Hammond Carol A Smith, Goldstein Larry B
Chest. 2006 Jan;129(1 Suppl):154S-168S. doi: 10.1378/chest.129.1_suppl.154S.
Cough may be an indicator of aspiration due to oral-pharyngeal dysphagia.
Relevant literature was identified by searching the Communication Sciences and Disorders Dome, the Cumulative Index to Nursing and Allied Health Literature, the Educational Resource Information Center, Health & Psychosocial Instruments, the American Psychological Association, and the National Library of Medicine databases from 1965 to 2004 using the terms "deglutition," "aspiration," and "cough."
Aspiration was observed on radiologic evaluation in over one third of acute stroke patients and in >40% of patients undergoing cervical spine surgery. Cough while eating may indicate aspiration, but aspiration may be clinically silent. Subjective patient and caregiver reports of cough while eating are useful in identifying patients who are at risk for aspiration. Objective measures of voluntary cough and tussigenic challenges to inhaled irritants are under investigation to determine their capacity to predict the risk for aspiration and subsequent pneumonia. The treatment of dysphagic patients by a multidisciplinary team, including early evaluation by a speech-language pathologist, is associated with improved outcomes. Effective clinical interventions such as the use of compensatory swallowing strategies and the alteration of food consistencies can be based on the results of instrumental swallowing studies. The efficacy of swallowing exercises and electrical muscle stimulation is under study. Surgical interventions may be considered in selected patients, but studies proving efficacy are generally lacking.
Patients who are at risk for aspiration can be identified, and appropriate interventions can reduce its associated morbidity.
咳嗽可能是口咽吞咽困难所致误吸的一个指标。
通过检索1965年至2004年的沟通科学与障碍领域数据库、护理及相关健康文献累积索引、教育资源信息中心、健康与心理社会测量工具、美国心理学会以及国立医学图书馆数据库，使用“吞咽”“误吸”和“咳嗽”等术语来识别相关文献。
超过三分之一的急性中风患者以及超过40%的颈椎手术患者在影像学评估中观察到误吸。进食时咳嗽可能提示误吸，但误吸在临床上可能并无表现。患者及照料者关于进食时咳嗽的主观报告有助于识别有误吸风险的患者。目前正在研究对吸入性刺激物的自主咳嗽及致咳激发试验的客观测量方法，以确定其预测误吸及后续肺炎风险的能力。由多学科团队对吞咽困难患者进行治疗，包括由言语语言病理学家进行早期评估，与改善预后相关。诸如采用代偿性吞咽策略和改变食物质地等有效的临床干预措施可基于吞咽功能检查研究的结果。吞咽练习和电刺激肌肉疗法的疗效正在研究中。对于部分患者可考虑手术干预，但普遍缺乏证明其疗效的研究。
可识别有误吸风险的患者，且适当的干预措施可降低其相关发病率。
