Thoracoabdominal motion in chronic obstructive pulmonary disease.
Thoracoabdominal motion in chronic obstructive pulmonary disease.
复制标题
慢性阻塞性肺疾病的胸腹部运动。
DOI：
--
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
J. Danon
中科院分区：
文献类型：
--
作者：
J. Sharp;N. B. Goldberg;W. Druz;H. Fishman;J. Danon
应用呼吸磁强计对30例慢性阻塞性肺疾病患者的胸腹运动进行了研究。利用Konno和Mead提出的概念和方法，建立了胸、腹部偏转的体积等效性。20名患者虽然残疾，但仍能行走，10名患者患有急性呼吸衰竭，在呼吸重症监护病房进行了研究。20例非卧床患者中有5例和10例急性呼吸衰竭患者中有8例在吸气时腹内向内运动与胸腔向外运动一致，提示隔膜功能不佳。这种胸腹运动模式与2例高位四肢瘫痪患者完全用颈部肌肉呼吸时的情况相同。在5名门诊患者中，有3名患者在透视下证实了横隔膜的吸气上升。表现出这种模式的患者通常是严重残疾的，残留量最大。在门诊患者实施最大自主呼吸机时，观察到两种异常的胸腹运动模式。20例患者中有9例表现为胸腔与腹部的往复或矛盾运动，胸腔体积增大，吸气时腹腔体积减小。第二种模式，在20例患者中有5例，表现为肋骨完全紊乱和腹部运动，没有一致或可复制的模式。因此，相当大比例的慢性阻塞性肺病患者表现出胸腹运动异常，这些异常可以用呼吸磁强计观察到，而且通常通过简单的检查就能观察到。这些异常大多提示呼吸肌功能障碍，尤其是横隔肌。
Studies of thoracoabdominal motion using the respiratory magnetometer were performed in 30 patients with chronic obstructive pulmonary disease. Volume equivalency of thoracic and abdominal deflections was established by using the concepts and methods developed by Konno and Mead. Twenty patients were ambulatory, although disabled, and 10 were in acute respiratory failure and were studied in a respiratory intensive care unit. Five of 20 ambulatory patients and 8 of 10 patients in acute respiratory failure showed inward abdominal motion coincident with outward rib cage motion during inspiration, suggesting ineffective diaphragmatic function. This pattern of thoracoabdominal motion was identical to that seen in 2 high quadriplegics with diaphragmatic paralysis when they were breathing entirely with their neck muscles. Inspiratory ascent of the diaphragm was confirmed fluoroscopically in 3 of the 5 ambulatory patients. Patients showing this pattern were generally severely disabled and had the largest residual volumes. Two abnormal patterns of thoracoabdominal motion were observed during the performance of maximal voluntary ventilation in the ambulatory patients. The first, seen in 9 of 20 patients, was characterized by reciprocal or paradoxical motion of rib cage and abdomen, with increase in rib cage volume associated with decrease in abdominal volume during inspiration. The second pattern, seen in 5 of 20 patients, showed complete disorganization of rib cage and abdominal motion, with no consistent or reproducible pattern. Thus, a significant proportion of patients with disabling chronic obstructive pulmonary disease show abnormalities in thoracoabdominal motion that are observable with the respiratory magnetometer and ofter by simple inspection. Most of these abnormalities suggest malfunction of respiratory muscles, particularly the diaphragm.