Nakajoh K, Nakagawa T, Sekizawa K, Matsui T, Arai H, Sasaki H
Department of Geriatric Medicine, Tohoku University School of Medicine, Sendai, Japan.
J Intern Med. 2000 Jan;247(1):39-42. doi: 10.1046/j.1365-2796.2000.00565.x.
Although attenuated protective reflexes have been implicated in the development of aspiration pneumonia, the relation between the incidence of pneumonia and the state of these reflexes has not been investigated. Furthermore, the role of feeding tube placement in preventing pneumonia in patients with attenuated protective reflexes is unknown. We studied the relationship between the incidence of pneumonia and the state of cough and swallowing reflexes in post-stroke patients with oral or tube feeding.
The incidence of pneumonia was prospectively analysed for 1 year in three groups of post-stroke patients on the basis of the following clinical conditions: oral feeding without dysphagia (n = 43); oral feeding with dysphagia (n = 48); and nasogastric tube feeding with dysphagia (n = 52). We also studied the incidence of pneumonia in bedridden patients with nasogastric tube feeding (n = 14). Before the start of the study, the swallowing and cough reflexes of each patient were measured. The swallowing reflex was evaluated according to latency of response, which was timed from the injection of 1 mL of distilled water into the pharynx through a nasal catheter to the onset of swallowing. The cough threshold of citric acid aerosols was defined as the concentration at which the patient coughed five times. RESULTS.;: The incidence of pneumonia was observed in patients having both a latency of response longer than 5 s and a cough threshold for citric acid higher than a concentration of 1.35 (log mg mL-1). The incidence of pneumonia was significantly higher in patients with oral feeding than in those with tube feeding (54.3 vs. 13.2%, P < 0.001). In bedridden patients with tube feeding, the latency of response was longer than 20 s and no patient coughed at the highest concentration of citric acid. The incidence of pneumonia was 64.3% in such patients.
The state of protective reflexes had a significant relation to the incidence of pneumonia. Feeding tube placement may have a beneficial role in preventing aspiration pneumonia in mildly or moderately disabled post-stroke patients with attenuated protective reflexes. Bedridden patients who were tube-fed had the highest incidence of pneumonia.
尽管保护性反射减弱被认为与吸入性肺炎的发生有关，但肺炎发病率与这些反射状态之间的关系尚未得到研究。此外，饲管放置在预防保护性反射减弱患者肺炎方面的作用尚不清楚。我们研究了脑卒中后经口进食或管饲患者的肺炎发病率与咳嗽和吞咽反射状态之间的关系。
根据以下临床情况，对三组脑卒中后患者的肺炎发病率进行了为期1年的前瞻性分析：无吞咽困难的经口进食（n = 43）；有吞咽困难的经口进食（n = 48）；有吞咽困难的鼻饲（n = 52）。我们还研究了卧床鼻饲患者（n = 14）的肺炎发病率。在研究开始前，测量了每位患者的吞咽和咳嗽反射。吞咽反射根据反应潜伏期进行评估，即从通过鼻导管向咽部注入1 mL蒸馏水到开始吞咽的时间。柠檬酸气雾剂的咳嗽阈值定义为患者咳嗽5次时的浓度。结果：在反应潜伏期超过5秒且柠檬酸咳嗽阈值高于1.35（log mg mL-1）浓度的患者中观察到肺炎发病率。经口进食患者的肺炎发病率显著高于管饲患者（54.3%对13.2%，P < 0.001）。在卧床管饲患者中，反应潜伏期超过20秒，且在最高柠檬酸浓度下无患者咳嗽。此类患者的肺炎发病率为64.3%。
保护性反射状态与肺炎发病率有显著关系。饲管放置在预防保护性反射减弱的轻度或中度残疾脑卒中后患者的吸入性肺炎方面可能具有有益作用。卧床管饲患者的肺炎发病率最高。
