果綠染色試驗在評價腦卒中后氣管切開并吞咽障礙患者滲漏和誤吸的臨床應用價值

樊留博 韓文勝 張露丁 羅咪咪 劉寶華

[關鍵詞] 氣管切開;吞咽障礙;腦卒中;果綠染色;滲漏;誤吸

[中圖分類號] R74? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）25-0098-04

The clinical application value of fruit green staining test in the evaluation of leakage and aspiration in the patients undergoing tracheotomy and dysphagia after stroke

FAN Liubo1? ?HAN Wensheng1? ?ZHANG Luding1? ?LUO Mimi1? ?LIU Baohua2

1.Taizhou Hospital of Zhejiang Province， Shaoxing University， Taizhou? ?317000， China; 2.The Second Affiliated Hospital of Wenzhou Medical University， Wenzhou? ?325035， China

[Abstract] Objective To explore the clinical application value of fruit green staining test in the evaluation of leakage and aspiration in the patients undergoing tracheotomy and dysphagia after stroke. Methods From January 2018 to June 2019， 46 patients with stroke who underwent difficulty in being unable to pull out the cannula and dysphagia after tracheotomy were selected. They were hospitalized in Taizhou Hospital of Zhejiang Province and the Second Affiliated Hospital of Wenzhou Medical University. Fruit green staining test and pharyngeal dynamic contrast test were carried out respectively. The difference in aspiration detection rate was compared between the two tests. At the same time， the occurrence of aspiration after eating different doses and shapes of food was observed. Results There was no statistically significant difference between the fruit green staining test and the pharyngeal dynamic contrast test in the incidence of mild leakage， severe leakage and aspiration （P>0.05）. In the patients with leakage and aspiration， the incidence of aspiration increases as the viscosity of food increases. The aspiration rate of swallowing 10 mL of food was higher than that of 3 mL， and the difference was statistically significant （P<0.05）. Conclusion The fruit green staining test can detect occult aspiration in the patients undergoing tracheotomy and dysphagia after stroke， and effectively improve the detection rate of aspiration. The method is objective， simple， and effective. The batter-like diet and the reduction of a mouthful amount can help patients reduce the occurrence of aspiration.

[Key words] Tracheotomy; Dysphagia; Stroke; Fruit green staining; Leakage; Aspiration

急性腦卒中患者并發吞咽障礙的發生率為22%～65%，由于腦卒中患者的機體防御能力下降，咳嗽反射減弱，呼吸道清除機制異常，支氣管管壁彈性降低等原因常會導致誤吸，發展至吸入性肺炎，甚至出現氣道阻塞等嚴重威脅生命安全的情況，病情嚴重患者給予留置胃管更易出現，腦卒中后吞咽困難患者誤吸發生率是52%～74%，期間安靜時誤吸大約占誤吸患者的44%～72%;同時吞咽障礙又會導致一系列并發癥，水、電解質、營養攝入不足，身體脫水、內環境紊亂，嚴重可導致死亡;同時患者在進食訓練時會出現不同程度的心理障礙，主要表現為焦慮、抑郁、甚至會出現自殺傾向，由于吞咽障礙引起的這些種種因素進而嚴重影響患者康復進度及生活質量[1]。腦卒中由于呼吸中樞受損、呼吸下行傳導通路被破壞后會繼發肺部疾病，病情逐漸加重常常出現呼吸功能衰竭的危險，此刻需要立即進行氣管切開術以盡快開放氣道采取呼吸機支持治療，隨著患者呼吸功能逐漸好轉，患者氣道壓力也逐漸發生改變，以至于患者在經口進食會出現不同程度的吞咽困難，待患者好轉后患者會出現氣道反射及咽反射減退或消失等情況，嚴重影響后期整體康復，對患者早期評價及干預，及時采取有計劃的康復訓練，在預防誤吸的發生及加快康復等方面有著非常重要的臨床意義，況且這方面目前在國內未見相關報道[2-3]。本研究在臨床應用果綠染色實驗能夠快速、準確地判定患者是否存在誤吸，受到患者及家屬的一直好評，對于加快患者康復時間有明顯的效果。臨床通常采用吞咽熒光透視造影檢查來評估患者在進食過程中的吞咽功能狀態，由于氣管切開患者病情較重，不能采取坐位等特定體位，同時搬動也不方便，因此在性吞咽造影檢查存在一定的困難。經過我們在臨床多年的摸索實驗，發現采用果綠染色試驗對重癥腦卒中后氣管切開并吞咽障礙患者滲漏和誤吸評估觀察取得較好的效果，現報道如下。