天津医药

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慢性阻塞性肺疾病急性加重期患者的膈神经电生理研究

朱炬1,王渝1,张哲成1,刘娜2,徐磊3,秦英智1,杨新忠4   

  1. 1. 天津市第三中心医院
    2. 第三中心医院神经内科
    3. 天津市第三中心医院ICU
    4. 天津市第三中心医院脑内
  • 收稿日期:2010-12-24 修回日期:2011-04-18 出版日期:2011-10-15 发布日期:2011-10-15
  • 通讯作者: 张哲成

Electrophysiological studies of phrenic nerve in patients with acute exacerbation of chronic obstructive pulmonary disease

  • Received:2010-12-24 Revised:2011-04-18 Published:2011-10-15 Online:2011-10-15

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摘要： 目的：探讨慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者膈神经运动传导(PNC)及磁刺激膈肌运动诱发电位(dMEP)的特点。方法：借助于Keypoint4肌电诱发电位仪和Magpro Compact型磁刺激器对20例因呼吸衰竭而行机械通气的AECOPD患者进行PNC检测和dMEP检测。选取20例同期健康体检者为对照组。结果：与对照组比较，AECOPD组脱机前PNC潜伏期延长，波幅对数值减低，经C7棘突磁刺激dMEP潜伏期、经皮层磁刺激dMEP潜伏期和中枢运动传导时间(CMCT)延长，经C7棘突磁刺激dMEP波幅对数值减低(P<0.01)，经皮层磁刺激dMEP波幅对数值差异无统计学意义(P>0.05)。AECOPD组13例患者脱机后复检，PNC潜伏期及波幅对数值、经C7棘突磁刺激dMEP潜伏期及波幅对数值、经皮层磁刺激dMEP波幅对数值与对照组相比差异情况同脱机前，而经皮层磁刺激dMEP潜伏期、CMCT与对照组差异无统计学意义(均P>0.05)。结论：AECOPD患者可存在膈神经和(或)膈肌功能不全及呼吸中枢运动传导功能异常，PNC及磁刺激dMEP联合应用对评价AECOPD患者膈神经、膈肌及呼吸中枢运动传导功能状态有一定参考价值。

关键词: 肺疾病, 慢性阻塞性, 呼吸功能不全, 膈神经, 呼吸, 人工, 神经传导, 诱发电位

Abstract: Objective: To investigate the characteristics of phrenic nerve motor conduction (PNC) and motor evoked potentials of diaphragm elicited through magnetic stimulation (dMEP) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who experienced acute respiratory failure. Methods: PNC and dMEP were performed in 20 AECOPD patients who experienced acute respiratory failure enough to require mechanical ventilation with a Keypoint 4 electromyography device and a Magpro Compact magnetic stimulator. 20 healthy subjects were chosen as a control group. Results: The latency of PNC in AECOPD group was longer than that of the control group (P<0.01); the common logarithm of the amplitude of PNC was lower in AECOPD group than that of the control group (P<0.01); the latencies of cervical and cortical dMEP, CMCT in AECOPD group were longer than those of the control group (P<0.01 for each); the common logarithm of the amplitude of cervical dMEP in AECOPD group was decreased compared with that of the control group (P<0.01); it showed no statistical difference between two groups in the common logarithm of the amplitude of cortical dMEP (P>0.05).13 patients in AECOPD group were reexamined after weaning, the differences between two groups were the same as before weaning in latency and the common logarithm of the amplitude of PNC, the latency and the common logarithm of the amplitude of cervical dMEP and the common logarithm of the amplitude of cortical dMEP; there were no statistical differences between two groups in the latencies of cortical dMEP and CMCT (P>0.05 for each). Conclusion: There may exist dysfunction of respiratory central motor conduction, phrenic nerve and (or) diaphragm in AECOPD patients, the combined use of PNC and dMEP may help evaluate the function of phrenic nerve, diaphragm and respiratory central motor conduction in AECOPD patients.

Key words: pulmonary disease, chronic obstructiverespiratory insufficiencyphrenic nerverespiration, artificialneural conductionevoked potentials, motortranscranial magnetic stimulationelectrophysiology, 诱发电位