Direct measurement of skeletal muscle fatigue in patients with chronic heart failure.
Direct measurement of skeletal muscle fatigue in patients with chronic heart failure.
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直接测量慢性心力衰竭患者的骨骼肌疲劳。
DOI：
10.1136/hrt.65.1.20
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发表时间：
1991
影响因子：
--
通讯作者：
P. Poole‐Wilson
中科院分区：
文献类型：
--
作者：
N. Buller;D. Jones;P. Poole‐Wilson
骨骼肌功能通过五名健康志愿者、五名轻度慢性心力衰竭患者和五名重度慢性心力衰竭患者的股四头肌（大运动肌）和拇内收肌（手内小肌）的力量产生和疲劳来测量。慢性心力衰竭患者的股四头肌肌肉横截面积减少，最大等长力产生减少，疲劳倾向增加。然而，在控制条件下，三组之间的等长力产生和拇内收肌疲劳没有显着差异。但在循环闭塞期间，患有严重慢性心力衰竭的患者拇内收肌的疲劳程度增加得更多。股四头肌和拇内收肌的这些不同发现表明，骨骼肌萎缩和等长力产生减少本身并不是慢性心力衰竭的必然结果，因为它们只存在于大运动肌中。在慢性心力衰竭患者的拇内收肌中观察到的肌肉疲劳的正常值意味着，当仅使用少量肌肉时，骨骼肌血流量在肌肉激活过程中必须正常增加。这些结果与活跃骨骼肌内正常血管舒张普遍受损的概念不相容。相反，激活大块肌肉（例如股四头肌）会导致严重慢性心力衰竭患者迅速出现疲劳。这种疲劳可能与心血管系统无法提供激活大块肌肉所需的血流有关。严重慢性心力衰竭患者循环闭塞期间拇内收肌疲劳程度相对较大的发现支持了对这些患者骨骼肌内在异常的催眠。
Skeletal muscle function was measured as force production and fatigue in both the quadriceps (a large locomotive muscle) and adductor pollicis (a small intrinsic hand muscle) in five healthy volunteers, five patients with mild chronic heart failure, and five patients with severe chronic heart failure. The quadriceps of patients with chronic heart failure had a reduced muscle cross sectional area, a reduced maximum isometric force production, and an increased tendency to fatigue. Isometric force production and fatigue of the adductor pollicis, however, were not significantly different between the three groups under control conditions. But during circulatory occlusion fatigue in the adductor pollicis increased more in the patients with severe chronic heart failure. These differing findings in quadriceps and adductor pollicis suggest that skeletal muscle atrophy and reduced isometric force production are not a necessary consequence of chronic heart failure per se, because they were only present in the large locomotive muscle. The normal values for muscle fatigue observed in adductor pollicis in patients with chronic heart failure imply that skeletal muscle blood flow must increase normally during muscle activation when only a small muscle mass is used. These results are not compatible with the concept of a generalised impairment of normal vasodilatation within active skeletal muscle. In contrast, activation of a large muscle, such as quadriceps, results in the rapid onset of fatigue in patients with severe chronic heart failure. This fatigue may be related to the inability of the cardiovascular system to provide the required blood flow for the activation of a large muscle mass. The finding of a relatively greater increase in fatigue of adductor pollicis during circulatory occlusion in patients with severe chronic heart failure supports the hypnosis of an intrinsic abnormality of skeletal muscle in these patients.