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【科普】脑卒中后肌肉无力促成咳嗽反射减弱
NEW YORK (Reuters Health) Jan 01 - Expiratory muscle weakness resulting from ischemic cortical injury contributes to cough impairment in stroke patients, according to UK researchers.
"Cough is an important defense mechanism that helps to clear airways of aspirate, but is impaired in stroke patients and associated with an increased risk of chest infections," Dr. Lalit Kalra from King's College London told Reuters Health. "Despite its importance, little attention is paid to assessing airway clearance, which may be equally important as assessment of aspiration in dysphagic patients."
Dr. Kalra and colleagues used transcranial magnetic stimulation (TMS) to induce expiratory muscle responses and evaluated the association between expiratory muscle function and cough flow rates in 15 patients who recently had an ischemic stroke.
After suprathreshold TMS over the vertex, stroke patients showed significantly lower gastric and transdiaphragmatic pressure increases than did control subjects, the authors report in the December 9 issue of Neurology.
Gastric pressure was significantly higher following unilateral TMS of the uninjured side in stroke patients than following unilateral TMS of the injured side, the report indicates.
In fact, the researchers note, unilateral TMS of the injured side failed to cause measurable activation in 12 of 15 patients even at 100% stimulator output.
Gastric pressure after TMS was the only independent determinant of cough effectiveness in a regression analysis that adjusted for age, gender, smoking habits, and other factors.
"Taken together," the investigators conclude, "these findings suggest that ischemic cerebral injury directly contributes to impaired cough in stroke patients."
"We have a program of research in this area and are currently examining different types of cough in stroke, particularly reflex cough, which is perceived as being protective but may not be so," Dr. Kalra said.
"In associated studies we are looking at cortical mechanisms that may underlie these impairments and various treatment options for strengthening cough, either through interventions aimed at peripheral mechanisms or those that drive cortical plasticity."
脑卒中后肌肉无力促成咳嗽反射减弱
（纽约路透电）1月1日-英国研究人员报道，脑卒中患者起因于皮质局部缺血性损伤诱发的呼气肌无力致咳嗽反射减弱。
“咳嗽是一个重要的防御机制，帮助清除呼吸道的分泌物，但中风病人咳嗽受损并增加胸部感染风险”，伦敦大学国王学院Lalit Kalra博士告诉路透社记者。“尽管它的重要性，人们很少注意评估气道清除，这可能与评估吞咽困难病人误吸同样重要。”
Kalra博士和同事利用经颅磁刺激(TMS)诱发呼气肌反应，评价15例新近缺血性中风患者呼气肌功能和咳嗽流速之间的相关性。
作者在12月9日出版的神经病学报告，TMS刺激颅后阈上顶点，脑卒中患者比对照组显示明显低的胃和跨膈压力增加。
报告指出，脑卒中患者健侧TMS后胃压明显高于伤侧TMS后。
研究人员指出，事实上，即使予100％的刺激输出，15例病人有12人伤侧TMS后不能引起可测定的激动。
调整年龄、性别、吸烟习惯以及其他因素，回归分析显示TMS后胃压是决定咳嗽效力的唯一独立因素。
研究人员由此得出结论：“总之，这些研究结果表明，缺血性脑损伤直接促成脑卒中患者咳嗽受损。”
“在这方面我们有一个研究项目，目前正在研究中风病人不同类型的咳嗽特别是咳嗽反射，这被视为保护，但可能并非如此，”Kalra博士说。
“在相关的研究，我们正在寻找皮层机制，可依据这些障碍和针对周边机制干预或驱动皮层可塑性的各种治疗选项以加强咳嗽。”
Neurology 2008;71:2000-2007. [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-07-29 05:15
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