。假设与非卒中对照组和非吸入性卒中患者相比，吸入性卒中患者的自主咳嗽客观指标受损。研究方法：通过标准放射学或内窥镜方法评估吞咽，并根据吸入严重程度对卒中患者进行分组（重度，n = 11;轻度，n = 17;无吸入，n = 15）。对18例脑卒中患者和18例正常对照者进行了自主咳嗽气流模式和声压级（SPL）的测定。采用加拿大神经病学量表回顾性测定初始卒中严重程度。结果：相对于非卒中对照组，卒中患者的所有咳嗽指标均发生改变。单因素分析显示，吸气相峰值流量（770.6 +/- 80.6 vs 1，120.1 +/- 148.4 mL/s），SPL（90.0 +/- 3.1与100.2 +/- 1.6 dB），排出相的峰值流量（875.1 +/- 122.7 vs 1，884.1 +/- 221.6 mL/s），排出相上升时间与非抽吸器相比，重度抽吸器的患者咳嗽流速（0.34 +/-0.1 vs 0.09 +/- 0.01 s）和咳嗽量加速（5.5 +/- 1.3 vs 27.8 +/- 3.9 mL/s/s）显著受损。吸痰患者比不吸痰患者有更严重的卒中（平均加拿大神经功能量表评分7.7 +/- 0.7 vs 9.8 +/- 0.3）。多元逻辑回归分析发现，只有咳嗽时的呼气相上升时间值与吸入状态相关。结论：客观分析咳嗽可为脑卒中患者误吸风险的识别提供一种无创性的方法。
Background: Dysphagia and subsequent aspiration are serious complications of acute stroke that may be related to an impaired cough reflex. It was hypothesized that aspirating stroke patients would have impaired objective measures of voluntary cough as compared with both nonstroke control subjects and nonaspirating stroke patients. Methods: Swallowing was evaluated by standard radiologic or endoscopic methods, and stroke patients were grouped by aspiration severity (severe, n = 11; mild, n = 17; no aspiration, n = 15). Airflow patterns and sound pressure level (SPL) of voluntary cough were measured in stroke patients and in a group of normal control subjects (n 18). Initial stroke severity was determined retrospectively with the Canadian Neurological Scale. Results: All cough measures were altered in stroke patients as a group relative to nonstroke control subjects. Univariate analysis showed that peak flow of the inspiration phase (770.6 +/- 80.6 versus 1,120.1 +/- 148.4 mL/s), SPL (90.0 +/- 3.1 versus 100.2 +/- 1.6 dB), peak flow of the expulsive phase (875.1 +/- 122.7 versus 1,884.1 +/- 221.6 mL/s), expulsive phase rise time (0.34 +/- 0.1 versus 0.09 +/- 0.01 s), and cough volume acceleration (5.5 +/- 1.3 versus 27.8 +/- 3.9 mL/s/s) were significantly impaired in severe aspirators as compared with nonaspirators. Aspirating patients had more severe strokes than nonaspirators (mean Canadian Neurological Scale score 7.7 +/- 0.7 versus 9.8 +/- 0.3). Multivariate logistic regression found only expulsive phase rise time values during cough correlated with aspiration status. Conclusion: Objective analysis of cough may provide a noninvasive way to identify the aspiration risk of stroke patients.