Gallagher Julie
United Health Services, Physical Therapy and Rehabilitation, Inpatient Rehabilitation Facility, Binghamton General Hospital, Binghamton, NY.
Medicine (Baltimore). 2018 Aug;97(34):e11934. doi: 10.1097/MD.0000000000011934.
Pathophysiologic mechanisms of the central nervous system, such as stroke, can be associated with intractable hiccups. Intractable hiccups can be associated with potentially fatal consequences, thus requiring safe management in an inpatient rehabilitation facility (IRF) setting with a multidisciplinary team approach to optimize mobility and feeding.
A 49-year-old male presented to the emergency department with complaints of vomiting and dizziness.
Head computed tomography revealed moderate acute inferior cerebellar infarct in the territory of the posterior inferior cerebellar artery. He required a percutaneous endoscopic gastrostomy tube for feeding and developed severe intractable hiccups which he rated 7/10 on the hiccup assessment instrument (HAI) on IRF admission. Functional independence measure (FIM) score for transfers was 2 (maximum assist), walking was 1 (total assist), stairs were not attempted on IRF admit due to safety concerns, and feeding (eating) was 1 (total assist).
Anterior and posterior diaphragm kinesio taping was applied on day 6 of IRF physical therapy in an attempt to inhibit diaphragm spasm and intractable hiccups given that pharmacologic interventions had not been effective up to that point (Table 3).
The HAI decreased from 7/10 on day 6 of IRF physical therapy to 0/10 on day 8. The taping was reapplied every 3 to 5 days. On IRF day 9, his diet was advanced to a regular consistency with extra moisture and thin liquids. On day 21, hiccup severity remained 0/10 on the HAI, while FIM score for transfers was 4 (minimal assist), walking was 4 (minimal assist), stairs was 4 (minimal assist), and feeding (eating) was 7 (independent).
Diaphragm kinesio taping is a very effective treatment at reducing hiccup severity in a patient after ischemic stroke, while at the same time reducing burden of care for caregivers per FIM score improvement and improving diet to that of regular consistency with extra moisture and thin liquids.
中枢神经系统的病理生理机制，如中风，可能与顽固性呃逆有关。顽固性呃逆可能会带来潜在的致命后果，因此需要在住院康复机构（IRF）中采用多学科团队方法进行安全管理，以优化活动能力和进食情况。
一名49岁男性因呕吐和头晕到急诊科就诊。
头部计算机断层扫描显示小脑后下动脉供血区域有中度急性小脑下梗死。他需要经皮内镜下胃造瘘管进食，并出现了严重的顽固性呃逆，在入住IRF时，他在呃逆评估工具（HAI）上的评分为7/10。入住IRF时，转移的功能独立性测量（FIM）评分为2（最大协助），行走评分为1（完全协助），由于安全问题未尝试上下楼梯，进食（吃饭）评分为1（完全协助）。
在IRF物理治疗的第6天应用前后膈肌肌内效贴，鉴于在此之前药物干预无效，试图抑制膈肌痉挛和顽固性呃逆（表3）。
HAI评分从IRF物理治疗第6天的7/10降至第8天的0/10。每3至5天重新贴一次。在IRF第9天，他的饮食改为正常质地，增加水分和稀液体。在第21天，HAI上呃逆严重程度仍为0/10，而转移的FIM评分为4（最小协助），行走评分为4（最小协助），上下楼梯评分为4（最小协助），进食（吃饭）评分为7（独立）。
膈肌肌内效贴在降低缺血性中风患者呃逆严重程度方面是一种非常有效的治疗方法，同时根据FIM评分的改善减轻护理人员的护理负担，并将饮食改善为正常质地，增加水分和稀液体。
