Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Centro IRCCS Santa Maria Nascente, Milan. Italy.
Am J Phys Med Rehabil. 2012 Sep;91(9):783-8. doi: 10.1097/PHM.0b013e3182556701.
The aim of this study was to ascertain whether an objective cough measure relates to the risk of pulmonary complications in dysphagic patients with persistent tracheobronchial aspiration.
This is a retrospective observational study involving 55 dysphagic patients who underwent a modified barium swallow study and pulmonary function tests including cough peak flow measurement. The results were compared between subjects with and without pulmonary complications because of aspiration.
The 18 patients (33%) with pulmonary complications had significantly lower mean cough peak flow values (202.2 ± 68.8 vs. 303.9 ± 80.7 liters/min; P < 0.001) than those without pulmonary complications. The finding of tracheobronchial coating in a modified barium swallow was not related to the occurrence of pulmonary morbidity. Receiver operating characteristic curve analysis showed that a CPF level lower than 242 liters/min predicted the development of pulmonary complications with a sensitivity of 77% and a specificity of 83%; the positive and negative predictive values were 65% and 90%, respectively.
Our findings indicate that cough peak flow is a valuable predictor of respiratory prognosis in chronic aspiration. This finding suggests a new rehabilitation strategy aimed at improving cough flows for dysphagic patients.
本研究旨在确定客观咳嗽测量指标与持续性气管支气管吸入的吞咽困难患者发生肺部并发症的风险之间是否存在关联。
这是一项回顾性观察研究，共纳入 55 例吞咽困难患者，这些患者均接受改良钡剂吞咽研究和肺功能测试，包括咳嗽峰流速测量。将有和无因吸入导致肺部并发症的患者的结果进行比较。
18 例（33%）发生肺部并发症的患者的平均咳嗽峰流速值明显更低（202.2 ± 68.8 升/分钟比 303.9 ± 80.7 升/分钟；P < 0.001）。改良钡剂吞咽检查中发现气管支气管涂层与肺部发病率的发生无关。受试者工作特征曲线分析显示，CPF 水平低于 242 升/分钟可预测肺部并发症的发生，其敏感性为 77%，特异性为 83%；阳性和阴性预测值分别为 65%和 90%。
我们的研究结果表明，咳嗽峰流速是慢性吸入患者呼吸预后的一个有价值的预测指标。这一发现提示了一种新的康复策略，旨在改善吞咽困难患者的咳嗽流量。
