Study of Pathogenesis in Dysphagia

在本研究项目中，通过对吞咽的多维分析来评估正常和病理吞咽功能。吞咽机制的咽-食管x线透视研究：老年人常观察到以下现象；液体造影剂对喉部渗透及会厌运动障碍的影响，固体造影剂对小囊内丸潴留及咽裂吞咽的影响。在有吞咽困难感觉的组中也观察到同样的结果。这些结果提示，在老年组和吞咽困难的初始阶段，肠丸推进力和吞咽反射机制可能存在扭曲。吞咽压力测量和肌电记录对吞咽机制的研究环咽肌主要调控食道口静息张力，受咽-食管神经单侧支配。通过对30例正常成人的观察，确定了腭咽区、下咽区和颈-食管区吞咽压力的正常临界范围。在此范围内定义了吞咽压力曲线的分类，分为5种类型。吞咽压力的正常传导曲线呈s形，该曲线能直观地反映吞咽压力的正常或异常传导模式。食道口的松弛从咽端开始。因此，为了研究吞咽时食道口的松弛情况，建议在咽端测量腔内压力。还确定了松弛的临界时间范围和持续时间。对130例吞咽困难患者进行了吞咽困难发病机制的多维分析。固体丸的应用是检测吞咽反射丧失和丸推进力下降的有效方法。通过吞咽压力的传导曲线可以明确中枢神经系统的吞咽程序，通过吞咽压力曲线的分类可以明确丸的推进力。此外，通过测量咽端腔内压力来诊断食道口的放松机制。少

In this research project, normal and pathological swallowing function was evaluated through multidimensional analyses of deglutition.Investigation of Swallowing Mechanisms by Pharyngo-esophageal FluorographyThe following findings were often observed in geriatric group ; laryngeal penetration and disorder of movement of epiglottis in using liquid contrast medium and retention of bolus in the valleculla and pharyngeal splitting deglutition in using solid contrast medium. The same findings were also observed in the group with a sensation of difficulty in swallowing. These results suggest that propelling power of bolus and swallowing reflectory mechanism may be distorted in geriatric group and at the initial stage of dysphagia.Investigation of Swallowing Mechanisms by Measurements of Swallowing Pressure and Electromyographic RecordingsThe cricopharyngeal muscle mainly regulated the resting tone of the esophageal orifice and was innervated by the pharyngo-esophageal nerve unilaterally. The … More normal critical ranges of the swallowing pressure at the velopharyngeal, hypopharyngeal and cervico-esophageal regions were determined through observation of 30 normal adults. From these ranges, the classification of swallowing pressure curve which consists of 5 types was defined. The normal conduction curve of swallowing pressure was an S-like figure and this curve could visualize normal or abnormal pattern of conduction of swallowing pressure. The relaxation of the esophageal orifice started at the pharyngeal end. Therefore, to investigate the relaxation of the esophageal orifice in swallowing, it was recommended that the intraluminal pressure should be measured at the pharyngeal end. The critical ranges of the time and duration of the relaxation was also determined.Multi-dimensional Analyses of Pathogenesis of DysphogiaMulti-dimensional analyses of pathogenesis of dysphagia was investigated in 130 patients with dysphagia. The application of solid bolus for fluorography is a useful method for detecting the loss of swallowing reflex and the decrease of propelling power of bolus. The program of swallowing in the central nervous system can be clarified by the conduction curve of swallowing pressure, and the propelling power of bolus by the classification of swallowing pressure curve. Moreover, the relaxing mechanisms of the esophageal orifice are diagnosed by the measurement of the intraluminal pressure at the pharyngeal end. Less