Addington W R, Stephens R E, Gilliland K, Rodriguez M
Brevard Rehabilitation Medicine, Melbourne, FL, USA.
Arch Phys Med Rehabil. 1999 Feb;80(2):150-4. doi: 10.1016/s0003-9993(99)90112-0.
To determine the effectiveness of a new reflex cough test, using nebulized tartaric acid, in the evaluation of the laryngeal cough reflex and the development of aspiration pneumonia.
In this two-phase study, the cough test assessed the cough reflex in 161 stroke subjects. Phase 1 was a double-blinded prospective study of 40 subjects scheduled to have both modified barium swallow and the reflex cough test. Phase 1 subjects with an abnormal cough test showed an increased pneumonia incidence, and therefore, phase 2 was not blinded. In phase 2, 121 subjects were evaluated using the cough test; 38 received a modified barium swallow. Test results were compared using the Fisher exact test.
A total of 131 subjects from both phases had a normal reflex cough test; none developed pneumonia (p < .01). Thirty subjects from both phases had abnormal reflex cough test results; 5 developed pneumonia. Modified barium swallow findings did not reliably indicate the risk for developing pneumonia. Specificity of a normal reflex cough test was 100%.
The reflex cough test reliably evaluated the laryngeal cough reflex and the associated risk of developing aspiration pneumonia in stroke patients. Testing the laryngeal cough reflex may significantly reduce morbidity, mortality, and costs in stroke patients.
确定使用雾化酒石酸的新型反射性咳嗽试验在评估喉咳嗽反射及误吸性肺炎发生方面的有效性。
在这项两阶段研究中，咳嗽试验评估了161名中风患者的咳嗽反射。第一阶段是对40名计划同时进行改良钡餐吞咽检查和反射性咳嗽试验的患者进行的双盲前瞻性研究。第一阶段咳嗽试验异常的患者肺炎发病率增加，因此，第二阶段未设盲。在第二阶段，使用咳嗽试验对121名患者进行评估；38名患者接受了改良钡餐吞咽检查。使用Fisher精确检验比较试验结果。
两个阶段共有131名患者反射性咳嗽试验正常；均未发生肺炎（p <.01）。两个阶段共有30名患者反射性咳嗽试验结果异常；5名发生了肺炎。改良钡餐吞咽检查结果不能可靠地表明发生肺炎的风险。正常反射性咳嗽试验的特异性为100%。
反射性咳嗽试验可靠地评估了中风患者的喉咳嗽反射及发生误吸性肺炎的相关风险。检测喉咳嗽反射可能会显著降低中风患者的发病率、死亡率和费用。
