帕金森患者连续性自发咳嗽和误吸及误吸风险的相关性
2014/07/15
摘要
背景：帕金森（PD）患者通常存在不同程度的吞咽障碍或吞咽困难，可导致吞咽过程中误吸或大大增加误吸风险，从而导致该类患者主要致死原因――吸入性肺炎的发生率增加。有效的气道保护措施有多种，其中包括咳嗽和吞咽。帕金森患者及吞咽困难患者通常存在单独自主咳嗽障碍。但是，人体对气道内误吸物的生理反应远不止一次咳嗽或连续多次咳嗽。本研究旨在评估伴或不伴吞咽困难的PD患者连续性自主咳嗽的功能。
方法：我们在40例诊断为特发性PD患者中进行2项连续性咳嗽试验。通过呼吸气流流速计及面罩检测患者咳嗽产生的气流，随后将测试结果数字化并保存。所有参加临床试验的患者进行改良后钡餐吞咽检查，将此作为临床护理的一部分。将得到的渗透－误吸量表得分最低值作为是否患有吞咽困难的评判标准。
结果：伴吞咽困难与不伴吞咽困难的PD患者连续咳嗽产生的呼气压缩时间、最大呼气流速、呼气量等指标均存在显著差异。
结论：吞咽困难PD患者通常伴有咳嗽功能障碍。连续性咳嗽功能对于清除大气道/小气道误吸物非常重要。相比不伴吞咽困难患者，伴吞咽困难的PD患者连续性咳嗽功能受损。某些与咳嗽和吞咽功能相关的神经基质可能在PD患者中受损，从而导致PD患者同时存在上述两种功能障碍。
（刘国梁 审校）
Lung. 2014 May 3. [Epub ahead of print]
Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson's Disease.
Hegland KW1, Okun MS, Troche MS.
ABSTRACT
BACKGROUND: Disordered swallowing, or dysphagia, is almost always present to some degree in people with Parkinson's disease (PD), either causing aspiration or greatly increasing the risk for aspiration during swallowing. This likely contributes to aspiration pneumonia, a leading cause of death in this patient population. Effective airway protection is dependent upon multiple behaviors, including cough and swallowing. Single voluntary cough function is disordered in people with PD and dysphagia. However, the appropriate response to aspirate material is more than one cough, or sequential cough. The goal of this study was to examine voluntary sequential coughing in people with PD, with and without dysphagia.
METHODS: Forty adults diagnosed with idiopathic PD produced two trials of sequential voluntary cough. The cough airflows were obtained using pneumotachograph and facemask and subsequently digitized and recorded. All participants received a modified barium swallow study as part of their clinical care, and the worst penetration-aspiration score observed was used to determine whether the patient had dysphagia.
RESULTS: There were significant differences in the compression phase duration, peak expiratory flow rates, and amount of air expired of the sequential cough produced by participants with and without dysphagia.
CONCLUSIONS: The presence of dysphagia in people with PD is associated with disordered cough function. Sequential cough, which is important in removing aspirate material from large- and smaller-diameter airways, is also impaired in people with PD and dysphagia compared with those without dysphagia. There may be common neuroanatomical substrates for cough and swallowing impairment in PD leading to the co-occurrence of these dysfunctions.
Lung. 2014 May 3. [Epub ahead of print]
