Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Center for Dysphagia of Tohoku University Hospital, Sendai, Miyagi, Japan.
Clin Exp Dent Res. 2023 Aug;9(4):670-678. doi: 10.1002/cre2.760. Epub 2023 Jul 5.
Body positions affect swallowing and gastroesophageal reflux. Swallowing impairment is one of the main causes of aspiration pneumonia. To prevent pneumonia, evaluation of body positions on gastroesophageal reflux recommended 30 degrees or higher semi-recumbent positions. The geniohypoid muscle and tongue play central roles in swallowing. However, the effects of body positions on contracting rates in the geniohyoid muscle and tongue pressure are unclear. Moreover, correlations between geniohyoid muscle contracting rates and subjective swallowing difficulties are unclear.
This study aimed to identify the proper body positions on contracting rates in the geniohyoid muscle, tongue pressure, and subjective swallowing difficulties.
MATERIALS & METHODS: Twenty healthy adults swallowed 15- or 50 ml of water at 90 degrees sitting, 60- and 30 degrees semi-recumbent, and 0 degrees supine positions. We scored the subjective swallowing difficulties and measured the tongue pressure and the number of swallows. An ultrasound evaluated the geniohyoid muscle size and contracting rates.
At sitting and 60 degrees semi-recumbent positions, the geniohyoid muscle showed greter contracting rates than at 30 degrees semi-recumbent and supine postions (P < 0.05), which resulted in easier swalloiwng. Greater tongue pressure was weakly correlated with fewer swallows (r = -0.339, P = 0.002), whereas the body positions did not affect.
Considering swallowing and gastroesophageal reflux together, a trunk angle of 60 degrees or more might be beneficial for reducing the risk of aspiration.
体位会影响吞咽和胃食管反流。吞咽障碍是导致吸入性肺炎的主要原因之一。为了预防肺炎,建议将胃食管反流的体位评估为 30 度或更高的半卧位。舌骨下肌群和舌在吞咽中起着核心作用。然而,体位对舌骨下肌群收缩率和舌压的影响尚不清楚。此外,舌骨下肌群收缩率与主观吞咽困难之间的相关性也不清楚。
本研究旨在确定适当的体位,以提高舌骨下肌群的收缩率、舌压和主观吞咽困难。
20 名健康成年人分别在 90 度坐姿、60 度和 30 度半卧位以及 0 度仰卧位下吞咽 15 或 50 毫升水。我们对主观吞咽困难进行评分,并测量舌压和吞咽次数。超声评估舌骨下肌群的大小和收缩率。
在坐姿和 60 度半卧位时,舌骨下肌群的收缩率高于 30 度半卧位和仰卧位(P<0.05),这使得吞咽更加容易。更大的舌压与更少的吞咽次数呈弱相关(r=-0.339,P=0.002),而体位则没有影响。
综合考虑吞咽和胃食管反流,躯干角度为 60 度或更大可能有助于降低吸入的风险。