Co-ordination of spontaneous swallowing with respiratory airflow and diaphragmatic and abdominal muscle activity in healthy adult humans
Co-ordination of spontaneous swallowing with respiratory airflow and diaphragmatic and abdominal muscle activity in healthy adult humans
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DOI：
10.1113/expphysiol.2008.045724
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发表时间：
2009-04-01
影响因子：
2.7
通讯作者：
Eriksson, Lars I.
中科院分区：
文献类型：
--
作者：
Cedborg, Anna I. Hardemark;Sundman, Eva;Eriksson, Lars I.
呼吸和吞咽的协调对于正常的咽功能和保护气道至关重要。为了让药丸安全地通过咽部，呼吸被中断（吞咽性呼吸暂停）；然而，吞咽和吞咽呼吸暂停期间气流和膈肌活动的控制尚不完全清楚。在这里，我们验证了一种用于检测呼吸气流的新型气流鉴别器，并将其与膈肌和腹部肌电图 (EMG)、肺活量测定法以及咽和食管测压法一起使用。对六名健康志愿者在休息、高碳酸血症期间和呼吸频率为 30 次/分钟(-1) 时的呼吸和自主吞咽协调进行了检查。事实证明，气流鉴别器高度可靠，使我们能够明确确定与咽部和膈肌活动相关的呼吸气流时间。在吞咽呼吸暂停期间，膈肌的被动呼气被静态活动中断，即“主动屏气”，这保留了吞咽后呼气的呼吸量。腹部肌电图在吞咽呼气前和吞咽后增加，在高碳酸血症期间比正常碳酸血症期间更明显，可能是为了帮助呼气气流。在这六名志愿者中，吞咽总是在呼气之前进行，并且在正常和高碳酸血症下，分别有 93% 和 85% 的吞咽之后会呼气，这表明，对于人类来说，呼吸呼气阶段的吞咽可能比之前认为的更为重要。这种呼吸和吞咽的协调模式可能会降低误吸的风险。健康志愿者和气流鉴别器的这些测量结果将用于未来关于气道保护以及疾病、药物和衰老影响的研究。
Co-ordination of breathing and swallowing is essential for normal pharyngeal function and to protect the airway. To allow for safe passage of a bolus through the pharynx, respiration is interrupted (swallowing apnoea); however, the control of airflow and diaphragmatic activity during swallowing and swallowing apnoea are not fully understood. Here, we validated a new airflow discriminator for detection of respiratory airflow and used it together with diaphragmatic and abdominal electromyography (EMG), spirometry and pharyngeal and oesophageal manometry. Co-ordination of breathing and spontaneous swallowing was examined in six healthy volunteers at rest, during hypercapnia and when breathing at 30 breaths min(-1). The airflow discriminator proved highly reliable and enabled us to determine timing of respiratory airflow unambiguously in relation to pharyngeal and diaphragmatic activity. During swallowing apnoea, the passive expiration of the diaphragm was interrupted by static activity, i.e. an 'active breath holding', which preserved respiratory volume for expiration after swallowing. Abdominal EMG increased throughout pre- and post-swallowing expiration, more so during hyper- than normocapnia, possibly to assist expiratory airflow. In these six volunteers, swallowing was always preceded by expiration, and 93 and 85% of swallows were also followed by expiration in normo- and hypercapnia, respectively, indicating that, in man, swallowing during the expiratory phase of breathing may be even more predominant than previously believed. This co-ordinated pattern of breathing and swallowing potentially reduces the risk for aspiration. Insights from these measurements in healthy volunteers and the airflow discriminator will be used for future studies on airway protection and effects of disease, drugs and ageing.