Multidisciplinary study on the organ interrelation between swallowing and regulation of respiration for furthering the quqlity of life in the elderly

近三年来，吞咽与呼吸调节关系的多学科研究结果总结如下：1)综合医院老年住院患者中吸入性肺疾病（APD）的发生率超过2%。2)脑血管疾病、痴呆和恶性肿瘤是APD常见的背景疾病，而日常生活活动功能障碍是APD最重要的危险因素。3)吞咽激发试验（SPT）和manofluorography （MF）等新技术是定量、可重复的吞咽功能评估方法，有助于APD高危患者的早期发现。4)吞咽受双侧脑盖、脑岛和基底节区等多个脑区调控，这些脑区可能协同脑干中枢程序生成吞咽。6) SPT和MF对吞咽功能的评价非常敏感，即使在健康的老年人中也经常发现因年龄而导致的吞咽功能损害。7)通过对吞咽困难患者进行mf评估，验证优化调节饮食内容和频率的有效性。8)前瞻性研究显示，SPT异常患者预计吸入性肺炎的死亡率较高。9)建立APD的临床实体，并在全国范围内开展弥漫性吸入性细支气管炎（DAB）监测。研究显示，DAB在全国各地都有发现，甚至在年轻患者中也有。10)证实APD是影响系统性硬化症（SSc）患者预后的重要因素之一。11)食管评分作为SSc吸痰的新指标，可能有助于APD的早期发现和丙酸预防。12)经皮内镜胃造口术（Percutaneous endoscopic gastrostomy， PEG）是一种有效的营养维持和预防APD的治疗干预措施。这些观察结果揭示了吞咽与呼吸系统之间密切的器官相互关系，并证实了其认识对提高老年人生活质量的意义。少

The results of multidisciplinary study on the relationship between swallowing and regulation of respiration for three years are summarized as follows ; 1) Aspiration pulmonary diseases (APD) were found in more than 2 % of all elderly inpatients in general hospitals. 2) Cerebrovascular diseases, dementia and malignancies are common background diseases, and impairment of active daily life is the most important risk factor of APD.3) The new techniques such as swallowing provocation test (SPT) and manofluorgrapy (MF) are quantitative and reproducible tests for assessment of swallowing function, and are useful for early detection of high-risk patients with APD.They are also helpful for the assessment of therapeutic effectiveness of APD.4) Swallowing appears to be regulated by multiple cerebral regions including bilateral operculum, insula and basal ganglia, and these regions may cooperate in conjunction with brain stem central program generation of deglutition. 5) SPT is helpful to assess t … More he function of second phase of swallowing, and correlates with the bolus passage time in MF.6) SPT and MF are so sensitive for evaluation of swallowing that impaiment by aging is frequently found even in the healthy elderly. 7) The effectiveness of optimal regulation of dietary contents and frequency is verified by evaluating the patients with dysphasia using MF.8) Prospective study revealed that the patients with abnormal SPT findings are predicted to haveaa higher martality rate of aspiration pneumonia. 9) Clinical entity of APD was established and nation-wide surveillance for diffuse aspiration bronchiolitis (DAB) was carried out. The study revealed DAB is found through out the country, and occurs even in younger patients. 10) It is verified that APD is one of important prognostic factors in patients with systemic sclerosis (SSc). 11) Esophagus scores, a new indicator of aspiration in SSc, may be useful for early detection and propylaxic prevention of APD.12) Percutaneous endoscopic gastrostomy (PEG) is confirmed as an effective therapeutic intervention regarding nutritional maintenance and prevention of APD.These observations revealed close organ interrelation between swallowing and respiratory system and confirmed the significance of its understanding to promote quality of life in the elderly. Less