Shaker R, Milbrath M, Ren J, Campbell B, Toohill R, Hogan W
Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
Gastroenterology. 1995 May;108(5):1357-60. doi: 10.1016/0016-5085(95)90682-7.
BACKGROUND/AIMS: Deglutitive aspiration in patients with tracheostomy has been attributed to impaired laryngeal movement, loss of protective laryngeal reflexes, and uncoordinated laryngeal closure. The aim of this study was to determine the effect of tracheostomy on the duration of deglutitive vocal cord closure.
Using concurrent videoendoscopy, respirography, and submental electromyography, deglutitive vocal cord closure and its temporal relationship with deglutitive apnea was compared between patients with tracheostomy and normal volunteers.
Between-group comparison showed that the duration of vocal cord adduction/abduction in patients with tracheostomy was significantly shorter than that of normal volunteers (P < 0.05). Contrary to normal volunteers, in patients with tracheostomy, 5-mL water swallows significantly increased the duration of vocal cord adduction/abduction compared with that of dry swallows (P < 0.05). In addition, in patients with tracheostomy, deglutitive apnea and submental electromyography were not coordinated with vocal cord kinetics.
Although the vocal cords close completely during swallowing in patients with tracheostomy, their duration of closure is significantly shorter compared with normal volunteers. Coordination of deglutitive vocal cord kinetics, apnea, and submental electromyography is altered in patients with tracheostomy. Contrary to normal controls, duration of deglutitive vocal cord closure in patients with tracheostomy is modified by the presence of liquid bolus.
背景/目的：气管切开患者的吞咽性误吸被认为与喉运动受损、保护性喉反射丧失及喉关闭不协调有关。本研究的目的是确定气管切开对吞咽时声带关闭持续时间的影响。
通过同步视频内镜检查、呼吸描记法和颏下肌电图，比较气管切开患者与正常志愿者吞咽时声带关闭情况及其与吞咽性呼吸暂停的时间关系。
组间比较显示，气管切开患者声带内收/外展的持续时间明显短于正常志愿者（P < 0.05）。与正常志愿者不同，气管切开患者吞咽5毫升水时声带内收/外展的持续时间比吞咽干食时明显增加（P < 0.05）。此外，气管切开患者的吞咽性呼吸暂停和颏下肌电图与声带运动不协调。
虽然气管切开患者吞咽时声带完全关闭，但其关闭持续时间明显短于正常志愿者。气管切开患者吞咽时声带运动、呼吸暂停和颏下肌电图的协调性发生改变。与正常对照不同，气管切开患者吞咽时声带关闭的持续时间受液体团块的影响。
