卒中气管切开患者拔管的康复治疗研究进展

气管切开是临床抢救重症卒中患者的一种重要手段，但长期气管切开套管留置易造成多种并发症，及早康复介入可促进患者早期拔管。本文从呼吸功能康复、吞咽康复、说话瓣膜的使用、气道及套管的循证护理管理和一般支持治疗方面对促进卒中气管切开患者拔管的康复治疗进展进行了归纳总结，为提高临床卒中患者拔管率提供参考。气道廓清技术、呼吸肌训练、运动训练和体位管理可改善患者呼吸功能；直接与间接吞咽功能训练、唾液的管理和咽腔电刺激可改善患者吞咽功能；说话瓣膜的合理使用可促进患者早日拔管；对气道进行气道湿化、气囊管理和吸痰护理，对套管进行合理的固定与清洁消毒等，可减少并发症，防止感染；稳定患者病情，给予良好的营养支持和心理康复等一般支持治疗，可提高拔管成功率。虽然目前对卒中气管切开患者拔管的康复治疗并无统一标准，但是多学科合作的综合性康复治疗可提高患者拔管率，促进患者早日康复。

Progress of Rehabilitation Therapy for Decannulation in Stroke Patients with Tracheostomy

Tracheostomy is an important method to rescue patients with severe stroke. However,
prolonged tracheostomy tube placement may lead to increased risk of complications. Early
rehabilitation intervention can promote patients’ early decannulation. This paper summarized the
progress of rehabilitation therapy to promote decannulation in stroke patients from the following
aspects: respiratory rehabilitation, swallowing rehabilitation, use of speech valves, evidencebased
nursing management of airway and cannula and general supportive treatment, so as to
provide reference for improving decannulation rate in stroke patients. Airway clearance technique,
respiratory muscle training, exercise training and position management can improve patients'
respiratory function.The swallowing function of patients can be improved by direct and indirect
swallowing function training, saliva management and pharyngeal electrical stimulation. Rational
use of speaking valve can promote early decannulation. Airway humidification, cuff management
and sputum aspiration care, as well as reasonable fixation, cleaning and disinfection of cannula can
reduce complications and prevent infection. The success rate of decannulation can be increased
by stabilizing the patient's medical status, giving good nutritional support and psychological
rehabilitation. Although there is no unified standard for rehabilitation treatment of decannulation
in stroke patients with tracheostomy, multidisciplinary comprehensive rehabilitation treatment can
improve the rate of decannulation and promote early rehabilitation of patients.