Dantas R O, Kern M K, Massey B T, Dodds W J, Kahrilas P J, Brasseur J G, Cook I J, Lang I M
Department of Medicine, Medical College of Wisconsin, Milwaukee 53226.
Am J Physiol. 1990 May;258(5 Pt 1):G675-81. doi: 10.1152/ajpgi.1990.258.5.G675.
In this investigation, we studied the effects of bolus volume and viscosity on the quantitative features of the oral and pharyngeal phases of swallowing. Concurrent videofluoroscopic and manometric studies were done in 10 healthy volunteers who were imaged in lateral projection. Videofluorography was done at 30 frames/s while concurrent manometry was done with 5 intraluminal transducers that straddled the pharynx and upper esophageal sphincter (UES). Submental electromyography was recorded also. Swallows of 2-20 ml were recorded for low-viscosity liquid barium and high-viscosity paste barium. Analysis indicated that the major effect of increases in bolus volume was an earlier onset of anterior tongue base movement, superior palatal movement, anterior laryngeal movement, and UES opening. These events provide receptive adaptation for receiving a swallowed bolus. Earlier UES opening was associated with an increase in the duration of sphincter opening and sphincter diameter. The major effects of high bolus viscosity, unrelated to bolus volume, were to delay oral and pharyngeal bolus transit, increase the duration of pharyngeal peristaltic waves, and prolong and increase UES opening. Thus the specific effect of bolus viscosity per se differs substantially from that of bolus volume. We conclude that 1) specific variables of swallowing are affected significantly by the variables of the swallowed bolus, such as volume and viscosity; 2) overall, bolus volume and viscosity affect swallowing in a different manner; and 3) the study findings have implications about the neural control mechanisms that govern swallowing as well as about the diagnosis and treatment of patients with abnormal oral-pharyngeal swallowing.
在本研究中，我们探讨了团块体积和黏度对吞咽口腔期和咽期定量特征的影响。对10名健康志愿者进行了同步视频荧光造影和测压研究，这些志愿者以侧位投影成像。视频荧光造影以每秒30帧的速度进行，同时使用5个跨咽和食管上括约肌（UES）的腔内换能器进行同步测压。还记录了颏下肌电图。记录了2 - 20毫升低黏度液体钡剂和高黏度糊状钡剂的吞咽情况。分析表明，团块体积增加的主要影响是舌根部向前运动、腭部向上运动、喉部向前运动和UES开放的起始时间提前。这些事件为接收吞咽的团块提供了适应性准备。UES开放提前与括约肌开放持续时间和括约肌直径增加有关。高团块黏度的主要影响（与团块体积无关）是延迟口腔和咽部团块的通过、增加咽部蠕动波的持续时间以及延长和增加UES开放。因此，团块黏度本身的特定影响与团块体积的影响有很大不同。我们得出结论：1）吞咽的特定变量受到吞咽团块的变量（如体积和黏度）的显著影响；2）总体而言，团块体积和黏度以不同方式影响吞咽；3）研究结果对控制吞咽的神经控制机制以及对口咽吞咽异常患者的诊断和治疗具有启示意义。
