慢性阻塞性肺疾病患者呼吸肌功能的测定

应用自行研制的ＲＭＳＥ－１型呼吸肌功能测定仪对健康正常人和缓解期ＣＯＰＤ患者的岂功能进行测定。结果表明，缓解期ＣＯＰＤ患者呼吸肌肌力指标如ＭＩＰ和ＭＥＰ与正常人无明显差别，而呼吸肌耐力指标如最大吸气贡荷、最大负荷时平均口腔压和最大负荷时最大持续吸气压占ＭＩＰ的百分数较正常人明显降低，差异非常显著。认为呼吸肌功能测定作为呼吸肌功能评定的客观方法，对于观察ＣＯＰＤ患者呼吸肌功能锻炼的效果和旨导呼吸康复     

脓毒症呼吸肌蛋白降解代谢的变化

目的探讨脓毒症早期呼吸肌蛋白降解代谢变化的规律及机制。方法45只雄性Wistar大鼠随机分为烫伤组（B组）、脓毒症组（S组）及对照组（C组）。B组大鼠使用沸水致背部30％总体表面积Ⅲ度烫伤,S组大鼠以同样方法烫伤后,立即腹腔注射内毒素（6mg／kg）制成烧伤脓毒症动物模型。分别于伤后2h和6h,采用高效液相一荧光法检测胸大肌、肋间肌和膈肌内三甲基组氨酸（3-MH）的含量,Northern杂交检测泛素、蛋白酶体C2亚基mRNA表达的变化。结果S组伤后2h和6h三处肌肉组织内3．MH的含量较B组和C组均显著升高（P〈0．05）,B组伤后2h胸大肌和肋间肌内3-MH的含量较C组显著升高（P〈0．05）,伤后6h三处肌肉组织内3-MH的含量均较C组显著升高（P〈0．01）。S组伤后2h和6h三处肌肉组织内泛素mRNA和蛋白酶体C2亚基mRNA表达较B组和C组均显著增强（P〈0．01）,B组伤后2h和6h三处肌肉组织内泛素和蛋白酶体C2亚基mRNA表达较C组均显著增强（P〈0．05）。结论严重烫伤特别是合并内毒素攻击后早期,呼吸肌细胞泛素-蛋白酶体途径活性呈现持续增强现象,肌纤维蛋白降解率也显著增加。这对于进一步从蛋白降解角度探讨烧伤脓毒症时呼吸肌功能异常的机制有参考意义。     

The study of respiratory muscles activation during respiratory muscle strength effort in adult females with chronic neck pain

[Purpose] This study aimed to compare maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) values and muscle activity during MIP and MEP between chronic neck pain and healthy participants. [Participants and Methods] Twenty chronic neck pain and 20 non-symptomatic females participated in this study. Maximal airway pressure (MIP and MEP) and surface electromyography (sEMG) for both sides of the upper trapezius, anterior scalene, pectoralis major and 6th intercostal muscles were recorded simultaneously. [Results] Significant differences of MIP and MEP values were found between the groups. The muscle activities of both sides of upper trapezius and 6th intercostal muscles during MEP were significantly higher in the chronic neck pain group than the healthy group except both sides of anterior scalene and pectoralis major muscles. During MIP, the activities of upper trapezius, 6th intercostal muscles and anterior scalene were significantly different between the two studied groups. Higher activity of left pectoralis major was found in the chronic neck pain group. [Conclusion] Decreasing values of MEP and MIP as well as muscles activities elevation in chronic neck pain participants were clearly demonstrated. Besides the musculoskeletal treatment, we suggest breathing exercise training to be considered in treatment programs.     

农药中毒诊治中42例阿托品中毒致呼吸肌麻痹的分析

目的 研究不同农药中毒治疗中因阿托品中毒所致的呼吸肌麻痹(RMP)发生率，探讨阿托品治疗与RMP的关系，并对阿托品中毒的原因进行分析。方法 对42例不同组别农药中毒病人进行分类分析，比较不同组别中阿托品治疗导致RMP的发生率及阿托品用量间的关系。结果 阿托品在治疗有机磷酸酯类、氨基甲酸酯类、混配农药类、除虫菊酯类后导致的RMP的发生率依次为60％、16．5％、16.5％、7.1％。阿托品在治疗非有机磷中毒和有机磷中毒病人中用量分别为80～320mg和290～6250mg。结论 农药中毒治疗时，阿托品用量一定要根据毒物类别、中毒途径及中毒程度而定，短时内盲目大剂量滥用阿托品可导致R脚。     

