AIR HUNGER FROM INCREASED PCO2 PERSISTS AFTER COMPLETE NEUROMUSCULAR BLOCK IN HUMANS
AIR HUNGER FROM INCREASED PCO2 PERSISTS AFTER COMPLETE NEUROMUSCULAR BLOCK IN HUMANS
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DOI：
10.1016/0034-5687(90)90065-7
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发表时间：
1990-07-01
期刊：
影响因子：
--
通讯作者：
NATIONS, CS
中科院分区：
文献类型：
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作者：
BANZETT, RB;LANSING, RW;NATIONS, CS
许多人认为，完全箭毒化的受试者对长时间屏气的耐受性是呼吸肌收缩对产生呼吸困难感至关重要的证据。虽然存在相互矛盾的证据，但没有一个是在完全神经肌肉阻滞期间获得的。我们用维库溴铵（一种非去极化神经肌肉阻滞剂）使四名正常的未镇静受试者完全瘫痪。受试者以固定速率和潮气量机械通气高氧气体混合物。呼气末二氧化碳分压（PETCO2）随吸入二氧化碳分压的变化而变化。受试者每45秒评定一次他们的呼吸不适或“空气饥饿”。在低PETCO2（中位数35 Torr）时，他们几乎感觉不到空气饥饿。当PETCO2升高（中位数44 Torr）时，所有受试者均报告严重空气饥饿。他们在瘫痪前报告了相同程度的空气饥饿，PETCO2基本相同。当事后询问时，所有受试者都说这种感觉可以用“空气饥饿”、“呼吸冲动”和“呼吸急促”来描述，就像屏住呼吸一样。他们报告说，瘫痪前后的感觉没有根本性的差异。我们的结论是，呼吸肌收缩是不重要的起源引起的高碳酸血症的空气饥饿。
The tolerance of totally curarized subjects for prolonged breath hold is viewed by many as evidence that respiratory muscle contraction is essential to generate the sensation of breathlessness. Although conflicting evidence exists, none of it was obtained during total neuromuscular block. We completely paralyzed four normal, unsedated subjects with vecuronium (a non-depolarizing neuromuscular blocker). Subjects were mechanically ventilated with hyperoxic gas mixtures at fixed rate and tidal volume. End-expiratory PCO2 (PETCO2) was varied surreptitiously by changing inspired PCO2. Subjects rated their respiratory discomfort or ''air hunger'' every 45 sec. At low PETCO2 (median 35 Torr) they felt little or no air hunger. When PETCO2 was raised (median 44 Torr) all subjects reported severe air hunger. They had reported the same degree of air hunger at essentially the same PETCO2 before paralysis. When questioned afterwards all subjects said the senstation could be described by the terms ''air hunger'', ''urge to breathe'', and ''shortness of breath'', and that it was like breath holding. They reported no fundamental difference in the sensation before and after paralysis. We conclude that respiratory muscle contraction is not important in the genesis of air hunger evoked by hypercapnia.