Kendall Katherine A, Leonard Rebecca J, McKenzie Susan W
Department of Otolaryngology, University of California, Davis Medical Center, Sacramento, California 95817, USA.
Dysphagia. 2003 Spring;18(2):85-91. doi: 10.1007/s00455-002-0086-z.
The pharyngeal phase of deglutition is considered to occur in a reflexive, preprogrammed fashion. Previous studies have determined a general sequence of events based on the mean timing of bolus transit and swallowing gestures. Individual variability has not been studied, however. The purpose of this study was to determine the amount of sequence variability that normally occurs during the hypopharyngeal phase of deglutition. Dynamic swallow studies from 60 normal volunteers were evaluated and event sequence variability was determined for 12 two-event sequences during swallowing of three bolus sizes. There was found to be some variability in event sequences for almost all events evaluated except for the following: (1) arytenoid cartilage elevation always began prior to opening of the upper esophageal sphincter, (2) the sphincter always opened prior to the arrival of the bolus at the sphincter, (3) larynx-to-hyoid approximation always occurred after the onset of upper esophageal sphincter opening, and (4) maximum pharyngeal constriction always occurred after maximal distension of the upper esophageal sphincter. Variability was more common during swallowing of the smallest bolus size. This information may be helpful in evaluating event coordination in patients with dysphagia.
吞咽的咽部阶段被认为是以一种反射性、预先设定的方式发生的。先前的研究已根据食团通过和吞咽动作的平均时间确定了一系列大致的事件顺序。然而，尚未对个体差异进行研究。本研究的目的是确定吞咽下咽阶段正常发生的顺序变异性的程度。对60名正常志愿者的动态吞咽研究进行了评估，并确定了在吞咽三种食团大小时12个两事件序列的事件顺序变异性。结果发现，除了以下情况外，几乎所有评估事件的事件序列都存在一定变异性：（1）杓状软骨抬高总是在上食管括约肌开放之前开始；（2）括约肌总是在食团到达括约肌之前开放；（3）喉与舌骨接近总是在上食管括约肌开始开放之后发生；（4）最大咽部收缩总是在上食管括约肌最大扩张之后发生。在吞咽最小食团大小时，变异性更为常见。这些信息可能有助于评估吞咽困难患者的事件协调性。
