帕金森病患者的呼吸-吞咽协调及其与咽部残留、渗透和吸入的关系。
Respiratory-Swallow Coordination and Its Relationship With Pharyngeal Residue, Penetration, and Aspiration in People With Parkinson's Disease.
机构信息
Aerodigestive Innovations Research Lab, Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medicine, Cornell University, New York, NY.
Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY.
出版信息
J Speech Lang Hear Res. 2024 Nov 7;67(11):4314-4338. doi: 10.1044/2024_JSLHR-24-00056. Epub 2024 Oct 10.
PURPOSE
Respiratory-swallow coordination (RSC) frequently changes in people with Parkinson's disease (PwPD). Little is known about how these changes relate to impairments in swallowing safety (penetration and aspiration) and efficiency (pharyngeal residue). Therefore, the aims of this study were to assess the relationships between RSC, pharyngeal residue, penetration, and aspiration in PwPD.
METHOD
Twenty-four PwPD were recruited to undergo simultaneous assessment of RSC, swallowing safety, and swallowing efficiency. RSC was assessed using respiratory inductive plethysmography and nasal airflow and included measurements of respiratory pause duration, respiratory phase patterning, and lung volume during swallowing. Swallowing safety and efficiency were assessed using flexible endoscopic evaluation of swallowing, analyzed using the Visual Analysis of Swallowing Efficiency and Safety, and included measurements of pharyngeal residue, penetration, and aspiration. All data were blindly analyzed, with 20% of the data repeated for interrater reliability assessment. Multilevel statistical models were used to examine the relationships between RSC and swallowing.
RESULTS
A total of 812 swallows were analyzed from 24 participants. Only 33.4% of swallows exhibited the typical exhale-swallow-exhale pattern. Additionally, 95% of participants exhibited abnormal swallow function. More severe hypopharyngeal residue ratings were associated with inhaling before the swallow compared to exhaling before the swallow. Additionally, more severe events of penetration and aspiration were associated with (a) inhaling before the swallow compared to exhaling before the swallow, (b) inhaling after the swallow compared to exhaling after the swallow, and (c) longer swallow-related respiratory pause durations. Inhaling after the swallow exhibited the strongest relationship with impairments in swallowing safety when compared to all other RSC variables.
CONCLUSIONS
RSC exhibited significant relationships with pharyngeal residue, penetration, and aspiration in these PwPD. Clinicians should attend to RSC when assessing swallowing in PwPD. Future research is needed to examine if training an exhale-swallow-exhale pattern can be used to improve disordered swallowing in PwPD.
OPEN SCIENCE FORM
目的
帕金森病（PD）患者的呼吸-吞咽协调性（RSC）经常发生变化。对于这些变化与吞咽安全性（渗透和吸入）和效率（咽部残留）之间的关系知之甚少。因此，本研究旨在评估 PD 患者的 RSC、咽部残留、渗透和吸入之间的关系。
方法
招募了 24 名 PD 患者，同时进行 RSC、吞咽安全性和吞咽效率评估。RSC 通过呼吸感应体积描记法和鼻气流进行评估，包括呼吸暂停持续时间、呼吸相位模式和吞咽时肺容量的测量。吞咽安全性和效率通过吞咽的灵活内镜评估进行评估，使用吞咽效率和安全性的视觉分析进行分析，包括咽部残留、渗透和吸入的测量。所有数据均进行盲法分析，20%的数据进行重复性评估。使用多级统计模型来检查 RSC 与吞咽之间的关系。
结果
共分析了 24 名参与者的 812 次吞咽。仅有 33.4%的吞咽表现出典型的呼气-吞咽-呼气模式。此外，95%的参与者表现出异常的吞咽功能。与吞咽前呼气相比，吞咽前吸气与更严重的下咽残留评分相关。此外，更严重的渗透和吸入事件与（a）吞咽前吸气与吞咽前呼气相比，（b）吞咽后吸气与吞咽后呼气相比，以及（c）与吞咽相关的呼吸暂停持续时间较长有关。与所有其他 RSC 变量相比，吞咽后吸气与吞咽安全性受损的关系最强。
结论
RSC 与 PD 患者的咽部残留、渗透和吸入之间存在显著关系。临床医生在评估 PD 患者的吞咽时应注意 RSC。需要进一步研究以检验训练呼气-吞咽-呼气模式是否可用于改善 PD 患者的吞咽障碍。
Zotero 插件