Kunieda Kenjiro, Fujishima Ichiro, Okamoto Keishi, Suzuki Saori, Naganuma Satoe, Ohno Tomohisa, Sugi Takafumi, Tanahashi Kazuo, Shigematsu Takashi, Yagi Naomi, Oku Yoshitaka
Department of Neurology, Gifu University Graduate School of Medicine, Gifu City, Japan.
Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan.
Prog Rehabil Med. 2025 Apr 22;10:20250011. doi: 10.2490/prm.20250011. eCollection 2025.
Vacuum swallowing improves pharyngeal bolus passage by creating negative pressure in the esophagus. In this study, we aimed to (1) assess whether patients with dysphagia and lateral medullary syndrome (LMS) could reproduce vacuum swallowing and (2) evaluate its safety using a swallowing and breathing monitoring system (SBMS).
Two patients with dysphagia and LMS were instructed to perform vacuum swallowing. Videofluoroscopic examination of swallowing (VF) was performed. High-resolution manometry parameters, including the esophageal minimum pressure (Pmin) and maximum pressure (Pmax) in the lower esophageal sphincter, were compared to the values obtained during non-vacuum swallowing. The coordination between vacuum swallowing and breathing was evaluated using an SBMS. VF showed that pharyngeal residues in the pyriform sinus were sucked into the esophagus during vacuum swallowing. No aspiration was observed. During vacuum swallowing, Pmin was significantly lower, and Pmax was significantly higher than the respective measurements during non-vacuum swallowing. In the SBMS study, vacuum swallowing followed an expiratory swallowing pattern; this pattern was observed in three out of five swallowing episodes in Patient 1 and in all swallowing episodes in Patient 2. Deglutition apnea was observed during vacuum swallowing.
Vacuum swallowing may be a feasible method for improving pharyngeal bolus passage. Patients could safely master vacuum swallowing. Instructions to exhale before and after vacuum swallowing are recommended to prevent aspiration.
吞咽时产生负压可改善食管内食团通过情况。本研究旨在：（1）评估吞咽困难合并延髓外侧综合征（LMS）患者是否能进行吞咽时产生负压的动作；（2）使用吞咽与呼吸监测系统（SBMS）评估其安全性。
两名吞咽困难合并LMS的患者接受了吞咽时产生负压动作的指导。进行了吞咽的视频荧光透视检查（VF）。将包括食管下括约肌的食管最小压力（Pmin）和最大压力（Pmax）在内的高分辨率测压参数与非吞咽时产生负压动作期间获得的值进行比较。使用SBMS评估吞咽时产生负压动作与呼吸之间的协调性。VF显示，吞咽时梨状窝内的咽部残留物被吸入食管。未观察到误吸。在吞咽时产生负压动作期间，Pmin显著降低，Pmax显著高于非吞咽时产生负压动作期间的相应测量值。在SBMS研究中，吞咽时产生负压动作遵循呼气吞咽模式；在患者1的五次吞咽发作中有三次观察到这种模式，在患者2的所有吞咽发作中均观察到。在吞咽时产生负压动作期间观察到吞咽呼吸暂停。
吞咽时产生负压动作可能是改善咽部食团通过的一种可行方法。患者可以安全地掌握吞咽时产生负压动作。建议在吞咽时产生负压动作前后呼气以防止误吸。
