Donzelli Joseph, Brady Susan, Wesling Michele, Theisen Melissa
Otolaryngology, Head & Neck Surgery, Ltd., Naperville, Illinois, USA.
Dysphagia. 2005 Fall;20(4):283-9. doi: 10.1007/s00455-005-0027-8.
This study investigated the effects, if any, that the presence of a tracheotomy tube has on the incidence of laryngeal penetration and aspiration in patients with a known or suspected dysphagia. This was a prospective, repeated-measure design study. A total of 37 consecutive patients with a tracheotomy tube underwent a fiberoptic endoscopic evaluation of swallowing (FEES). Patients were first provided with pureed food boluses with the tracheotomy tube in place. The tracheotomy tube was then removed and the tracheostoma site was covered with gauze and gentle hand pressure was applied. The patients were then evaluated without the tracheotomy tube in place with additional puree. Aspiration status was in agreement with and without the tracheotomy tube in place in 95% (35/37) of the patients. The two patients who demonstrated a different swallowing pattern with regard to aspiration demonstrated aspiration only when the tracheotomy tube was removed. Laryngeal penetration status was in agreement with and without the tracheotomy tube in place in 78% (29/37) of the patients. For the majority of the patients, the removal of the tracheotomy tube made no difference in the incidence of aspiration and/or laryngeal penetration. Results of this study do not support the clinical notion that the patient's swallowing function will improve once the tracheotomy tube has been removed.
本研究调查了气管切开管的存在对已知或疑似吞咽困难患者喉穿透和误吸发生率的影响（如有）。这是一项前瞻性重复测量设计研究。共有37例连续的气管切开管患者接受了纤维内镜吞咽评估（FEES）。首先在气管切开管在位的情况下为患者提供泥状食物团。然后移除气管切开管，用纱布覆盖气管造口部位并轻轻施加手部压力。然后在气管切开管不在位的情况下用额外的泥状食物对患者进行评估。95%（35/37）的患者在气管切开管在位和不在位时误吸状态一致。在误吸方面表现出不同吞咽模式的两名患者仅在气管切开管移除时出现误吸。78%（29/37）的患者在气管切开管在位和不在位时喉穿透状态一致。对于大多数患者而言，气管切开管的移除对误吸和/或喉穿透的发生率没有影响。本研究结果不支持一旦移除气管切开管患者吞咽功能就会改善这一临床观点。
