EFFECTS OF NASAL POSITIVE-PRESSURE HYPERVENTILATION ON THE GLOTTIS IN NORMAL AWAKE SUBJECTS
EFFECTS OF NASAL POSITIVE-PRESSURE HYPERVENTILATION ON THE GLOTTIS IN NORMAL AWAKE SUBJECTS
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DOI：
10.1152/jappl.1995.79.1.176
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发表时间：
1995-07-01
影响因子：
3.3
通讯作者：
RODENSTEIN, DO
中科院分区：
文献类型：
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作者：
JOUNIEAUX, V;AUBERT, G;RODENSTEIN, DO
我们最近观察到阻塞性呼吸暂停在鼻间歇正压通气（nIPPV），并建议他们是由于低碳酸血症引起的声门关闭。为了证实这一假设，我们研究了7名健康受试者，并将他们提交给nIPPV，同时通过光纤支气管镜连续监测他们的声门。在清醒状态下，我们测量了每一次呼吸时声带在前连合沿着形成的最大吸气角以及其他几项指标。机械通气逐渐增加到30升/分钟。在没有呼吸活动的情况下，每分钟通气量的增加导致声带逐渐变窄，吸气阻力增加，有效到达肺部的潮气量百分比逐渐减少。在吸入的气体中加入CO2导致三名受试者中的两名声门部分扩大。此外，喉肌的激活总是与声带的显著吸气外展相关联。偶尔，声带完全内收是阻塞性喉呼吸暂停的直接原因，声门的周期性变化导致潮气量的增加和减少。我们的结论是，在清醒的人被动通气与nIPPV的结果声带内收，部分取决于低碳酸血症，但我们的研究结果表明，其他因素也可能影响声门宽度。
We have recently observed obstructive apneas during nasal intermittent positive-pressure ventilation (nIPPV) and suggested that they were due to hypocapnia-induced glottic closure. To confirm this hypothesis, we studied seven healthy subjects and submitted them to nIPPV while their glottis was continuously monitored through a fiber-optic bronchoscope. During wakefulness, we measured breath by breath the widest inspiratory angle formed by the vocal cords at the anterior commissure along with several other indexes. Mechanical ventilation was progressively increased up to 30 l/min. In the absence of diaphragmatic activity, increases in delivered minute ventilation resulted in progressive narrowing of the vocal cords, with an increase in inspiratory resistance and a progressive reduction in the percentage of the delivered tidal volume effectively reaching the lungs. Adding CO2 to the inspired gas led to partial widening of the glottis in two of three subjects. Moreover, activation of the diaphragmatic muscle was always associated with a significant inspiratory abduction of the vocal cords. Sporadically, complete adduction of the vocal cords was directly responsible for obstructive laryngeal apneas and cyclic changes in the glottic aperture resulted in waxing and waning of tidal volume. We conclude that in awake humans passive ventilation with nIPPV results in vocal cord adduction that depends partly on hypocapnia, but our results suggest that other factors may also influence glottic width.