与头部转动和收下巴相关的咽部吞咽压力事件的高分辨率测压法。
High-resolution manometry of pharyngeal swallow pressure events associated with head turn and chin tuck.
作者信息
McCulloch Timothy M, Hoffman Matthew R, Ciucci Michelle R
机构信息
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
出版信息
Ann Otol Rhinol Laryngol. 2010 Jun;119(6):369-76. doi: 10.1177/000348941011900602.
OBJECTIVES
We quantified the effect of swallowing maneuvers on pharyngeal pressure events using high-resolution manometry.
METHODS
Seven subjects swallowed multiple 5-mL water boluses in 3 different postural conditions: neutral, head turn, and chin tuck. Pressure and timing events were recorded with a 36-sensor high-resolution manometry catheter. We analyzed the regions of the velopharynx and the base of the tongue for maximum pressure, rate of pressure increase, pressure gradient, and duration of pressure above baseline. In the region of the upper esophageal sphincter (UES), we analyzed the duration of pressure declination, minimum pressure during UES opening, and maximum pressures before and after UES opening.
RESULTS
The maneuvers did not have a significant effect on maximum pressure, rate of pressure increase, or pressure gradients in the velopharyngeal or tongue base regions. The duration of pressure above baseline was significantly longer in the velopharynx for head turn. The preswallow maximum UES pressure was significantly greater for neutral swallows than for head turn, and the postswallow maximum pressure was significantly lower for chin tuck. Both maneuvers appeared to prolong UES pressure declination duration, but neither prolongation reached significance.
CONCLUSIONS
High-resolution manometry allows for optimal spatial and temporal resolution during recording of pressure events along the length of the pharynx, and revealed previously undetected task-dependent pressure and timing differences during chin tuck and head turn in healthy adults. These maneuvers appear to influence the UES to a greater degree than the velopharynx or the tongue base. Further studies designed to quantify the effect of other maneuvers and bolus consistencies on the generation of pharyngeal pressure events both in normal and in disordered subjects may lead to hypothesis-driven, optimal, individualized swallowing therapies.
目的
我们使用高分辨率测压法量化吞咽动作对咽部压力事件的影响。
方法
7名受试者在3种不同体位条件下吞咽多次5毫升水团：中立位、转头位和收颌位。使用36传感器高分辨率测压导管记录压力和时间事件。我们分析了腭咽和舌根区域的最大压力、压力上升速率、压力梯度以及高于基线的压力持续时间。在上食管括约肌（UES）区域，我们分析了压力下降持续时间、UES开放时的最小压力以及UES开放前后的最大压力。
结果
这些动作对腭咽或舌根区域的最大压力、压力上升速率或压力梯度没有显著影响。转头位时，腭咽高于基线的压力持续时间显著更长。中立位吞咽时UES吞咽前的最大压力显著高于转头位，收颌位吞咽后最大压力显著更低。两种动作似乎都延长了UES压力下降持续时间，但延长均未达到显著水平。
结论
高分辨率测压法在记录咽部长度上的压力事件时能实现最佳的空间和时间分辨率，并揭示了健康成年人在收颌和转头时先前未被发现的任务依赖性压力和时间差异。这些动作对UES的影响似乎比对腭咽或舌根的影响更大。旨在量化其他动作和食团黏稠度对正常和患病受试者咽部压力事件产生的影响的进一步研究，可能会导致基于假设的、最佳的、个性化的吞咽治疗方法。
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