Chellini E, Magni C, Lavorini F, Rucci L, Fontana G A
Department of Internal Medicine, Section of Immunoallergology, Respiratory Medicine and Cell Therapy, University of Florence, Florence, Italy.
Bratisl Lek Listy. 2011;112(3):115-9.
Aspiration and respiratory tract infections are commonly observed in patients following conservative laryngeal surgery such as supracricoid laryngectomy with cricohyoidopexy (CHP). Since laryngeal closure is important for cough effectiveness, we hypothesised that CHP reduced cough intensity by affecting the cough motor pattern.
In ten male patients with laryngeal cancer eligible for CHP, we assessed the intensity of maximum voluntary cough (MVC) prior to and 2 months after surgery. Cough intensity was indexed in terms of both the peak amplitude of the integrated electromyographic activity of abdominal muscles (IEMGp) and the ratio of IEMGp to the duration of the expiratory ramp during cough (TEC), i.e. the rate of rise of IEMG activity (IEMGp/ TEC). For each cough effort, the duration of the compressive phase (CP), the cough peak flow (CPF), the time elapsed from the onset of cough to CPF (TTP) and their ratio, i.e. the volume acceleration (VA), were also evaluated.
CHP did not affect IEMG-related variables; in contrast, it reduced (p < 0.01) CPF, CP and lengthened (p < 0.05) TTP values. In consequence, cough VA values after CHP were consistently lower than in control condition.
Supracricoid laryngectomy with CHP alters the intensity of voluntary cough as indexed by flow-related variables. This may reduce cough efficiency and facilitate the onset and/or persistence of chest infections (Tab. 2, Fig. 1, Ref. 22).
在诸如环状软骨上喉切除术联合环舌骨固定术（CHP）等保守性喉部手术后，患者中常观察到误吸和呼吸道感染。由于喉部闭合对咳嗽有效性很重要，我们推测CHP通过影响咳嗽运动模式降低了咳嗽强度。
在10名符合CHP手术条件的男性喉癌患者中，我们评估了手术前和术后2个月的最大自主咳嗽（MVC）强度。咳嗽强度通过腹部肌肉综合肌电图活动的峰值幅度（IEMGp）以及咳嗽期间IEMGp与呼气斜坡持续时间的比值（TEC）来衡量，即IEMG活动的上升速率（IEMGp/TEC）。对于每次咳嗽努力，还评估了压缩期（CP）的持续时间、咳嗽峰值流量（CPF）、从咳嗽开始到CPF的时间（TTP）及其比值，即容积加速度（VA）。
CHP不影响与IEMG相关的变量；相反，它降低了（p<0.01）CPF、CP，并延长了（p<0.05）TTP值。因此，CHP后的咳嗽VA值始终低于对照条件下的值。
环状软骨上喉切除术联合CHP改变了由流量相关变量所衡量的自主咳嗽强度。这可能会降低咳嗽效率，并促进胸部感染的发生和/或持续存在（表2，图1，参考文献22）。
