RESPIRATORY MUSCLE COMPENSATION FOR UNILATERAL OR BILATERAL HEMIDIAPHRAGM PARALYSIS IN AWAKE CANINES
RESPIRATORY MUSCLE COMPENSATION FOR UNILATERAL OR BILATERAL HEMIDIAPHRAGM PARALYSIS IN AWAKE CANINES
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DOI：
10.1152/jappl.1994.77.4.1972
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发表时间：
1994-10-01
影响因子：
3.3
通讯作者：
EASTON, PA
中科院分区：
文献类型：
--
作者：
KATAGIRI, M;YOUNG, RN;EASTON, PA
在人类和一些动物中，幸存的呼吸肌能够完全补偿单侧瘫痪，部分补偿双侧半膈瘫痪。为了研究单侧或双侧膈肌麻痹后个体呼吸肌的活动差异，在三种情况下，在5只清醒的犬中，直接用声速测量传感器和双极肌电电极测量左肋和脚膈肌段、胸骨旁肋间肌段和腹横肌段的长度和肌电图（EMG）：在正常呼吸（NOFRZ）、经颈膈神经套输注局麻药（布比卡因）诱导可逆性对侧半膈（CNFRZ）和双侧膈（BIFRZ）麻痹后。从NOFRZ到CNFRZ，肋肌、脚肌、胸骨旁肌和腹横肌的缩短和肌电图活动增加，以补偿对侧膈肌麻痹，但每种肌肉的活动增加并不相等。使用BIFRZ时，胸骨旁肌和腹横肌的活动进一步增加，在吸气和呼气之间协调一致。随着麻痹的恶化，规范化的呼吸内概况揭示了每次呼吸中肌肉活动发展的动态差异。对同步肌肉活动的回顾显示补偿肌肉之间的协调相互作用：横肌被动缩短，肋肌和脚肌延长，同时胸骨旁肌主动吸气缩短。我们得出结论，胸壁肌、腹部肌和膈肌节段肌对单侧或双侧膈肌麻痹的呼吸肌代偿是一种综合策略，根据膈肌功能障碍的程度调整各个肌肉的相对贡献。
In humans and some animals, the surviving respiratory muscles are able to compensate fully for unilateral, and partially for bilateral, hemidiaphragm paralysis. To examine differential activity of individual respiratory muscles after unilateral or bilateral diaphragm paralysis, length and electromyogram (EMG) of left costal and crural diaphragm segments, parasternal intercostal, and transversus abdominis were measured directly in five awake canines after implantation with sonomicrometry transducers and bipolar EMG electrodes under three conditions: during normal breathing (NOFRZ), after infusion of local anesthetic (bupivacaine) through a cervical phrenic nerve cuff to induce reversible contralateral hemidiaphragm (CNFRZ), and after bilateral diaphragm (BIFRZ) paralysis. From NOFRZ to CNFRZ, costal, crural, parasternal, and transversus abdominis increased shortening and EMG activity to compensate for contralateral diaphragm paralysis, but the increase in activity was not equivalent for each muscle. With BIFRZ, parasternal and transversus abdominis showed further increases in activity, coordinated between both inspiration and expiration. Normalized intrabreath profiles revealed dynamic differences in development of muscle activity within each breath as paralysis worsened. Review of simultaneous muscle activities showed coordinated interactions among the compensating muscles: passive shortening of transversus, and lengthening of costal and crural, coincided with increased active inspiratory shortening of parasternal. We conclude that an integrated strategy of respiratory muscle compensation for unilateral or bilateral diaphragm paralysis occurs among chest wall, abdominal, and diaphragm segmental muscles, with relative contributions of individual muscles adjusted according to the degree of diaphragm dysfunction.