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小儿重症监护病房中使用东莨菪碱治疗流涎:病例系列报告

Treatment of drooling with scopolamine in pediatric ICU: A case series report.

作者信息

Franco Juliana Bertoldi, Cacita Nadia, Freua Karina Albuquerque, Ortega Karem López, de Melo Peres Maria Paula Siqueira

机构信息

Hospital Auxiliar de Suzano, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, Brazil.

Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil.

出版信息

Spec Care Dentist. 2018 Nov;38(6):362-366. doi: 10.1111/scd.12326. Epub 2018 Sep 20.

Abstract

Drooling is a condition that affects patients with difficulties in swallowing, being common in patients with mental, neurological or dysphagic deficiency. This condition is difficult to diagnose, as it is often confused with sialorrhea, and in many cases we have a hyposalivation scenario. Its diagnosis is subjective, which is why scales should be used for the standardization of the evaluation of the degree of drooling before and after the proposed treatment, as the Thomas-Stonell and Greenberg scale. It causes problems such as perioral infections, rashes, wet clothing, leading to social embarrassment, and may be a risk factor for respiratory infections caused by asymptomatic aspiration of saliva. It presents several treatments, among them the pharmacological one, that is dependent of the clinical picture of each patient that must be evaluated daily. This article refers to a series of reports of cases of children in mechanical ventilation by tracheostomy, hospitalized, with clinical diagnosis of drooling, and clinical improvement with the use of scopolamine by gastrostomy, without intercurrences during its use. The objective of this study is to show other professionals the importance of drooling management, and to expose the adopted behavior in the described cases, providing reduction of respiratory infections and improvement of the clinical and social complications resulting from drooling.

摘要

流口水是一种影响吞咽困难患者的病症,在患有精神、神经或吞咽障碍缺陷的患者中很常见。这种病症难以诊断,因为它常与唾液分泌过多相混淆,而且在许多情况下我们面对的是唾液分泌过少的情况。其诊断具有主观性,这就是为什么应该使用量表来标准化所提议治疗前后流口水程度的评估,比如托马斯 - 斯托内尔量表和格林伯格量表。它会引发诸如口周感染、皮疹、衣物潮湿等问题,导致社交尴尬,并且可能是因唾液无症状误吸引起呼吸道感染的一个风险因素。它有多种治疗方法,其中药物治疗取决于每位患者的临床症状,必须每日进行评估。本文涉及一系列经气管切开术进行机械通气的住院儿童病例报告,这些儿童临床诊断为流口水,通过胃造口使用东莨菪碱后临床症状改善,且使用过程中无并发症。本研究的目的是向其他专业人员展示流口水管理的重要性,并揭示所描述病例中所采取的行为,减少呼吸道感染,改善因流口水导致的临床和社会并发症。

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