DYSPNEA IN DYSTONIA - A FUNCTIONAL-EVALUATION
DYSPNEA IN DYSTONIA - A FUNCTIONAL-EVALUATION
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DOI：
10.1378/chest.107.5.1309
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发表时间：
1995-05-01
期刊：
影响因子：
9.6
通讯作者：
BRIN, M
中科院分区：
文献类型：
--
作者：
BRAUN, N;ABD, A;BRIN, M
背景资料：肌张力障碍包括动作触发持续局灶性肌肉收缩，恶化的努力，并导致声音变化，异常姿势，呼吸困难，呼吸困难的原因，以前无法解释的，是本report.Methods的基础：由于需要进行肺功能测试（PFT）的最大努力可能会恶化肌张力障碍患者的肌肉收缩，我们使用了几个测试，以确定可能的原因呼吸困难。这些包括肺功能测定与流量容量环（FVL），潮气量呼吸，最大自主通气量（MVV），吸气和呼气肌肉压力（PImax，PEmax），坐位和仰卧位，我们使用循环测力计与动脉血气（ABG）值检测心脏/肺限制和呼吸感应体积描记术（RIP）评估胸壁/腹部运动的同步性，动态视频透视（VF）评估并记录了安静呼吸、言语、吞咽和最大呼吸动作期间上呼吸道和膈肌的动作触发肌肉活动，这些动作类似于PFT期间所需的努力。26名肌张力障碍患者，12名女性和14名男性，年龄14至70岁（平均年龄52.3岁）进行了评价。他们的神经系统分类包括22个原发性（特发性）和4个继发性（2个神经安定剂使用后，2个创伤后）。最初被归类为具有局灶性肌张力障碍的四名患者具有呼吸困难，并且被发现也具有呼吸困难和/或上气道功能障碍。PFT显示FVL和/或潮气量呼吸模式异常，24例患者中有20例在吸气或呼气期间出现间歇性空气中断。26例患者中24例VF异常，其中19例合并上气道（UA）功能障碍（DD），1例仅UA功能障碍，4例仅DD功能障碍。除了较差的努力和/或张力障碍运动，踏车测力计是正常的21例患者中的18例。22例患者中有19例的ABG值和/或脉搏血氧饱和度正常。肌张力障碍中的呼吸困难似乎是由于上呼吸道和/或隔膜的过度和/或不同步收缩，通常具有正常的气体交换。在言语和日常活动期间的这些痉挛性和不规则的肌肉收缩与克服痉挛的过度努力的感觉有关，过度痉挛可以在PFT期间触发，并且最好在FVL模式与动态VF结合时检测到。
Background: Dystonia consists of action-triggered sustained focal muscle contractions, worsened by effort, and resulting in voice changes, abnormal posturing, and dyspnea, The cause of dyspnea, previously unexplained, is the basis of this report.Methods: Since the maximal efforts required to perform pulmonary function testing (PFT) could worsen the muscular contractions in dystonic patients, we used several tests to identify possible causes of dyspnea. These included spirometry with flow volume loops (FVL), tidal volume breathing, maximum voluntary ventilation (MVV), and inspiratory and expiratory muscle pressures (PImax, PEmax), sitting and supine, We used cycle ergometry with arterial blood gas (ABG) values to detect cardiac/pulmonary limitations and respiratory inductive plethysmography (RIP) to assess chest wall/abdominal movements for synchrony, Dynamic videofluoroscopy (VF) assessed and recorded the action-triggered muscle activity of the upper airways and the diaphragm during quiet breathing, speech, swallowing, and maximal respiratory maneuvers similar to the efforts required during PFT.Results: Twenty-six dystonic patients, 12 women and 14 men, ages 14 to 70 years (mean age, 52.3 years) were evaluated. Their neurologic classification included 22 primary (idiopathic) and 4 secondary (2 postneuroleptic use, 2 posttraumatic). Four patients originally classified as having focal dystonia had dyspnea and were found to have diaphragmatic and/or upper airway dysfunction too. The PFTs showed abnormal FVL and/or tidal volume breathing patterns, with intermittent interruptions of air now during inspiration or expiration in 20 of 24 patients. The VF was abnormal in 24 of 26 patients: 19 patients had combined upper airway (UA) and diaphragmatic dysfunction (DD); 1 patient had UA dysfunction alone, and 4 patients had DD alone. Except for poor effort and/or dystonic movements, cycle ergometry was normal in 18 of 21 patients. The ABG values and/or pulse oximetry were normal in 19 of 22 patients.Conclusion: Dyspnea in dystonia appears to be due to excessive and/or dysynchronized contractions of the upper airways and/or diaphragm, with usually normal gas exchange, These spasmodic and irregular muscular contractions during speech and daily activities are associated with the sensation of excessive effort to overcome the spasms, Excessive spasms can be triggered during PFT and are best detected on FVL patterns coupled with dynamic VF.