RESPIRATORY PHASE RESETTING AND AIR-FLOW CHANGES INDUCED BY SWALLOWING IN HUMANS
RESPIRATORY PHASE RESETTING AND AIR-FLOW CHANGES INDUCED BY SWALLOWING IN HUMANS
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DOI：
10.1113/jphysiol.1995.sp020584
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发表时间：
1995-02-15
影响因子：
5.5
通讯作者：
NASSAB, PF
中科院分区：
文献类型：
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作者：
PAYDARFAR, D;GILBERT, RJ;NASSAB, PF
1. 研究了30例清醒健康受试者休息时呼吸时间与吞咽的关系。通过颏下肌电图、咽压测量和视频透视监测吞咽情况。通过测量口鼻气流和胸壁运动记录呼吸。研究了三种类型的吞咽：注射吞丸、自发吞丸和预先放入口中的视觉提示吞丸。每次吞咽对呼吸节律的影响是通过测量相来表征的，相定义为吞咽下肌电图活动开始到随后重新安排吸气开始之间的间隔。确定了在呼吸周期的不同阶段开始的燕子的相期。在所有受试者中，吞咽引起呼吸节律的相位重置。在吸气-呼气（I-E）过渡附近开始的燕子的相位最大，在呼气-吸气（E-I）过渡附近开始的燕子的相位最小。吞咽呼吸复位模式拓扑分类为0型。这一模式在大剂量注射或视觉提示诱导的吞咽和自发吞咽中均有表现。自发性吞咽的发生受吞咽在呼吸循环中的位置影响。自发吞咽很少发生在E-I转换附近，而大多数发生在吸气后期到呼气中期。吞咽引起气流突然减少，导致呼吸暂停，随后是一段时间的呼气。自发吞下的吞咽呼吸暂停持续时间比5ml灌胃的吞咽呼吸暂停持续时间短，且不受吞咽起始呼吸期的影响。在I-E过渡时开始的吞咽后呼气期最长，E-I过渡时最短。5 .在吞咽发生的呼吸周期中，大剂量注射与吞咽呼吸暂停之间的时间间隔和吞咽事件发生的时间并没有明显改变。为了量化吸入气流流量和呼吸之间的关系，我们确定了吸入气流停止和吸入气流到达喉部之间的潜伏期（α），以及喉丸离开和吸入气流恢复之间的潜伏期（δ）。这两个值都取决于吞咽时的呼吸相。α值和δ值分别在吸气早和呼气晚的燕子中最低。我们得出的结论是，吞咽引起呼吸相重置的模式是一个吸引子周期振荡器的强扰动的特征。清醒受试者开始吞咽的阈值受呼吸阶段的影响，但与呼吸阶段没有强烈的耦合。我们认为，除了上气道内的解剖障碍外，呼吸时机也会影响吞咽过程中误吸的易感性。在E-I过渡期附近开始的吞咽可能最有可能导致丸剂吸入，特别是在吞咽对呼吸节律的影响减弱或丸剂通过咽的运输减慢的病理情况下。
1. Relationships between the timing of respiration and deglutition were studied in thirty awake healthy subjects at rest. Deglutition was monitored by submental electromyography, pharyngeal manometry and videofluoroscopy. Respiration was recorded by measurement of oronasal airflow and chest wall movement. Three types of deglutition were studied: injected bolus swallows, spontaneous swallows, and visually cued swallows of boluses previously placed in the mouth.2. The effect of each swallow on respiratory rhythm was characterized by measurement of cophase, defined as the interval between the onset of deglutitive submental EMG activity to the onset of subsequent rescheduled inspirations. Cophase was determined for swallows initiated at different phases of the respiratory cycle. In all subjects deglutition caused phase resetting of respiratory rhythm. Cophase was largest for swallows initiated near the inspiratory-expiratory (I-E) transition and smallest for swallows initiated near the expiratory-inspiratory (E-I) transition. The pattern of respiratory resetting by deglutition was topologically classified as type 0. This pattern was shown for swallows induced by bolus injection or visual cue, and for spontaneous swallows.3. The incidence of spontaneous deglutition was influenced by the position of the swallow in the respiratory cycle. Few spontaneous swallows were initiated near the E-I transition whereas most occurred from late inspiration to mid-expiration.4. Deglutition caused an abrupt decrease in airflow leading to an interval of apnoea, followed by a period of expiration. The duration of deglutition apnoea for spontaneous swallows was shorter than that for 5 ml bolus swallows, and was unaffected by the respiratory phase of swallow initiation. The period of expiration after swallowing was longest for swallows initiated at the I-E transition, and shortest for E-I swallows.5. The intervals between bolus injection and the onset of deglutition apnoea, and the timing of swallowing events, were not significantly altered by the phase in the respiratory cycle at which swallowing was exhibited.6. To quantify the relationship between bolus flow and respiration, we determined the latencies between cessation of inspiratory airflow and arrival of the bolus at the larynx (alpha), and between laryngeal bolus departure and resumption of inspiratory airflow (delta). Both values were dependent upon the respiratory phase of swallowing. The lowest values for alpha and delta were found for early-inspiratory and late-expiratory swallows, respectively.7. We conclude that swallowing causes respiratory phase resetting with a pattern that is characteristic of the strong perturbations of an attractor-cycle oscillator. The threshold for initiation of swallowing in awake subjects is influenced by, but not strongly coupled to, the phase of respiration. We propose that respiratory timing, in addition to anatomical barriers within the upper airway, influences the vulnerability for aspiration during deglutition. Swallows initiated near the E-I transition may be the most likely to result in bolus aspiration, especially in pathological conditions that weaken the impact of swallowing on respiratory rhythm or slow the transport of the bolus through the pharynx.