声门下正压技术及其在气管切开患者多功能协同康复中的应用进展

Subglottic positive pressure technology and its application in coordinated multifunctional rehabilitation of patients undergoing tracheotomy

  • 摘要: 气管切开术是危重症患者的关键救治手段,能有效维持气道通畅,但会改变上呼吸道解剖结构并削弱其防御功能,常引发呼吸、吞咽及言语等多重功能障碍,严重影响患者生活质量和康复进程。优化此类患者的气道管理、减少相关并发症、促进呼吸功能康复,并最终实现安全、高效拔管已成为临床亟需解决的核心问题。呼吸、吞咽、言语及咳嗽等功能在解剖结构、生理机制及神经调控方面关联密切,任何一环的功能受损均可能影响整体康复效果。声门下正压技术通过外源性气流重建声门下压力环境,部分恢复上呼吸道气流动力学特征,可在改善气道通畅性、增强气道保护功能、重建声门下压力及促进呼吸-吞咽协调性等方面发挥作用,有望实现多功能协同康复。作为一种新兴康复手段,该技术已在发声辅助、分泌物清除及吞咽障碍治疗等方面显示出较高临床价值。然而,针对气管切开患者多功能协同康复的研究仍相对有限,其在作用机制、参数优化及个体化应用等方面尚缺乏统一标准和循证依据。鉴于此,本文系统综述声门下正压技术在气管切开患者多功能协同康复中的作用机制、临床应用现状、存在问题及未来研究方向,旨在为优化康复策略、推动技术规范化应用及改善患者预后提供参考。

     

    Abstract: As a key treatment for critically ill patients, tracheotomy can effectively maintain airway patency, whereas may change the anatomical structure of the upper respiratory tract and weaken the defense function, often causing multiple dysfunctions in breathing, swallowing and speech and seriously affecting the quality of life and rehabilitation process of patients. Optimizing airway management, reducing related complications, promoting the recovery of respiratory function, and finally achieving safe and efficient extubation have become the core problems to be urgently solved in clinical practice. Respiratory, swallowing, speech and cough functions are intimately correlated with anatomical structure, physiological mechanism and nerve regulation. Any functional impairment among these may affect the overall rehabilitation effect. Subglottic positive pressure technology reconstructs subglottic pressure environment through exogenous airflow, and partially restores the aerodynamic characteristics of the upper respiratory tract. It plays a role in improving airway patency, enhancing airway protection function, reconstructing subglottic pressure and promoting breathing-swallowing coordination, which is expected to achieve coordinated multifunctional rehabilitation. As a new rehabilitation method, this technology has shown high clinical value in assisted phonation, secretion clearance and treatment of dysphagia. However, the research on coordinated multifunctional rehabilitation of patients undergoing tracheotomy is still relatively limited. Unified standards and evidence-based data are lacking in terms of the mechanism, parameter optimization and individualized application. In this article, the mechanism, clinical application status, existing problems and future research direction of subglottic positive pressure technology in coordinated multifunctional rehabilitation of patients undergoing tracheotomy were systematically reviewed, aiming to provide reference for optimizing rehabilitation strategies, promoting standardized application of this technology and improving clinical prognosis.

     

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