Stein M, Williams A J, Grossman F, Weinberg A S, Zuckerbraun L
Medical Service, Brotman Medical Center, Culver City.
Chest. 1990 Feb;97(2):347-52. doi: 10.1378/chest.97.2.347.
Dysphagia due to cricopharyngeal dysfunction is well known; however, there have been no previous data indicating an association between cricopharyngeal dysfunction and COPD. After observing marked cricopharyngeal dysfunction with aspiration in three patients who had frequent and severe exacerbations of COPD, we performed pharyngoesophageal examinations with videotaping in another 22 nonrandomized patients. Cineradiography or videofluoroscopic recording with capabilities of slow-motion and freeze-frame playback is mandatory, since the transit time of the bolus through the pharynx is rapid. Severe cricopharyngeal dysfunction was observed in 17 elderly patients with COPD. Deglutition disorders were elicited by careful questioning in 15 of these. In eight subjects, cricopharyngeal myotomy resulted in improvement of swallowing and complete or partial relief of acute exacerbations of respiratory distress. In one subject, myotomy relieved only the swallowing problem. The mechanism of cricopharyngeal dysfunction in elderly patients with COPD is unknown at this time, but may be related to gastroesophageal reflux, therapeutic agents, and/or alterations in pharyngoesophageal anatomic structures. We conclude that investigations for swallowing disorders should be considered in patients with COPD who have frequent acute exacerbations of respiratory distress.
环咽肌功能障碍所致吞咽困难已为人熟知；然而，此前尚无数据表明环咽肌功能障碍与慢性阻塞性肺疾病（COPD）之间存在关联。在观察到3例COPD频繁重度加重患者存在明显的环咽肌功能障碍并伴有误吸后，我们对另外22例非随机患者进行了咽食管检查并录像。必须采用具备慢动作和定格回放功能的动态放射造影或视频荧光透视记录，因为食团通过咽部的时间很快。在17例老年COPD患者中观察到严重的环咽肌功能障碍。通过仔细询问，其中15例存在吞咽障碍。在8例患者中，环咽肌肌切开术改善了吞咽情况，并使急性呼吸窘迫加重完全或部分缓解。在1例患者中，肌切开术仅缓解了吞咽问题。目前老年COPD患者环咽肌功能障碍的机制尚不清楚，但可能与胃食管反流、治疗药物和/或咽食管解剖结构改变有关。我们得出结论，对于呼吸窘迫频繁急性加重的COPD患者，应考虑进行吞咽障碍检查。
