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目的评估脑卒中后吞咽障碍患者及正常人上气道咳嗽防御反射功能的差异。方法脑卒中患者根据洼田饮水试验结合吞咽造影检查,分为卒中后无吞咽障碍组(SND,n=20)和卒中后吞咽障碍组(SD,n=20);另选择正常人20名为对照组(NC)。所有受试者完成4种不同浓度柠檬酸(0.2 mol/L、0.4 mol/L、0.6 mol/L、0.8 mol/L)吸入,计算不同浓度下咳嗽反射通过率。结果与NC组相比,SD组吸入0.2 mol/L、0.4 mol/L柠檬酸通过率下降(P<0.05);与SND组相比,SD组吸入0.4 mol/L柠檬酸通过率下降(P<0.05)。SNC组通过率与NC组无显著性差异(P>0.05)。NC组90%通过0.4 mol/L柠檬酸试验;SD组0.2 mol/L、0.4 mol/L通过率无显著差异(P>0.05),均低于0.6 mol/L、0.8 mol/L通过率(P<0.05);SND组0.4 mol/L通过率为85%,高于0.2 mol/L通过率(P<0.05)。柠檬酸咳嗽反射试验的评价者间信度κ=0.97。同一浓度两次测试,一致率96.8%。受试者无哮喘、窒息等症状发生。结论中低浓度柠檬酸咳嗽反射试验可以评估脑卒中后吞咽障碍患者上气道的咳嗽保护能力,可以作为吞咽障碍呼吸道功能筛查指标之一。
Objective To evaluate the difference of upper airway cough defense and reflex function between patients with swallowing disorders and normal subjects after stroke. Methods Stroke patients were divided into two groups according to the Kubota drinking water test and swallowing angiography: no swallowing dysfunction group (SND, n = 20) and post-stroke dysphagia group (SD, n = 20) Control group (NC). All subjects completed inhalation of citric acid (0.2 mol / L, 0.4 mol / L, 0.6 mol / L, 0.8 mol / L) in 4 different concentrations to calculate cough reflex pass rates. Results Compared with NC group, the passage rate of 0.4 mol / L citric acid decreased (P <0.05) in SD group compared with SND group (0.2 mol / L) <0.05). There was no significant difference in pass rate between SNC group and NC group (P> 0.05). 90% of NC group passed 0.4 mol / L citric acid test; SD group 0.2 mol / L and 0.4 mol / L of pass rate had no significant difference (P> 0.05), both lower than 0.6 mol / L, 0.8 mol / L pass rate P <0.05). The passage rate of 0.4 mol / L in SND group was 85%, which was higher than that of 0.2 mol / L group (P <0.05). Interobserver reliability of citric acid cough reflex test κ = 0.97. The same concentration of two tests, the same rate of 96.8%. Subjects without asthma, suffocation and other symptoms occur. Conclusions Citric acid cough reflex test can assess the cough protection ability of upper airway in patients with swallowing disorder after stroke, which can be used as an index of respiratory function screening for swallowing disorders.