Thin Liquid Bolus Volume Alters Pharyngeal Swallowing: Kinematic Analysis Using 3D Dynamic CT
Thin Liquid Bolus Volume Alters Pharyngeal Swallowing: Kinematic Analysis Using 3D Dynamic CT
复制标题
稀液体推注量改变咽部吞咽：使用 3D 动态 CT 进行运动学分析
DOI：
10.1007/s00455-021-10397-y
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发表时间：
2021
期刊：
影响因子：
2.6
通讯作者：
Gonzalez-Fernandez M
中科院分区：
文献类型：
--
作者：
Pongpipatpaiboon K;Inamoto Y;Aihara K;Kagaya H;Shibata S;Mukaino M;Saitoh E;Gonzalez-Fernandez M
先前的研究报道了不同体积的浓液对吞咽的时空特征和咽部反应的影响。然而，粗、稀两种液体的灌胃流量和吞咽运动模式不同。薄丸量对咽部吞咽，特别是真声带闭合的影响尚不清楚。本研究使用320排面积检测器计算机断层扫描（320-ADCT）评估吞咽不同体积的稀液体时的时间特征，以确定机械适应性，并研究吞咽生理学的变化，包括喉关闭，特别是TVC关闭。14名健康女性（28-45岁）在45°半卧位上分别吞咽3、10和20 ml薄液体钡，行320-ADCT检查。对每次吞咽进行运动学分析，包括时间特征、吞咽时的结构运动和食管上括约肌（UES）开口的最大横截面积。体积较大时，丸头到达咽、食道的时间明显早，表明随着体积的增加，丸头的运输速度也更快。对吞咽机制有显著影响，显示TVC关闭和UES打开随体积增加而提前。增加了UES开口的最大横截面积以容纳更大的丸。通过大剂量运输和吞咽结构运动的机械适应差异在增加的体积中被检测到。这些与体积相关的适应措施可能降低误吸的风险。了解吞咽体积增大时的吞咽生理变化，有助于临床对吞咽困难患者的诊断和治疗以及吞咽康复的效果。
The previous studies reported that different volumes of thick liquid had an impact on spatiotemporal characteristics and pharyngeal response of swallowing. However, the bolus flow and swallowing motion pattern were different between thick and thin liquids. The effects of thin bolus volume on pharyngeal swallowing, especially true vocal cord (TVC) closure is still unclear. This study assessed the temporal characteristics when swallowing different volumes of thin liquid to determine the mechanical adaptation using 320-row area detector computed tomography (320-ADCT) and investigated a change of swallowing physiology including laryngeal closure, particularly TVC closure. Fourteen healthy women (28–45 years) underwent 320-ADCT while swallowing of 3, 10, and 20 ml of thin liquid barium in 45° semi-reclining position. Kinematic analysis was performed for each swallow including temporal characteristic, structural movements while swallowing, and maximal cross-sectional area of the upper esophageal sphincter (UES) opening. Bolus head reached to pharynx and esophagus earlier in larger volume significantly, indicating faster bolus transport as volume increased. There were significant effects on swallowing mechanism revealing earlier TVC closure and UES opening with increasing volume. Maximum cross-sectional area of the UES opening was increased to accommodate a larger bolus. Differences in mechanical adaptation through bolus transit and motion of swallowing structures were detected across increasing volumes. These volume-dependent adaptations potentially reduce the risk of aspiration. Understanding the swallowing physiological changes as volume increased is helpful for diagnosis and treatment of dysphagia patients as well as outcomes of swallowing rehabilitation in clinical practice.