UPPER ESOPHAGEAL SPHINCTER OPENING AND MODULATION DURING SWALLOWING
UPPER ESOPHAGEAL SPHINCTER OPENING AND MODULATION DURING SWALLOWING
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DOI：
10.1016/0016-5085(89)90391-0
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发表时间：
1989-12-01
期刊：
影响因子：
29.4
通讯作者：
HA, T
中科院分区：
文献类型：
--
作者：
JACOB, P;KAHRILAS, PJ;HA, T
对8名正常受试者进行了同步视频透视和测压的研究，以便于吞咽过程中上食管括约肌打开和容量依赖性调制的生物力学分析。在吞咽1、5、10和20 ml液体钡的过程中，以1/30 th-s的间隔测定舌骨和喉的运动、括约肌开口的尺寸和腔内括约肌压力。我们的分析将吞咽过程中的上食管括约肌活动细分为五个阶段：（a）放松，（B）打开，（c）扩张，（d）塌陷，（e）闭合。括约肌松弛发生在喉提升和开放之前的平均时间为0.1秒。当括约肌通过舌骨的肌肉附件被拉开时，发生打开，使得括约肌打开和关闭发生的舌骨坐标在推注体积之间是恒定的。括约肌扩张开放后调制的团内压力，而不是分级舌骨运动。团内压力的产生与舌的后推力相一致，最终导致咽壁接触和咽痉挛的开始。较大的吞咽量与较大的团内压力和增加的团头速度相关。括约肌打开的持续时间增加，同时舌骨前上移位延长，咽部痉挛发作延迟（决定括约肌关闭时间的事件）。我们得出结论，通过调节括约肌直径、开口间隔和流速（反映在推注头速度上）来实现增加吞咽推注体积的经括约肌运输。此外，上食管括约肌开放是一个积极的机械事件，而不仅仅是一个结果，颈咽松弛。
Studies were done on 8 normal subjects with synchronized videofluoroscopy and manometry to facilitate a biomechanical analysis of upper esophageal sphincter opening and volume-dependent modulation during swallowing. Movements of the hyoid and larynx, dimensions of sphincter opening, and intraluminal sphincter pressure were determined at 1/30th-s intervals during swallows of 1, 5, 10, and 20 ml of liquid barium. Our analysis subdivided upper esophageal sphincter activity during swallowing into five phases: (a) relaxation, (b) opening, (c) distention, (d) collapse, and (e) closure. Sphincter relaxation occurred during laryngeal elevation and preceded opening by a mean period of 0.1 s. Opening occurred as the sphincter was pulled apart via muscular attachments to the hyoid such that the hyoid coordinates at which sphincter opening and closing occurred were constant among bolus volumes. Sphincter distention after opening was modulated by intrabolus pressures rather than graded hyoid movement. The generation of intrabolus pressure coincided with the posterior thrust of the tongue that culminated in pharyngeal wall contact and the initiation of pharyngeal peristalsis. Larger volume swallows were associated with greater intrabolus pressure and increased bolus head velocity. The duration of sphincter opening increased in conjunction with a prolongation of the anterior-superior excursion of the hyoid and a delay in the onset of pharyngeal peristalsis (the event that determined the timing of sphincter closure). We conclude that transsphincteric transport of increasing swallow bolus volumes is accomplished by modulating sphincter diameter, opening interval, and flow rate (reflected by bolus head velocity). Furthermore, upper esophageal sphincter opening is an active mechanical event rather than simply a consequence of cricopharyngeal relaxation.