哮喘联盟

   摘要
   目的：此研究的目的是从咳嗽反射---一个重要的气道保护机制方面去评估冠状动脉旁路移植术(CABG)后插管的效果。
   材料：86例参与研究的CABG患者（70例为男性）在插管前接受咳嗽反射试验（CRT）从而建立反射性咳嗽的基线阈值。咳嗽反射试验在拔管的2小时内、每天早晨以及夜晚重复进行直至参与研究的患者咳嗽恢复至基线水平，退出研究或者出院。
   结果：60%的受试者在CRT2(x = 70 分钟)时没有咳嗽出现。受试者从咳嗽反射中恢复的时间各异。在CRT6时，仅余3例受试者无咳嗽出现。年龄、性别或插管的深度对咳嗽反射恢复的时间并无明显的影响(P > .3)。
   结论：CABG后的患者持续无咳嗽反射出现，这可能会影响患者在遇到激惹事件时气道清理的能力。这个结果对于我们更好地理解拔管后吞咽困难也是有帮助的。我们需要更多的研究去判断咳嗽反射是否会对更多重症监护治疗病房的拔管后患者产生影响以及CRT是否是检测这些患者静息激惹的一个有效工具。
 

（苏欣 审校）
J Crit Care. 2015 Aug;30(4):758-61. doi: 10.1016/j.jcrc.2015.03.013. Epub 2015 Mar 21.


 

Recovery of cough after extubation after coronary artery bypass grafting: A prospective study.
 

Kallesen M1, Psirides A2, Huckabee ML3.
 

Abstract
PURPOSE:This study aims to evaluate the effect of intubation for coronary artery bypass grafting (CABG) on the cough reflex, an important airway protection mechanism.
MATERIALS:Eighty-six participants (70 males) underwent cough reflex texting (CRT) before intubation for CABG to establish baseline threshold for reflexive cough. Cough reflex texting was repeated within 2 hours of extubation and every morning and evening thereafter until the participant coughed at baseline level, withdrew, or was discharged from hospital.
RESULTS:Sixty percent of participants had an absent cough reflex at CRT2 (x = 70 minutes). Participants varied in time to recovery of cough reflex. By CRT6, only 3 remaining participants persisted with an absentcough. Age, sex, or length of intubation had no significant impact on the time to recovery of cough reflex (P > .3).
CONCLUSIONS:Absent cough reflex persists after CABG and may impact patients' ability to clear their airway in the event of aspiration. These results could contribute to better understanding postextubation dysphagia. More research is needed to determine if cough reflex is affected in the wider intensive care unit population postextubation and if CRT is a valid tool for detecting silent aspiration in this population.
 

J Crit Care. 2015 Aug;30(4):758-61. doi: 10.1016/j.jcrc.2015.03.013. Epub 2015 Mar 21.