EFFECT OF VENTILATORY SUPPORT ON RESPIRATORY MUSCLE FATIGUE

通气支持对呼吸肌疲劳的影响

• 批准号: 08457400
• 负责人: HASHIMOTO Yasuhiko
• 金额: $ 4.99万
• 依托单位: TOHOKU UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1996
• 资助国家: 日本
• 起止时间: 1996 至 1997
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-08457400/
• 关键词: Resplratory Muscle Fatigue; Mechanichal Ventilatory support; Diaphragma; Muscle Tension; TRANSDIAPHRAGMATIC PRESSURE DIFFERENCE; Inspiratory Synchronization; 吸気同期; 横隔膜筋収縮; 胃-食道内圧較差; テタヌス刺激; 筋疲労

We compared the diaphragmatic fatigue produced by bilateral phrenic nerve stimulation, which is synchronized to inspiratory and expiratory phase fo mechanical ventilation, to investigate the effect of mechanichal ventilatory suport on the diaphragmatic fatigue in mongrel dogs.[METHOD] Phrenic nerves were exposed and stimulated at neck region (tetanus stimulation for 1 sec at 40Hz), and bilateral diaphragmatic muscle tensions were measured through transducers attached to infradiaphragmatic surface. Two balooon-catheters were placed at esophgus and stomach, then pressure differences (Pdi) were measured. Diaphragmatic muscle fatigue was induced by tetanic phrenic stimulation (tetanic stimuli for 1sec at a rate of 12/min) for 30min synchronized to inspiratory phase (Insp.group, n=9) and expiratory phase (Exp.group, n=9) of mechanical ventilation. Muscle twitchs and Pdi were measured before induction of fatigue, immediately after fatigue, 30min and 60min after fatigue. Fatigue was assesed by the profile of muscle twitches at tetanic frequencies of 10,20,30,40,50 and lOOHz.[RESULT] Muscle twitches and Pdi in both group were reduced after induction of fatigue, where the higher the frequency of stimuli was, the smaller the depressions of muscle twitch and Pdi were. The depression in muscle twitch and Pdi did not differ significantly between two groups. The depression in Pdi were lesser than that in muscle twitch at some frequencies.[DISCUSSION] Inspiratory synchronization failed to relieve the diaphragmatic fatigue. This might be due to the low inspiratory flow, which was not enough to lessen the work of diaphragmatic muscle. In our study, we adopted the supramaximal stimulation to induce the muscle fatigue, and this might in part be a cause not to relieve the fatigue.[CONCLUSIONS] In clinical setting, the reduction of the actual inspiratory effort is more important than the synchronization to respiratory phase.

本实验通过比较机械通气时吸气相和呼气相同步刺激双侧膈神经所产生的运动性疲劳，探讨机械通气支持对杂种犬运动性疲劳的影响。[方法]暴露膈神经，刺激颈部（40 Hz，强直刺激1 s），通过贴附于膈神经下表面的传感器测量双侧膈神经肌张力。分别在胃和直肠放置球囊导管，测量压力差（Pdi）。在机械通气的吸气相（吸气组，n=9）和呼气相（呼气组，n = 9）同步进行强直刺激膈神经（以12次/min的频率刺激膈神经1 s）30 min，诱导膈肌疲劳。分别于诱导疲劳前、疲劳后即刻、疲劳后30 min、60 min测定肌颤次数和Pdi。通过在10、20、30、40、50和100 Hz强直频率下的肌肉抽搐的轮廓来评估疲劳。[结果]疲劳诱导后，两组大鼠的肌颤和Pdi均降低，且刺激频率越高，肌颤和Pdi的降低越小。两组间肌颤和Pdi的抑制无显著性差异。在某些频率下，Pdi的抑制程度小于肌颤。[讨论]吸气同步未能缓解呼吸疲劳。这可能是由于吸气流量低，不足以减轻肌肉的工作。在我们的研究中，我们采用了超极大的刺激来引起肌肉疲劳，这可能是一个原因，不能缓解疲劳。[结论]在临床上，减少实际吸气努力比同步呼吸相位更重要。

项目成果

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Satoh D et al.: "Peri-operative Management of Volume Reduction Surgery for Emphysematous Patiens." The Japanese J Respir Care Med. 14. 101-108 (1997)

Satoh D 等人：“肺气肿患者减容手术的围手术期管理”。

Satoh S et al.: "Re-distribution of Alveolar Pressure during End-Inspiratory Pause." J Japan Soc Intensive Care Med. 3. 203-208 (1996)

Satoh S 等人：“吸气末暂停期间肺泡压力的重新分布。”