Department of Pharmacology and Clinical Pharmacology, ChungBuk National University Hospital, Cheongju, 28644, Republic of Korea.
Department of Physical Medicine and Rehabilitation, Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, 34943, Republic of Korea.
Dysphagia. 2018 Dec;33(6):857-865. doi: 10.1007/s00455-018-9920-9. Epub 2018 Jun 18.
We investigated the functional changes in swallowing and voluntary coughing before and after tracheostomy decannulation among stroke patients who had undergone a tracheostomy. We also compared these functions between stroke patients who underwent tracheostomy tube removal and those who did not within 6 months of their stroke. Seventy-seven stroke patients who had undergone a tracheostomy were enrolled. All patients were evaluated by videofluoroscopic swallowing studies and a peak flow meter through the oral cavity serially until 6 months after their stroke. During the intensive rehabilitation period, if a patient satisfied the criteria for tracheostomy tube removal, the tube was removed. The patients were divided into the 'decannulated' group and the 'non-decannulated' group according to their tracheostomy tube removal status. In the decannulated group, swallowing function did not change before and after tracheostomy decannulation; however, cough function was significantly improved after decannulation. Although both groups exhibited functional improvement in swallowing and coughing over time, the improvement in the decannulated group was more significant than the improvement in the non-decannulated group. Our results revealed that stroke patients who had better functional improvement in swallowing and coughing were more likely to be potential candidates for tracheostomy decannulation. Stroke patients who recovered from neurogenic dysphagia, they were no longer affected by the mechanical effect of the tracheostomy tube on swallowing function. This study suggests that if patients show improvement in swallowing and coughing after their stroke, a multidisciplinary approach to tracheostomy decannulation would be needed to achieve better rehabilitation outcomes.
我们研究了中风患者气管切开拔管前后吞咽和自主咳嗽功能的变化，并比较了在中风后 6 个月内进行气管切开管移除和未进行气管切开管移除的中风患者之间的这些功能。共纳入 77 例进行过气管切开术的中风患者。所有患者均通过视频透视吞咽研究和口腔峰值流量计进行连续评估，直至中风后 6 个月。在强化康复期间，如果患者符合气管切开管移除标准，则将其移除。根据患者气管切开管的移除情况，将患者分为“拔管”组和“未拔管”组。在拔管组中，气管切开拔管前后吞咽功能无变化，但拔管后咳嗽功能明显改善。尽管两组的吞咽和咳嗽功能随时间推移均有改善，但拔管组的改善程度明显大于未拔管组。我们的研究结果表明，吞咽和咳嗽功能改善较好的中风患者更有可能成为气管切开拔管的潜在候选者。中风患者恢复了神经源性吞咽困难，他们不再受到气管切开管对吞咽功能的机械影响。本研究表明，如果患者在中风后吞咽和咳嗽功能有所改善，可能需要多学科方法来进行气管切开管的移除，以实现更好的康复效果。
