Smith Hammond C A, Goldstein L B, Zajac D J, Gray L, Davenport P W, Bolser D C
Duke University and Durham Veterans Affairs Medical, Durham, NC, USA.
Neurology. 2001 Feb 27;56(4):502-6. doi: 10.1212/wnl.56.4.502.
Dysphagia and subsequent aspiration are serious complications of acute stroke that may be related to an impaired cough reflex. It was hypothesized that aspirating stroke patients would have impaired objective measures of voluntary cough as compared with both nonstroke control subjects and nonaspirating stroke patients.
Swallowing was evaluated by standard radiologic or endoscopic methods, and stroke patients were grouped by aspiration severity (severe, n = 11; mild, n = 17; no aspiration, n = 15). Airflow patterns and sound pressure level (SPL) of voluntary cough were measured in stroke patients and in a group of normal control subjects (n = 18). Initial stroke severity was determined retrospectively with the Canadian Neurological Scale.
All cough measures were altered in stroke patients as a group relative to nonstroke control subjects. Univariate analysis showed that peak flow of the inspiration phase (770.6 +/- 80.6 versus 1,120.1 +/- 148.4 mL/s), SPL (90.0 +/- 3.1 versus 100.2 +/- 1.6 dB), peak flow of the expulsive phase (875.1 +/- 122.7 versus 1,884.1 +/- 221.6 mL/s), expulsive phase rise time (0.34 +/- 0.1 versus 0.09 +/- 0.01 s), and cough volume acceleration (5.5 +/- 1.3 versus 27.8 +/- 3.9 mL/s/s) were significantly impaired in severe aspirators as compared with nonaspirators. Aspirating patients had more severe strokes than nonaspirators (mean Canadian Neurological Scale score 7.7 +/- 0.7 versus 9.8 +/- 0.3). Multivariate logistic regression found only expulsive phase rise time values during cough correlated with aspiration status.
Objective analysis of cough may provide a noninvasive way to identify the aspiration risk of stroke patients.
吞咽困难及随后的误吸是急性卒中的严重并发症，可能与咳嗽反射受损有关。据推测，与非卒中对照受试者和无误吸的卒中患者相比，有误吸的卒中患者的自主咳嗽客观指标会受损。
采用标准放射学或内镜方法评估吞咽情况，将卒中患者按误吸严重程度分组（重度，n = 11；轻度，n = 17；无误吸，n = 15）。测量了卒中患者和一组正常对照受试者（n = 18）的自主咳嗽气流模式和声压级（SPL）。采用加拿大神经功能量表回顾性确定初始卒中严重程度。
与非卒中对照受试者相比，卒中患者作为一个整体，所有咳嗽指标均发生改变。单因素分析显示，重度误吸患者吸气相峰值流速（770.6±80.6对1,120.1±148.4 mL/s）、声压级（90.0±3.1对100.2±1.6 dB）、呼气相峰值流速（875.1±122.7对1,884.1±221.6 mL/s）、呼气相上升时间（0.34±0.1对0.09±0.01 s）和咳嗽容积加速度（5.5±1.3对27.8±3.9 mL/s/s）与无误吸患者相比显著受损。有误吸的患者比无误吸的患者卒中更严重（加拿大神经功能量表平均评分7.7±0.7对9.8±0.3）。多因素逻辑回归发现，咳嗽时仅呼气相上升时间值与误吸状态相关。
咳嗽客观分析可能为识别卒中患者误吸风险提供一种非侵入性方法。
