高齢者の液体誤嚥と最大咽頭圧

健常高齢者で液体誤嚥と最大咽頭圧の関係を調査した論文を紹介します。

Butler SG, Stuart A, Wilhelm E, Rees C, Williamson J, Kritchevsky S. The effects of aspiration status, liquid type, and bolus volume on pharyngeal peak pressure in healthy older adults. Dysphagia. 2011 Sep;26(3):225-31.

誤嚥の有無、液体の種類（水か牛乳）、液体の量（5mlか10ml）で咽頭圧と上部食道括約筋圧を測定しました。結果ですが、最大咽頭圧は誤嚥のある高齢者のほうが誤嚥のない高齢者より有意に低かったです。咽頭の上部と下部で咽頭圧を比較すると、上部のほうがより低かったです。下部咽頭圧が誤嚥に関連するかもという結論です。

サルコペニアの嚥下障害を考える時、全身のサルコペニアと同様に、嚥下筋の筋肉量、嚥下筋の筋力、嚥下機能の3つを評価することが重要です。咽頭圧を計測できれば嚥下筋の筋力指標の1つになりうると思われます。そして、咽頭圧と誤嚥に関連を認めるということは、サルコペニアが嚥下障害に関与している可能性が疑われます。

Abstract

The reasons for aspiration in healthy adults remain unknown. Given that the pharyngeal phase of swallowing is a key component of the safe swallow, it was hypothesized that healthy older adults who aspirate are likely to generate less pharyngeal peak pressures when swallowing. Accordingly, pharyngeal and upper esophageal sphincter pressures were examined as a function of aspiration status (i.e., nonaspirator vs. aspirator), sensor location (upper vs. lower pharynx), liquid type (i.e., water vs. milk), and volume (i.e., 5 vs. 10 ml) in healthy older adults. Manometric measurements were acquired with a 2.1-mm catheter during flexible endoscopic evaluation. Participants (N = 19, mean age = 79.2 years) contributed 28 swallows; during 8 swallows, simultaneous manometric measurements of upper and lower pharyngeal and upper esophageal pressures were obtained. Pharyngeal manometric peak pressure was significantly less for aspirators (mean = 82, SD = 31 mmHg) than for nonaspirators (mean = 112, SD = 20 mmHg), and upper pharyngeal pressures (mean = 85, SD = 32 mmHg) generated less pressure than lower pharyngeal pressures (mean = 116, SD = 38 mmHg). Manometric measurements vary with respect to aspiration status and sensor location. Lower pharyngeal pressures in healthy older adults may predispose them to aspiration.