A computational fluid dynamics simulation of liquid swallowing by impaired pharyngeal motion: bolus pathway and pharyngeal residue
A computational fluid dynamics simulation of liquid swallowing by impaired pharyngeal motion: bolus pathway and pharyngeal residue
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DOI：
10.1152/ajpgi.00082.2019
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发表时间：
2019-12-01
影响因子：
4.5
通讯作者：
Imai, Yohsuke
中科院分区：
文献类型：
--
作者：
Ohta, Jun;Ishida, Shunichi;Imai, Yohsuke
提高吞咽能力的常见做法包括改变食物的物理性质和改变患者的姿势。在这里，我们使用计算流体动力学模拟量化了液体推注的粘度和患者姿势对推注路径和咽部残留物的影响。我们开发了一种咽部运动受损、咽部压力低且无咽部适应的计算模型。我们将粘度从 0.002 变化到 1 Pa.s，姿势从 -15 度变化到 30 度（从几乎垂直到前倾）。在缺乏咽部适应的情况下，蜂蜜状液体丸剂会导致咽部残留，特别是在前倾姿势的情况下。尽管不同粘度的推注速度不同，但最终的路径仅略有不同。会厌的形状、位置和倾斜有效地将食团引入两个侧向通路，表明吞咽过程具有高度稳健性。新的和值得注意的增稠剂通常用于吞咽困难患者。推注粘度的增加不仅会降低误吸的风险，还会导致咽部残留体积。由于从电视荧光吞咽研究中获得的信息只是二维的，因此咽部残留物的测量在实验上很困难。我们使用计算建模和模拟成功量化了三维推注路径和咽部残留量。
Common practices to improve the ability to swallow include modifying physical properties of foods and changing the posture of patients. Here, we quantified the effects of the viscosity of a liquid bolus and patient posture on the bolus pathway and pharyngeal residue using a computational fluid dynamics simulation. We developed a computational model of an impaired pharyngeal motion with a low pharyngeal pressure and no pharyngeal adaptation. We varied viscosities from 0.002 to 1 Pa.s and postures from -15 degrees to 30 degrees (from nearly vertical to forward leaning). In the absence of pharyngeal adaptation, a honey-like liquid bolus caused pharyngeal residue, particularly in the case of forward-leaning postures. Although the bolus speed was different among viscosities, the final pathway was only slightly different. The shape, location, and tilting of the epiglottis effectively invited a bolus to two lateral pathways, suggesting a high robustness of the swallowing process.NEW & NOTEWORTHY Thickening agents are often used for patients with dysphagia. An increase in bolus viscosity not only reduces the risk of aspiration but also can cause a residual volume in the pharynx. Because information obtained from videofluoroscopic swallowing studies is only two-dimensional, measurement of pharyngeal residue is experimentally difficult. We successfully quantified the three-dimensional bolus pathway and the pharyngeal residual volume using computational modeling and simulation.