Lazarus C L, Logemann J A, Rademaker A W, Kahrilas P J, Pajak T, Lazar R, Halper A
Northwestern University, Evanston, IL 60208.
Arch Phys Med Rehabil. 1993 Oct;74(10):1066-70. doi: 10.1016/0003-9993(93)90063-g.
This study examined the effects of bolus volume and viscosity and the variability of repeated swallows in ten stroke patients and ten age-matched nonstroke subjects. The ten stroke patients demonstrated single unilateral cortical (three subjects), subcortical (six subjects), or brainstem (one subject) infarcts on computed tomography or magnetic resonance imaging scans at three weeks post-ictus. All subjects underwent videofluoroscopic swallow studies in which seven temporal pharyngeal swallow measures were examined. Despite the dissimilarity in lesion locations, the swallow physiology in the stroke patients was relatively homogeneous, ie, no swallowing disorders severe enough to prevent oral intake. As bolus volume increased, pharyngeal delay time diminished in stroke patients, but not in nonstroke subjects. Increasing bolus volume affected three other pharyngeal swallow measures similarly in nonstroke and stroke subjects: laryngeal closure durations and cricopharyngeal (CP) opening durations increased and duration of tongue base contact to posterior pharyngeal wall decreased. On viscosity comparisons (liquid vs paste), both subject groups displayed longer duration of base of tongue contact to posterior pharyngeal wall. On paste swallows, nonstroke subjects had longer CP opening and lower swallow efficiency, whereas stroke patients did not. This study found no statistically significant learning/repetition effect for repeated swallows in either subject group, or both groups combined.
本研究调查了10名中风患者和10名年龄匹配的非中风受试者的团块体积、粘度以及重复吞咽的变异性的影响。10名中风患者在发病三周后的计算机断层扫描或磁共振成像扫描中显示出单侧皮质（3名受试者）、皮质下（6名受试者）或脑干（1名受试者）梗死。所有受试者均接受了视频荧光吞咽研究，其中检查了七个咽部吞咽时间指标。尽管病变位置不同，但中风患者的吞咽生理相对一致，即没有严重到足以妨碍经口摄入的吞咽障碍。随着团块体积增加，中风患者的咽部延迟时间缩短，但非中风受试者没有。增加团块体积对非中风和中风受试者的其他三个咽部吞咽指标有类似影响：喉关闭持续时间和环咽肌（CP）开放持续时间增加，舌根与咽后壁接触持续时间减少。在粘度比较（液体与糊状物）中，两组受试者的舌根与咽后壁接触持续时间都更长。在吞咽糊状物时，非中风受试者的CP开放时间更长且吞咽效率更低，而中风患者则没有。本研究发现，在任何一组受试者或两组受试者合并的情况下，重复吞咽均无统计学上显著的学习/重复效应。
