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Pressure Support during Sleep in Chronic Respiratory Failure : Cooperative Clinical and Basic Science Investigations.

慢性呼吸衰竭睡眠期间的压力支持：临床和基础科学合作研究。

基本信息

批准号：
06045053
负责人：
ABE Tadashi
金额：
$ 2.69万
依托单位：
KITASATO UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for international Scientific Research
财政年份：
1994
资助国家：
日本
起止时间：
1994 至 1995
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-06045053/
关键词：
Respiratory failure Sleep Pressure support n-CPAP BiPAP 呼吸筋腹筋 nasal-CPAP 呼吸調節 fine wire 電極

项目摘要

There have been several reports that nasal pressure support is a useful treatment for patients with respiratory failure. However, there have been no research on the respiratory muscle during sleep or the effect of pressure support therapy in terms of respiratory muscle control. Combining basic research and clinical research, we investigated control of respiratory muscle to suggest safe and correct usage of the nasal pressure support during sleep for patients with chronic respiratory failure. We did basic animal research in University of Calgary, using unique experimental system with chronically instrumented dogs, which Dr.Easton created for the research of the respiratory muscle control during sleep. Each mongrel dog had pairs of sonomicrometry transducers and bipolar fine-wire EMG electrodes implanted in left costal and crural diaphragm segments, transversus abdominis, and parasternal intercostal muscles. Animals were studied after diaphragm segmental shortening had recovered fully. W … More e did basic research on humans and clinical research in Kitasato University, using another unique system for the research of the human respiratory muscle control. Fine wire electrodes were inserted into four abdominal muscles ; rectus abdominis, externaloblique, internal oblique, and transversus abdominis with real-time, high resolution ultrasound. N-BiPAP was applied to the patients with hypercapnia. In humans, transversus abdominis showed significant expiratory activity during resting supine breathing. To increasing CO2 stimulation or increasing nasal continuous positive airway pressure (n-CPAP), transversus abdominis was activated first, followed by internal oblique, then external oblique, and finally rectus abdominis. In patients with respiratory failure with hypercapnia, significant amelioration of PaCO2 and pH was observed by nasal bilevel positive airway pressure (n-BiPAP), although PaO2 was not significantly improoved. In chronically instrumented dogs, followings were suggested ; 1) Respiratory muscle activity depends on sleep stage, 2) Respiratory muscle control is very different during REM sleep from during non-REM sleep, 3) Differential activity of respiratory muscles occurs during REM sleep. Less

有几篇报道称鼻压支持是治疗呼吸衰竭的有效方法。然而，目前还没有关于睡眠时呼吸肌的研究，也没有关于压力支持疗法对呼吸肌控制效果的研究。通过基础研究与临床研究相结合，探讨呼吸肌肉的控制情况，为慢性呼吸衰竭患者睡眠时安全、正确使用鼻压支持提供建议。我们在卡尔加里大学做了基础的动物研究，使用独特的实验系统，用长期仪器狗，这是Dr.Easton为研究睡眠时的呼吸肌控制而创建的。每只杂种狗在左肋和脚膈肌段、腹横肌和胸骨旁肋间肌上植入一对声速传感器和双极细丝肌电图电极。动物在膈节段缩短完全恢复后进行研究。W . More在北中大学进行人体基础研究和临床研究，使用另一种独特的系统进行人体呼吸肌控制的研究。细丝电极插入四块腹部肌肉；实时高分辨率超声检查腹直肌、腹外斜肌、腹内斜肌和腹横肌。N-BiPAP应用于高碳酸血症患者。人类在静息仰卧呼吸时，腹横肌表现出明显的呼气活动。增加CO2刺激或增加鼻持续气道正压（n-CPAP），先激活腹横肌，然后是内斜肌，再是外斜肌，最后是腹直肌。在呼吸衰竭合并高碳酸血症患者中，采用鼻双水平气道正压通气（n-BiPAP）观察到PaCO2和pH有明显改善，但PaO2没有明显改善。对于长期使用仪器的狗，建议如下；1)呼吸肌活动与睡眠阶段有关；2)快速眼动睡眠与非快速眼动睡眠期间呼吸肌的控制有很大不同；3)快速眼动睡眠期间呼吸肌活动存在差异。少