Modulation of laryngeal responses to superior laryngeal nerve stimulation by volitional swallowing in awake humans
Modulation of laryngeal responses to superior laryngeal nerve stimulation by volitional swallowing in awake humans
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DOI：
10.1152/jn.2000.83.3.1264
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发表时间：
2000-03-01
影响因子：
2.5
通讯作者：
Ludlow, CL
中科院分区：
文献类型：
--
作者：
Barkmeier, JM;Bielamowicz, S;Ludlow, CL
喉感觉运动闭合反射对于保护气道和防止异物进入气管和肺部非常重要。这项研究的目的是确定当清醒的人有食物或液体进入气道的危险时，这种反射是如何被调节的。研究了电刺激喉上神经内支引起的喉内收肌反应在不同吞咽阶段的频率和幅度。受试者根据指令吞咽水，同时在指令下达后的500 ms至5 s的不同时间间隔内对ISLN进行电刺激。用钩丝电极记录喉内收肌对单侧ISLN刺激的反应。早期同侧R1反应发生在17 ms，随后双侧R2反应在65 ms左右开始。在没有吞咽的呼气过程中，肌肉对刺激的反应被量化为对照试验。测量了吞咽前、吞咽中、吞咽后3 s内、吞咽后3 ~ 5 s内对刺激的反应。相对于对照反应的三种反应（同侧RI和双侧R2）的频率和幅度在不同阶段相对于吞咽的发生进行比较。结果表明，吞咽后长达3 s的电刺激后，双侧R2喉反应的频率和幅度都有所降低（P = 0.005）。然而，吞咽后同侧R1喉反应的幅度和频率并没有显示出显著的主要影响（P = 0.28），尽管通过测量相互作用的显著时间（P = 0.006）与吞咽后3 s内R1反应幅度的降低有关（P = 0.021）。因此，吞咽后，更快速和更短的单侧R1反应继续提供一些（尽管减少了）喉保护功能，而吞咽后，更晚的双侧R2反应在发生和振幅上都被抑制了长达3 s。结果表明，吞咽后R2喉内收肌反应被抑制，当残留物可能留在喉前庭时，使人增加外来物质进入气道的风险。
Laryngeal sensorimotor closure reflexes are important for the protection of the airway and prevent the entry of foreign substances into the trachea and lungs. The purpose of this study was to determine how such reflexes might be modulated during volitional swallowing in awake humans, when persons are at risk of entry of food or liquids into the airway. The frequency and the amplitude of laryngeal adductor responses evoked by electrical stimulation of the internal branch of the superior laryngeal nerve (ISLN) were studied during different phases of volitional swallowing. Subjects swallowed water on command while electrical stimuli were presented to the ISLN at various intervals from 500 ms to 5 s following the command. Laryngeal adductor responses to unilateral ISLN stimulation were recorded bilaterally in the thyroarytenoid muscles using hooked wire electrodes. Early ipsilateral R1 responses occurred at 17 ms, and later bilateral R2 began around 65 ms. The muscle responses to stimuli occurring during expiration without swallowing were quantified as control trials. Responses to stimulation presented before swallowing, during the swallow, within 3 s after swallowing, and between 3 and 5 s after a swallow were measured. The frequency and amplitude of three responses (ipsilateral RI and bilateral R2) relative to the control responses were compared across the different phases relative to the occurrence of swallowing. Results demonstrated that a reduction occurred in both the frequency and amplitude of the later bilateral R2 laryngeal responses to electrical stimulation for up to 3 s after swallowing (P = 0.005). The amplitude and frequency of ipsilateral R1 laryngeal responses, however, did not show a significant main effect following the swallow (P = 0.28), although there was a significant time by measure interaction (P = 0.006) related to reduced R1 response amplitude up to 3 s after swallowing (P = 0.021). Therefore, the more rapid and shorter unilateral R1 responses continued to provide some, albeit reduced, laryngeal protective functions after swallowing, whereas thr,later bilateral R2 responses were suppressed both in occurrence and amplitude for up to 3 s after swallowing. The results suggest that R2 laryngeal adductor responses are suppressed following swallowing when residues may remain in the laryngeal vestibule putting persons at increased risk for the entry of foreign substances into the airway.