健康成人吞咽液体过程中舌压变化的研究

The study of tongue pressure during swallowing liquid in healthy adults

目的 研究健康成人生理性吞咽液体过程中的舌压变化规律,为临床评估吞咽功能和诊断吞咽障碍提供可能.方法 13名健康成年男性（24～31岁）志愿者直立坐位吞咽5 ml水,用舌压传感器测量吞咽过程中舌与硬腭中线前、中和后部以及硬腭两侧后部接触产生舌压的变化,同时将麦克风记录吞咽音的发生时间做为参考时间.比较吞咽时各位点舌压变化相关参数.结果 正常吞咽时,硬腭中线上舌压由前向后逐渐发生[（-0.40±0.22）s、（-0.36±0.21）s、（-0.24±0.18）s],硬腭两侧后部舌压[（-0.38±0.23）s、（-0.40±0.23）s]与硬腭中线前部舌压产生时间相似（P＞0.05）;以上各位点舌压峰值出现时间[（-0.12±0.24）s、（-0.16±0.22）s、（-0.13±0.21）s、（-0.16±0.23）s、（-0.17±0.23）s]接近（P＞0.05）,且早于吞咽音发生时间（P＜0.05）,舌压消失时间接近[（0.32±0.23）s、（0.27±0.21）s、（0.23±0.16）s、（0.33±0.31）s、（0.33±0.29）s]（P＞0.05）,且晚于吞咽音发生时间（P＜0.05）.无论是舌压持续时间、舌压峰值时间、舌压回落时间、舌压峰值及舌压积分值,均是腭中线后部的数值最小,而腭后部双侧上述参数相似（P＞0.05）.结论 吞咽时舌与硬腭接触各位点产生的舌压存在精确协调性;舌压传感器为无创简单评估吞咽功能和诊断吞咽障碍提供了可能.

Objective To investigate the tongue pressure（TP） produced by tongue-hard palate contact in the process of normally swallowing liquid in healthy adults.Methods Thirteen adult male subjects were recruited to perform a single swallow of 5 ml water when sitting with upright position.The tongue pressure sensor sheet was used to monitor TP as a result of tongue-hard palate approximatation in the anteriomedian,midmedian,posteriomedian and circumferential parts,and the swallowing sound was recorded by microphone.The temporal sequence of TP at each measured part was obtained after setting the swallowing sound as the reference time.Also,the total duration,pre-peak duration,post-peak duration,maximum magnitude and integrated value of TP were recorded and compared among the measured parts.Results TP was produced from anterior to posterior along the midline of hard palate during normal swallowing of water[Ch1：（-0.40±0.22） s,Ch2：（-0.36±0.21） s,Ch3：（-0.24±0.18） s],with the circumferential TP[Ch4：（-0.38±0.23） s,Ch5：（-0.40±0.23） s] occurring nearly to the anteriomedian one（P〉0.05）.Before the swallowing sound（P〈0.05）,TP at each part reached a peak synchronously[Ch 1 （-0.12±0.24） s,Ch2：（-0.16± 0.22） s,Ch3：（-0.13±0.21） s,Ch4：（-0.16±0.23） s,Ch5：（-0.17±0.23） s] in a rapid manner（P〉0.05）,then decreased gradually until disappeared simultaneously[Ch 1：（0.32±0.23） s,Ch2：（0.27±0.21） s,Ch3：（0.23±0.16） s,Ch4：（0.33±0.31） s,Ch5：（0.33±0.29） s]（P〉0.05） after the swallowing sound（P〈0.05）.The TP related parameters（the total duration of TP：Ch1：（0.72±0.20） s,Ch2：（0.63±0.16） s,Ch3：（0.47±0.17） s,Ch4：（0.70± 0.35） s,Ch5：（0.73±0.29） s; the pre-peak duration ofTP：Ch1：（0.28±0.21） s,Ch2：（0.20±0.16） s,Ch3：（0.12± 0.10） s,Ch4：（0.21±0.22） s,Ch5：（0.23±0.21） s; the post-peak duration of TP：Ch1：（0.44±0.23） s,Ch2：（0.43± 0.18） s,Ch3：（0.36±0.18） s,Ch4：（0.49±0.25） s,Ch5：（0.50±0.23） s; the maximum magnitude of TP：Ch1：（13.80±7.73） kPa,Ch2：（12.40±6.51） kPa,Ch3：（10.26±7.15） kPa,Ch4：（12.16±5.38） kPa,Ch5：（13.08± 5.05） kPa; the integrated value ofTP：Ch1：（4.99±3.69） kPa×s,Ch2：（4.25±2.13） kPa×s,Ch3：（2.88±1.87） kPa× s,Ch4：（4.32± 3.47） kPa× s,Ch5：（4.63± 2.49） kPa×s were significantly smaller in the posteriomedian part among all the five parts measured.No laterality was found in TP produced at the circumferential parts of the hard palate（P〉0.05）.Conclusions The TP at each part coordinates precisely during swallowing.The effective measurement of TP by tongue pressure sensor sheet will facilitate the evaluation of oral swallowing and the diagnosis of dysphagia simply and non-invasively.