哮喘联盟

   摘要
   背景：卒中后吞咽困难患者罹患肺炎将带来严重的健康问题和治疗费用。静默性误吸会导致肺炎和死亡增加。本项随机、对照试验的目的是评价应用咳嗽反射试验(CRT)降低急性卒中患者肺炎发生的作用。
   方法：所有患者根据吞咽评估分为两组：1）接受标准评估的对照组和2）接受标准评估+CRT的实验组。实验组患者吸入雾化柠檬酸，检查结果供临床参考。以测试3个月后肺炎发病率和其他吞咽管理的临床指标来评价两组的结局。
   结果：数据分析显示，两组肺炎发生率(P = 0.38)或死亡率(P = 0.15)没有显著性差异。CRT结果影响饮食推荐(P < 0.0001)和转为仪器评估(P < 0.0001)。
   结论：尽管组间临床管理有所不同，但均没有达到降低卒中后吞咽困难患者肺炎发生率的目的。

 

（林江涛 审校）
J Clin Med Res. 2013 Jun;5(3):222-33. doi: 10.4021/jocmr1340w. Epub 2013 Apr 23.


 

Cough reflex testing in Dysphagia following stroke: a randomized controlled trial.

Miles A, Zeng IS, McLauchlan H, Huckabee ML.

Abstract
BACKGROUND: Significant health issues and service delivery costs are associated with post-stroke pneumonia related to dysphagia. Silent aspiration is known to increase pneumonia and mortality in this population. The utility of cough reflex testing (CRT) for reducing pneumonia in acute stroke patients was the subject of this randomised, controlled trial.
METHODS: Patients referred for swallowing evaluation (N = 311) were assigned to either 1) a control group receiving standard evaluation or 2) an experimental group receiving standard evaluation with CRT.Participants in the experimental group were administered nebulised citric acid with test results contributing to clinical decisions. Outcomes for both groups were measured by pneumonia rates at 3 months post evaluation and other clinical indices of swallowing management.
RESULTS: Analysis of the data identified no significant differences between groups in pneumonia rate (P = 0.38) or mortality (P = 0.15). Results of CRT were shown to influence diet recommendations (P < 0.0001) and referrals for instrumental assessment (P < 0.0001).
CONCLUSIONS: Despite differences in clinical management between groups, the end goal of reducing pneumonia in post stroke dysphagia was not achieved.

J Clin Med Res. 2013 Jun;5(3):222-33. doi: 10.4021/jocmr1340w. Epub 2013 Apr 23.