Impaired deglutitive airway protection: A videofluoroscopic analysis of severity and mechanism
Impaired deglutitive airway protection: A videofluoroscopic analysis of severity and mechanism
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DOI：
10.1053/gast.1997.v113.pm9352847
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发表时间：
1997-11-01
期刊：
影响因子：
29.4
通讯作者：
Logemann, JA
中科院分区：
文献类型：
--
作者：
Kahrilas, PJ;Lin, SZ;Logemann, JA
背景与目的：喉前庭穿透是吞咽的先决条件。本研究旨在分析咽部吞咽前或咽部吞咽时喉部穿透风险的机制和模型。方法：对29例咽吞咽前或咽吞咽时有穿透性吞咽障碍的患者进行视频透视吞咽检查，并与12例对照组进行比较。使用逐步回归分析来确定导致团状物穿透到喉前庭的协调缺陷。对其机制进行了生物力学分析。结果：逐步回归模型从喉前庭关闭与舌咽交界处的团块释放的协调性以及上食道括约肌开放的时间与舌咽交界处开放的时间两个方面建立了喉穿透指数模型。该模型解释了吞咽困难患者喉部穿透严重程度的观察差异的86%。观察到的不协调是由于吞咽喉部抬高的启动延迟和实施缓慢所致。结论：吞咽困难的个体在吞咽1毫升、3毫升或5毫升的燕子之前或期间引起喉部穿透的风险与由1毫升的燕子组成的两个时间协调度量值成正比。相关缺陷的严重程度(喉部抬高延迟和减慢)与吞咽功能障碍的严重程度成正比。
Background & Aims: Laryngeal vestibule penetration is a prerequisite for deglutitive aspiration. This study aimed to analyze the mechanism and model the risk of laryngeal penetration before or during the pharyngeal swallow. Methods: Videofluoroscopic swallowing studies of 29 patients with neurogenic dysphagia with penetration before or during the pharyngeal swallow were compared with 12 controls. A stepwise regression analysis was used to define the coordinative defects leading to bolus penetration into the laryngeal vestibule. The mechanism was biomechanically analyzed, Results: The stepwise regression modeled a laryngeal penetration index from the coordination between laryngeal vestibule closure and bolus release at the glossopalatal junction and the timing of upper esophageal sphincter opening relative to glossopalatal junction opening. The model accounted for 86% of the observed variance in severity of laryngeal penetration among the dysphagics. The observed incoordination resulted from both delayed initiation and slowed enactment of deglutitive laryngeal elevation. Conclusions: A dysphagic individual's risk of incurring laryngeal penetration before or during 1-, 3-, or 5-mL swallows is proportional to two temporal measures of coordination made from 1-mL swallows. The severity of the relevant defects (delayed and slowed laryngeal elevation) is proportional to the severity of swallow dysfunction.