摘要
目的探讨采用食管膈肌肌电和跨膈肌压评估人体呼吸中枢驱动敏感度的差别。方法研究对象为呼吸疾病国家重点实验室10名健康受试者，男4名，女6名；年龄22～34岁，平均（26±4）岁。采用膈肌功能检测导管记录受试者在二氧化碳重复呼吸时的跨膈肌压和膈肌肌电，开始吸人7％的二氧化碳，直至呼气末二氧化碳浓度达到9％或因呼吸困难不能耐受为止。最大呼吸中枢驱动的吸气动作包括：（1）通过鼻子进行用力最快吸气（Sniff动作）；（2）在功能残气位做最大用力吸气至肺总量（TLC动作）；（3）在功能残气位阻断气流后做最大用力吸气（MIP动作）。采用Pearson相关性检验进行相关性分析，相关系数或斜率的比较采用非参数Mann—WhitneyU检验，多组问比较采用方差分析。结果受试者在二氧化碳重复呼吸过程中，跨膈肌压和膈肌肌电随呼气末二氧化碳浓度增高而增高，膈肌肌电与呼气末二氧化碳浓度的相关系数（r值为0．83～0．98，均P〈0．01）显著大于跨膈肌压与呼气末二氧化碳浓度的相关系数（r值为0．48～0．96，均P〈0．01），差异有统计学意义（Z=-2．731，P〈0．05）；膈肌肌电与呼气末二氧化碳浓度的线性相关斜率（16．3～32．5）显著高于跨膈肌压与呼气末二氧化碳浓度的线性相关斜率（0．4～11．1），差异有统计学意义（Z=-3．780，P〈0．01）。做TLC动作时的膈肌肌电值[（2114-48）IxV]显著大于做MIP和Sniff动作时的膈肌肌电值[（161±48）μV和（145±37）μV]，差异有统计学意义（F=5．931，P〈0．05）；做TLC动作时的跨膈肌压[（58±27）cmH，0，1cmH，0=0．098kPa]显著低于MIP和Sniff动作时的跨膈肌压[（92±32）cmH，O和（95±27）cmH，O]，差异有统计学意义（F=5．155，P〈0．05）。结论食管膈肌肌电在反映人体呼吸中枢驱动方面较跨膈肌压更敏感。
Objective Assessment of neural respiratory drive is useful for diagnosis of dyspnea and respiratmy failure with unknown causes. The purpose of the study was to compare the sensitivity of trandiaphragmatic pressure （Pdi） and diaphragm eleetromyogram （EMGdi） in assessment of neural respiratory drive. Methods A combined catheter with 10 electrodes and 2 balloons was used to record EMGdi and Pdi during CO2 rebreathing. Three different inspiratory maneuvers-inspiration from functional residual capacity to total lung capacity （TLC） , deep inspiration fi＇om functional residual capacity against closed airway （MIP）, and short sharp inspiration through the nose （Sniff） were performed. Ten healthy subjects ~ male 4 and female 6 ; age （ 26 ± 4 ） years ] were studied. Results Linear relationship between EMGdi and end-tidal CO2 （r =0. 83 -0. 98, all P 〈 0. 01 ） was better than that between Pdi and end-tidal CO2（r =0. 48 -0. 96, all P 〈0. 01 ） during CO2 rebreathing, Z = -2. 731, P 〈0. 05. The slope of linear relation between EMGdi and end-tidal CO2 （ 16. 3 - 32. 5 ） was significantly higher than that between Pdi and end-tidal CO2 （0. 4 - 11.1 ） , Z = - 3. 780, P 〈 0. 01. The maximal EMGdi derived from TLC maneuver （211±48）V was larger than those from the MIP maneuver （161 48） V and the Sniff maneuver （145±437） V, F = 5. 931, P 〈 0. 05, whereas the maximal Pdi derived from TLC maneuver （58 ± 27 ） em H2 0 （ 1 cm H2 0 = 0. 098 kPa） was significantly lower than those from the MIP maneuver （92±4 32） em H20 and the Sniff maneuver （95 ±427） cm H20, F = 5. 155, P 〈 0. 05. Conclusion EMGdi is moresensitive than Pdi in the assessment of neural respiratory drive.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2013年第7期493-496,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家自然科学基金（81120108001）
关键词
呼吸中枢
肌电描记术
二氧化碳
Respiratoy center
Eleetromyography
Carbon dioxide
