Pharyngoglottal closure reflex: Characterization in healthy young, elderly and dysphagic patients with predeglutitive aspiration
Pharyngoglottal closure reflex: Characterization in healthy young, elderly and dysphagic patients with predeglutitive aspiration
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DOI：
10.1159/000066504
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发表时间：
2003-01-01
期刊：
影响因子：
3.5
通讯作者：
Kern, M
中科院分区：
文献类型：
--
作者：
Shaker, R;Ren, JL;Kern, M
背景：误吸是口咽部吞咽困难的常见并发症，其机制尚未完全阐明。由于咽声门闭合反射会诱导健康年轻人声带内收，因此它可能有助于防止口腔内容物过早溢出时误吸。目的：本研究的目的是表征正常年轻人和老年人以及吞咽困难患者吞咽前误吸的这种反射；可能出现这种反射异常的群体。方法：我们使用同时视频内窥镜和测压技术来记录声带对咽水刺激的反应。我们首先研究了 9 名年轻（26 +/- 2 岁）和 9 名老年（77 +/- 14 岁）健康志愿者，以表征和确定衰老对咽声门闭合反射的影响。随后，我们研究了 8 名吞咽前误吸患者（65 +/- 16 岁）和 7 名年龄匹配的对照患者，以表征吞咽期间气道安全受损的患者的这种反射。结果：老年志愿者快速脉冲注射触发声门关闭和反射性咽部吞咽的阈值水体积显着大于年轻人（p < 0.05）。注射水量达1ml时，任何吞咽困难患者均不能诱导声门闭合反射和咽部反射性吞咽。相比之下，在所有年龄匹配的对照中，咽声门反射和反射性咽吞咽分别受到0.3+/-0.07和0.6+/-0.05ml阈值体积的刺激。结论：水刺激咽部可诱导人声带内收；咽声门闭合反射。尽管保存完好，但老年人需要大量的水来通过快速脉冲注射刺激这种反射，这表明该年龄组的情况有所恶化。吞咽困难且吞咽前误吸的患者不存在由快速脉冲注射引起的咽声门闭合反射，这表明其有助于保护气道以防止误吸。版权所有 (C) 2003 S. Karger AG，巴塞尔。
Background: Mechanism(s) of aspiration, a common complication of oropharyngeal dysphagia, is not completely elucidated. Since the pharyngoglottal closure reflex induces vocal cord adduction in healthy young humans, it may help prevent aspiration during premature spill of oral content. Objective: The objective of this study was to characterize this reflex in normal young and elderly humans and dysphagic patients with predeglutitive aspiration; a potential group for developing abnormalities of this reflex. Methods: We used a concurrent video endoscopic and manometric technique for recording of the vocal cords' response to pharyngeal water stimulation. We first studied 9 young (26 +/- 2 years) and 9 elderly (77 +/- 14 years) healthy volunteers to characterize and determine the effect of aging on the pharyngoglottal closure reflex. Subsequently, we studied 8 patients (65 +/- 16 years) with predeglutitive aspiration and 7 age-matched controls to characterize this reflex among patients with compromised airway safety during swallowing. Results: The threshold volume of water for triggering both glottal closure and reflexive pharyngeal swallow in the elderly volunteers for rapid pulse injection was significantly larger than that for the young (p < 0.05). Neither glottal closure reflex nor pharyngeal reflexive swallow could be induced in any of the dysphagic patients with volumes of injected water as large as 1 ml. In contrast, in all age-matched controls, both the pharyngoglottal reflex and reflexive pharyngeal swallow were stimulated with threshold volumes of 0.3 +/- 0.07 and 0.6 +/- 0.05 ml, respectively. Conclusions: Pharyngeal stimulation by water induces vocal cord adduction in humans; the pharyngoglottal closure reflex. Although preserved, a significantly larger volume of water is required to stimulate this reflex by rapid pulse injection in the elderly, suggesting some deterioration in this age group. The pharyngoglottal closure reflex induced by rapid pulse injection is absent in dysphagic patients with predeglutitive aspiration, suggesting its contribution to airway protection against aspiration. Copyright (C) 2003 S. Karger AG, Basel.