Inspiratory muscle testing in stable COPD patients.
Inspiratory muscle testing in stable COPD patients.
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稳定慢性阻塞性肺病患者的吸气肌测试。
DOI：
10.1183/09031936.94.07101871
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发表时间：
1994
期刊：
影响因子：
--
通讯作者：
J. Derenne
中科院分区：
文献类型：
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作者：
T. Similowski;J. Derenne
对稳定期慢性肺病患者的吸气肌进行探查，对于调查被动呼吸系统改变导致的呼吸障碍，或对接受可能干扰肌肉功能治疗的患者进行随访，都具有重要意义。代偿机制往往会抵消这些患者过度充气的有害影响，需要精确的临床数据，以避免由于未经验证的假设而导致的错误。研究吸气肌功能需要研究系统在各种活动状态下的输出数据。作为输出，容积位移缺乏特异性，压力测量可能更特异，但有时是侵入性的，应与肺容积测量相关，肌电图在方法上复杂，非定量和再现性差。自愿演习取决于主体的合作，并不允许不同肌肉群的行动之间的输出分区。经皮膈神经电刺激没有这些不便，但它只探索一个肌肉（隔膜）的条件下，不是“自然”（放松肋骨）。最近，颈部磁刺激，更好地理解口压与膈神经刺激的关系，以及无创测试的发展，如吸气压力或音肌描记术，打开了慢性阻塞性肺疾病患者吸气肌功能更容易临床评估的前景。如果得到验证，这些测试应该提供一个合理有限的临床工具，以更好地了解这种情况下的肌肉功能。
Exploration of inspiratory muscles in stable chronic pulmonary disease patients can be important in the investigation of a respiratory handicap unsatisfactorily explained by alterations of the passive respiratory system, or in the follow-up of patients undergoing treatments that can interfere with muscle function. Compensatory mechanisms tend to counterbalance the deleterious effects of hyperinflation in these patients, and precise clinical data are needed in order to avoid mistakes due to underverified hypotheses. Investigation of inspiratory muscle function requires the study of output data under various states of activity of the system. As outputs, volume displacement lacks specificity, pressure measurements can be more specific but are at times invasive and should be associated with lung volume measurements, electromyography is methodologically complex, nonquantitative and of poor reproducibility. Voluntary manoeuvres depend upon subject co-operation, and do not allow partitioning of output between the action of different muscle groups. Transcutaneous electrical phrenic nerve stimulation is devoid of these inconveniences, but it explores only one muscle (the diaphragm) under conditions that are not "natural" (relaxed rib cage). Recently, perspectives for easier clinical assessment of inspiratory muscle function in chronic obstructive pulmonary disease patients have been opened by cervical magnetic stimulation, better understanding of the meaning of mouth pressure in relationship to phrenic stimulation, and development of noninvasive tests, such as nostril pressure during sniff or phonomyography. If validated, such tests should provide a reasonably limited panel of clinical tools to better appreciate muscle function in this setting.