Anaesthesia and Intensive Care Unit Department, Jean Verdier University Hospital of Paris, Av du 14 Juillet, 93143 Bondy, France.
Br J Anaesth. 2012 Oct;109(4):578-83. doi: 10.1093/bja/aes210. Epub 2012 Jun 26.
Because recovery of an efficient swallowing reflex is a determining factor for the recovery of airway protective reflexes, we have studied the influence of the tracheostomy tube cuff pressure (CP) on the swallowing reflex in tracheotomized patients.
Twelve conscious adult intensive care unit (ICU) patients who had been weaned from mechanical ventilation were studied. Simultaneous EMG of the submental muscles with measurement of peak activity (EMGp) and amplitude of laryngeal acceleration (ALA) were performed during reflex swallows elicited by pharyngeal injection of distilled water boluses during end expiration. After cuff deflation, characteristics of the swallowing reflex (latency time: LaT, EMGp, and ALA) were measured at CPs of 5, 10, 15, 20, 25, 30, 40, 50, and 60 cm H(2)O.
LaT and CP were linearly related (P<0.01). CP was inversely correlated (P<0.01) to both ALA and EMGp.
We demonstrated that LaT, EMGp, and ALA of the swallowing reflex were influenced by tracheostomy tube CP. The swallowing reflex was progressively more difficult to elicit with increasing CP and when activated, the resulting motor swallowing activity and efficiency at elevating the larynx were depressed.
由于恢复有效的吞咽反射是恢复气道保护反射的决定因素，我们研究了气管造口管套囊压力（CP）对气管切开患者吞咽反射的影响。
研究了 12 名意识清醒的成人重症监护病房（ICU）患者，这些患者已从机械通气中脱机。在呼气末通过咽注水诱发反射性吞咽时，同时记录颏下肌的肌电图（EMGp）和声带加速度（ALA）的峰值活动（EMGp）。在放气套囊后，在 CP 为 5、10、15、20、25、30、40、50 和 60 cm H2O 时测量吞咽反射的特征（潜伏期时间：LaT、EMGp 和 ALA）。
LaT 与 CP 呈线性相关（P<0.01）。CP 与 ALA 和 EMGp 呈负相关（P<0.01）。
我们证明了吞咽反射的 LaT、EMGp 和 ALA 受气管造口管 CP 的影响。随着 CP 的增加，吞咽反射越来越难以诱发，而当被激活时，导致的运动性吞咽活动和提高声带的效率降低。
