Ren J, Shaker R, Zamir Z, Dodds W J, Hogan W J, Hoffmann R G
Medical College of Wisconsin Dysphagia Institute, Milwaukee.
Am J Gastroenterol. 1993 May;88(5):665-9.
We studied 1) the effect of age and bolus variables on a) the coordination of deglutitive vocal cord adduction and upper esophageal sphincter (UES) relaxation and b) the duration of deglutitive vocal cord adduction; 2) the effect of the presence of a manometric catheter across the UES on the deglutitive glottal function; and 3) the temporal relationship between deglutitive vocal cord closure and swallow-induced apnea. We studied 10 young (23 +/- 2 yr) and 10 healthy elderly (73 +/- 2 yr) volunteers by concurrent videoendoscopy, UES manometry, respirography, and submental surface electromyography. In both groups the onset of vocal cord adduction preceded the onset of UES relaxation, deglutitive apnea, and submental electromyogram swallowing signal. In both groups, bolus volume and temperature did not have any significant effect on the duration of deglutitive vocal cord adduction. In both young and elderly volunteers, water swallows, compared with dry swallows, significantly shortened the interval between the onset of deglutitive vocal cord adduction and the onset of UES relaxation. In conclusion, coordination between deglutitive glottal and UES function, as well as the duration of deglutitive vocal cord adduction, is preserved in the elderly. Bolus volume and temperature do not have a modulatory effect on the duration of vocal cord closure, but water swallow shortens the interval between the onset of glottal closure and UES relaxation. This shortened interval may contribute to the safety of the airway during swallowing of liquid volumes.
1）年龄和推注变量对a）吞咽时声带内收与食管上括约肌（UES）松弛的协调性以及b）吞咽时声带内收持续时间的影响；2）一根测压导管穿过UES对吞咽时声门功能的影响；3）吞咽时声带闭合与吞咽诱发的呼吸暂停之间的时间关系。我们通过同步视频内镜检查、UES测压、呼吸描记法和颏下表面肌电图，对10名年轻（23±2岁）和10名健康老年（73±2岁）志愿者进行了研究。在两组中，声带内收的起始均先于UES松弛、吞咽性呼吸暂停和颏下肌电图吞咽信号的起始。在两组中，推注量和温度对吞咽时声带内收的持续时间均无显著影响。在年轻和老年志愿者中，与干吞相比，水吞咽显著缩短了吞咽时声带内收起始与UES松弛起始之间的间隔。总之，老年人吞咽时声门与UES功能之间的协调性以及吞咽时声带内收的持续时间得以保留。推注量和温度对声带闭合持续时间无调节作用，但水吞咽缩短了声门闭合起始与UES松弛之间的间隔。这种缩短的间隔可能有助于在吞咽液体量时气道的安全。
