Addington W R, Stephens R E, Gilliland K A
Brevard Rehabilitation Medicine, HealthSouth Sea Pines Rehabilitation Hospital, Melbourne, FL, USA.
Stroke. 1999 Jun;30(6):1203-7. doi: 10.1161/01.str.30.6.1203.
We sought to evaluate the efficacy of testing the laryngeal cough reflex in identifying pneumonia risk in acute stroke patients.
We performed a prospective study of 400 consecutive acute stroke patients examined using the reflex cough test (RCT) compared with 204 consecutive acute stroke patients from a sister facility examined without using the RCT. The binary end point for the study outcome was the development of pneumonia.
Of the 400 patients examined with the RCT, 5 developed pneumonia. Of the 204 patients examined without the RCT, 27 developed pneumonia (P<0.001). Three of the 27 patients died in the rehabilitation hospital of respiratory failure secondary to pneumonia. Seven others were transferred to the emergency department with acute respiratory distress. Power analysis for this comparison was 0.99. There were no other significant differences between the 2 groups.
A normal RCT after an acute stroke indicates a neurologically intact laryngeal cough reflex, a protected airway, and a low risk for developing aspiration pneumonia with oral feeding. An abnormal RCT indicates risk of an unprotected airway and an increased incidence of aspiration pneumonia. Alternate feeding strategies and preventive measures are necessary with an abnormal RCT. Clinical treatment algorithm and prescription of food, fluids, and medications are discussed on the basis of RCT results.
我们旨在评估检测喉咳嗽反射在识别急性卒中患者肺炎风险方面的有效性。
我们对400例连续的急性卒中患者进行了前瞻性研究，这些患者接受了反射性咳嗽试验（RCT），并与来自姐妹机构的204例连续急性卒中患者进行了比较，后者未进行RCT检查。研究结果的二元终点是肺炎的发生。
在接受RCT检查的400例患者中，5例发生了肺炎。在未进行RCT检查的204例患者中，27例发生了肺炎（P<0.001）。27例患者中有3例在康复医院死于肺炎继发的呼吸衰竭。另外7例因急性呼吸窘迫被转至急诊科。该比较的效能分析为0.99。两组之间无其他显著差异。
急性卒中后RCT正常表明喉咳嗽反射神经功能完整、气道受保护且经口进食时发生误吸性肺炎的风险较低。RCT异常表明气道无保护风险及误吸性肺炎发病率增加。RCT异常时需要采取替代喂养策略和预防措施。根据RCT结果讨论了临床治疗方案以及食物、液体和药物的处方。
