記述言語：日本語   出版者・発行元：(一社)日本摂食嚥下リハビリテーション学会  

【目的】精神科病院の病棟内食堂で食事摂取可能な入院患者における誤嚥性肺炎リスクの影響要因を明らかにし、誤嚥性肺炎予防に向けた支援への示唆を得るために調査研究を行った。【方法】対象者は、A精神科病院入院患者約400名のうち、病棟内食堂で食事摂取可能な20歳以上85歳未満の者100名とした。対象者を誤嚥性肺炎リスク評価により高・中・低リスクに分け、その群のそれぞれの基本属性、日常生活の状況、食事摂取の状況、栄養状態(Body Mass Index:BMI、Geriatric Nutritional Risk Index:GNRI)、血液生化学所見(Total Protein:TP、Albumin:Alb、Hemoglobin:Hb、Hematocrit:Ht、White Blood Cell:WBC)を調査し、統計学的に検討した。【結果】対象者のうち、高リスク群0名、中等度リスク群24名、低リスク群76名であった。群間比較において、年齢は、中等度リスク群で有意に高値であった。BMI、GNRI、Ht、Hb、Peak Expiratory Flow:PEF、Repetitive Saliva Swallowing Test:RSSTは、中等度リスク群で有意に低値であった。Spearmanの順位相関係数では、年齢、BMI、GNRI、Alb、Ht、Hb、PEF、RSSTにおいて相関を認めた。二項ロジスティック回帰分析において、BMI、PEF、RSSTが独立変数として得られた。【結論】精神科病院の病棟内食堂で食事摂取可能な入院患者における誤嚥性肺炎リスクの影響要因は、BMI、PEF、RSSTの低下であることが示唆された。誤嚥性肺炎予防に向けた支援として、栄養状態や呼吸機能、嚥下機能の維持・改善を目指す取り組みが必要と考える。(著者抄録)

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掲載種別：研究論文（学術雑誌）   出版者・発行元：American Physiological Society  

The initiation of swallowing evoked by laryngeal capsaicin and carbonated water application was diminished by the coapplication of QX-314 and capsaicin. Carbonated water-evoked swallows were also abolished by transection of the superior laryngeal nerves and were inhibited by the acid-sensing ion channel-3 inhibitor. Capsaicin-sensitive nerves are involved in the initiation of carbonated-water-evoked swallows.

DOI： 10.1152/ajpgi.00233.2020

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掲載種別：研究論文（学術雑誌）   出版者・発行元：American Physiological Society  

Although a transient receptor potential vanilloid 1 (TRPV1) inhibitor or TRPV1-expressed neuronal inhibitor significantly inhibited HCl/capsaicin-evoked swallowing, air flow-induced swallowing was not affected. The number of air flow-induced swallows was significantly reduced within 60 min of TRPV1 activation. Evans blue dye concentration in the larynx increased 60 min after capsaicin application. TPRV1 activation not only desensitizes TRPV1 but also inactivates mechanoreceptors caused by increases in vascular permeability and edema.

DOI： 10.1152/ajpgi.00082.2020

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.brainres.2018.05.002

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掲載種別：研究論文（学術雑誌）   出版者・発行元：American Physiological Society  

Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates.

NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper esophageal sphincter negative pressure during swallowing.

DOI： 10.1152/japplphysiol.00944.2017

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Physiological Society  

Dysphagia is caused not only by neurological and/or structural damage but also by medication. We hypothesized memantine, dextromethorphan, diazepam, and baclofen, all commonly used drugs with central sites of action, may regulate swallowing function. Swallows were evoked by upper airway (UA)/pharyngeal distension, punctate mechanical stimulation using a von Frey filament, capsaicin or distilled water (DW) applied topically to the vocal folds, and electrical stimulation of a superior laryngeal nerve (SLN) in anesthetized rats and were documented by recording electromyographic activation of the suprahyoid and thyrohyoid muscles and by visualizing laryngeal elevation. The effects of intraperitoneal or topical administration of each drug on swallowing function were studied. Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABA_A receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABA_B receptor antagonist diminished the effects of baclofen. Topically applied diazepam or baclofen had no effect on swallowing. These data indicate that diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats.

NEW & NOTEWORTHY Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABA_A receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABA_B receptor antagonist diminished the effects of baclofen. Topical applied diazepam or baclofen was without effect on swallowing. Diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats.

DOI： 10.1152/ajpgi.00299.2016

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.brainresbull.2016.02.015

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担当区分：筆頭著者  

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