Hyperventilation as a simple cure for severe exercise-associated muscle cramping.
Hyperventilation as a simple cure for severe exercise-associated muscle cramping.
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过度换气是治疗严重运动相关肌肉痉挛的简单方法。
DOI：
10.1111/j.1526-4637.2011.01112.x
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Murphy,CarolynA
中科院分区：
文献类型：
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作者：
Murphy,PhilipM;Murphy,CarolynA
运动相关肌肉痉挛（EAMC）通常会影响腿部，矛盾的是，运动停止后很久，包括晚上睡觉时，可能会开始[1]。在严重的睡眠相关EAMC病例中，痉挛可能对目前推荐的非药物干预（拉伸、按摩、热、冰、步行、腿抬高、腿抖动和水合作用）反应不佳[2，3]，使患者在半夜遭受极端的失能性疼痛和可能的恐慌。由于发作通常在其他健康个体中零星地、不可预测地和短暂地发生，并最终消退，因此该病症被低估并且难以研究。EAMC的发病机制知之甚少，但假设包括液体和电解质失衡，高肌肉乳酸水平和脊髓水平的神经肌肉控制异常[4]。我们中的一位（PMM）是一位57岁的白色男性，他从青春期开始就患有严重的睡眠相关、运动相关（跑步、骑自行车、游泳、打篮球）小腿和脚抽筋发作，持续时间长达2-3小时。我们假设，通气不足和由此产生的呼吸性酸中毒，这是一个主要的生理变化在睡眠中，可能是一个诱因。为了验证这一点，在一个典型的严重的睡眠相关的EAMC发作期间，涉及两条小腿，持续一个多小时，PMM故意过度通气（深频繁呼吸，大约20-30/分钟）。这是在仰卧位进行的，以尽量减少头晕目眩、头晕和昏厥的风险。痉挛在1分钟内完全消退，恢复睡眠后未复发。PMM在随后的四次攻击中重复了该技术，结果相同。另外两名白色男性，年龄分别为58岁（PMM的兄弟）和55岁（无关），他们也患有间歇性严重和长期睡眠相关的下肢运动相关痉挛。在这两种情况下，痉挛在开始过度通气后几分钟内消退。在任何病例中，均未使用药物治疗痉挛。三名受试者均未报告副作用。PMM还在100英里山地自行车骑行的67英里运动期间进行了换气过度的双侧股四头肌痉挛自我实验，并在3分钟内完全解决，在剩下的33英里骑行中没有复发。在这一小系列病例中发现100%有效性且无副作用，因此需要继续研究过度通气作为EAMC和其他发生严重骨骼肌痉挛的临床疾病的简单、自我给药、无成本治疗的临床安全性和有效性以及作用机制。
Exercise-associated muscle cramping (EAMC), which typically affects the legs, may start, paradoxically, long after exercise has stopped, including at night during sleep [1]. In severe cases of sleep-related EAMC, cramps may respond poorly to currently recommended nonpharmacologic interventions (stretching, massage, heat, ice, walking, leg elevation, leg jiggling, and hydration)[2, 3], subjecting the patient to extreme, incapacitating pain and possible panic in the middle of the night. As attacks typically occur sporadically, unpredictably, and transiently in otherwise healthy individuals, and eventually resolve, the condition is underreported and difficult to study. EAMC pathogenesis is poorly understood, but hypotheses include fluid and electrolyte imbalance, high muscle lactate levels, and abnormality of neuromuscular control at the spinal level [4]. One of us (PMM) is a 57-year-old white male who, since adolescence, has had severe episodic attacks of sleep-associated, exercise-related (running, cycling, swimming, basketball) cramping of the lower legs and feet, lasting as long as 2–3 hours. We hypothesized that hypoventilation and the resulting respiratory acidosis, which is a major physiologic change during sleep, may be a precipitating factor. To test this, during a typical severe attack of sleep-related EAMC involving both lower legs and lasting over an hour, PMM deliberately hyperventilated (deep frequent breaths, approximately 20–30/minute). This was performed while supine, to minimize the risk of light-headedness, dizziness, and fainting. The cramp resolved completely within 1 minute and did not recur after sleep resumed. PMM repeated the technique during four subsequent attacks with identical results. Hyperventilation was then tried by two other white males, ages 58 (brother of PMM) and 55 (unrelated), who also suffered from episodic severe and prolonged sleep-associated, exerciserelated cramping of the lower legs. In both cases, cramping resolved within several minutes of initiating hyperventilation. No pharmacologic agents were taken for the cramp in any of the cases. None of the three subjects reported side effects. PMM also self-experimented with hyperventilation for bilateral quadriceps cramping during exercise at mile 67 of a 100-mile mountainous bicycle ride and experienced complete resolution within 3 minutes without recurrence during the remaining 33 miles of the ride. The finding of 100% efficacy and no side effects in this small series of cases warrants continued study of the clinical safety and efficacy and mechanism of action of hyperventilation as a simple, self-administered, cost-free treatment for EAMC and for other clinical conditions in which severe skeletal muscle cramping occurs.