CAJ | 학술논문

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。
목적：평고뇌졸중후탄인장애환자급정상인상기도해수방어반사공능적차이。방법뇌졸중환자근거와전음수시험결합탄인조영검사，분위졸중후무탄인장애조(SND, n=20)화졸중후탄인장애조(SD, n=20)；령선택정상인20명위대조조(NC)。소유수시자완성4충불동농도저몽산(0.2 mol/L、0.4 mol/L、0.6 mol/L、0.8 mol/L)흡입，계산불동농도하해수반사통과솔。결과여NC조상비，SD조흡입0.2 mol/L、0.4 mol/L저몽산통과솔하강(P<0.05)；여SND조상비，SD조흡입0.4 mol/L저몽산통과솔하강(P<0.05)。SNC조통과솔여NC조무현저성차이(P>0.05)。NC조90%통과0.4 mol/L저몽산시험；SD조0.2 mol/L、0.4 mol/L통과솔무현저차이(P>0.05)，균저우0.6 mol/L、0.8 mol/L통과솔(P<0.05)；SND조0.4 mol/L통과솔위85%，고우0.2 mol/L통과솔(P<0.05)。저몽산해수반사시험적평개자간신도κ=0.97。동일농도량차측시，일치솔96.8%。수시자무효천、질식등증상발생。결론중저농도저몽산해수반사시험가이평고뇌졸중후탄인장애환자상기도적해수보호능력，가이작위탄인장애호흡도공능사사지표지일。
Objective To evaluate the application of cough reflex testing with various concentrations of citric acid for dysphagia post stroke. Methods 20 normal controls (NC), 20 stroke patients with dysphagia (SD) and 20 stroke patients without dysphagia (SND) were test-ed with cough reflex inhalated 4 kinds of dosage of citric acid:0.2 mol/L, 0.4 mol/L, 0.6 mol/L and 0.8 mol/L. Results The incidence of pass (coughed twice or more) decreased in the SD compared with those in the NC as inhalated citric acid of 0.2 mol/L and 0.4 mol/L (P<0.05), and decreased under 0.4 mol/L compared with the SND (P<0.05). There was no significant difference between the SND and the NC (P>0.05). 90%of the NC passed as inhalated citric acid of 0.4 mol/L;however, it was 45%in the SD, and increased when they inhalated more dosage of citric acid (P<0.05). The incidence of pass decreased under 0.2 mol/L citric acid in the SND compared with other concentra-tion (P<0.05). The result of the test was reliable interrater (κ=0.97). The incidence of cough was consistent of 96.8%with the same concen-tration. No asthma and asphyxia was observed. Conclusion Cough reflex testing with citric acid inhalation can be used to assess the defen-sive function of airway in lower concentration for dysphagia after stroke.