Intra-abdominal pressures during voluntary and reflex cough.
Intra-abdominal pressures during voluntary and reflex cough.
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DOI：
10.1186/1745-9974-4-2
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发表时间：
2008-04-30
期刊：
影响因子：
--
通讯作者：
Ockey RR
中科院分区：
文献类型：
--
作者：
Addington WR;Stephens RE;Phelipa MM;Widdicombe JG;Ockey RR
非自主咳嗽，例如从喉部诱发的咳嗽，喉咳嗽反射（LCR），触发胸部、腹部和骨盆肌肉的协调收缩，这增加了腹内压（IAP），使隔膜向上移位，并产生用于咳嗽和气道清除的呼气力。在自主咳嗽（VC）和LCR期间IAP的变化可以通过膀胱中的压力导管测量。本研究评价了VC和LCR期间产生的IAP的生理特征，包括咳嗽事件或时期期间的峰值和平均压力以及曲线下面积（AUC）值的计算。11名年龄在18岁至75岁之间的女性受试者接受了标准的尿动力学评估，并放置了带有光纤应变计压力传感器的膀胱内导管。用200 ml无菌水填充膀胱，用VC和使用雾化吸入20%酒石酸诱导LCR的诱导反射咳嗽试验（RCT）获得IAP记录。通过囊内压随时间的数值积分（cm H2O·s），使用IAP值计算曲线下面积（AUC）。VC和LCR的平均（± SEM）AUC值分别为349.6 ± 55.2和986.6 ± 116.8 cm H2O·s（p < 0.01）。VC和LCR的平均IAP值分别为45.6 ± 4.65和44.5 ± 9.31 cm H2O（NS = 0.052），峰值IAP值分别为139.5 ± 14.2和164.9 ± 15.8 cm H2O（p = 0.07）。诱导的LCR是不自主的快速和重复的同步呼气肌肉激活，其引起并维持随时间升高的IAP，足以保护气道。VC和LCR具有不同的神经生理功能。使用AUC值和平均或峰值IAP值对LCR进行定量可用作确定神经生理气道保护状态的临床工具，并提供对患者功能恢复或下降的变化的定量评估。
Involuntary coughing such as that evoked from the larynx, the laryngeal cough reflex (LCR), triggers a coordinated contraction of the thoracic, abdominal and pelvic muscles, which increases intra-abdominal pressure (IAP), displaces the diaphragm upwards and generates the expiratory force for cough and airway clearance. Changes in the IAP during voluntary cough (VC) and the LCR can be measured via a pressure catheter in the bladder. This study evaluated the physiological characteristics of IAP generated during VC and the LCR including peak and mean pressures and calculations of the area under the curve (AUC) values during the time of the cough event or epoch. Eleven female subjects between the ages of 18 and 75 underwent standard urodynamic assessment with placement of an intravesicular catheter with a fiberoptic strain gauge pressure transducer. The bladder was filled with 200 ml of sterile water and IAP recordings were obtained with VC and the induced reflex cough test (RCT) using nebulized inhaled 20% tartaric acid to induce the LCR. IAP values were used to calculate the area under the curve (AUC) by the numerical integration of intravesicular pressure over time (cm H2O·s). The mean (± SEM) AUC values for VC and the LCR were 349.6 ± 55.2 and 986.6 ± 116.8 cm H2O·s (p < 0.01). The mean IAP values were 45.6 ± 4.65 and 44.5 ± 9.31 cm H2O (NS = .052), and the peak IAP values were 139.5 ± 14.2 and 164.9 ± 15.8 cm H2O (p = 0.07) for VC and LCR, respectively. The induced LCR is the involuntary rapid and repeated synchronous expiratory muscle activation that causes and sustains an elevated IAP over time, sufficient for airway protection. VC and LCR have different neurophysiological functions. Quantification of the LCR using AUC values and mean or peak IAP values may be useful as a clinical tool for determining neurophysiological airway protection status and provide a quantitative assessment of changes in a patient's functional recovery or decline.