超高龄慢性阻塞性肺疾病患者呼吸肌锻炼效果研究

目的探讨呼吸肌功能锻炼对慢性阻塞性肺疾病（chronic obstructive pulmonaly disease,COPD）康复期患者动脉血气及肺功能的影响。方法选择2008年5月-2009年1月接受治疗的超高龄COPD缓解期患者45例,进行腹式呼吸训练和缩唇呼吸训练,观察患者肺功能及动脉血气的变化。结果呼吸操训练3-6个月后患者的第1秒用力呼气容积（FEV1）、第1秒用力呼气容积占用力肺活量的百分比（FEV1／FVC）和二氧化碳分压（PaCO2）、氧分压（PaO2）的差异有统计学意义（P均〈0.05）。结论呼吸肌功能锻炼能有效的改善超高龄COPD患者的动脉血气和肺功能。     

健康教育路径对COPD病人呼吸肌功能锻炼效果的研究

目的:探讨健康教育路径对慢性阻塞性肺疾病(COPD)病人呼吸肌功能锻炼效果的影响。方法:将63例COPD病人分为对照组(n=31)和试验组(n=32),对照组采用传统的健康宣教,试验组采用COPD健康教育路径表进行教育,评估两组病人咳嗽、气短、生存质量、步行距离、肺功能情况。结果:与对照组相比,试验组病人咳嗽、气短、生存质量、步行距离及肺功能均显著改善,两组比较差异有统计学意义(P<0.05)。结论:应用健康教育路径表实施健康教育,可提高COPD病人呼吸肌功能锻炼效果。     

中药联合胆碱酯酶抑制剂治疗重症肌无力患者呼吸肌力的变化

目的 探讨重症肌无力(MG)患者呼吸肌力在中药联合胆碱酯酶抑制剂治疗后的变化.方法 对胆碱酯酶抑制剂耐药的MG患者34例,其中Ⅰ型MG14例,Ⅱ型MG20例.均经溴化吡啶斯的明360～480 mg/d治疗3个月～3年无效复诊,除维持原有治疗外再联合中药饮剂治疗,待临床症状改善时,对溴化吡啶斯的明逐渐减量,继续中药治疗4～6个月.观察治疗前后肺功能:肺活量(VC)、最大自主通气量(MVV)、最大吸气压(PIM)、最大呼气压(PEM)、呼吸中枢驱动压(P0.1)、残气量(RV),分别取实测值占预计值百分比(P0.1除外),并进行临床严重程度评分.结果 34例MG患者经胆碱酯酶抑制剂单独治疗一段时间后,VC、MVV、PIM、PEM、RV等占预计值百分比无明显改善(P均＞0.05);联合中药治疗后,MG患者VC、MVV、PIM、PEM占预计值的百分比分别由治疗前的(76.66±18.59)%、(68.03±10.45)%、(43.25±18.16)%、(21.75±14.44)%增加到(86.91±14.87)%、(75.11±11.17)%、(52.66±20.32)%、(28.56±10.06)%,RV由治疗前的(164.94±67.97)%降到(143.16±79.21)%(t值分别为3.41、3.03、3.56、2.36、4.71,P均＜0.05);与Ⅱ型MG患者相比,Ⅰ型MG患者PIM[(65.80±28.03)%、(52.66±20.32)%]、PEM[(37.03±20.57)%、(28.56±19.06)%]改善显著(t值分别为3.85、3.16,P均＜0.01),另外Ⅱ型MG患者呼吸肌耐力[(108.71±17.56)%]较Ⅰ型MG组[(96.01±14.12)%]改善更加显著(t=3.92,P＜0.05).结论 中药联合胆碱酯酶抑制剂能有效地改善对胆碱酯酶抑制剂耐药患者的肺功能和呼吸肌力,与Ⅱ型MG患者相比,Ⅰ型患者肺功能的呼吸肌肌力改善更加明显,但Ⅱ型MG患者呼吸肌耐力的改善优于Ⅰ型MG患者.     

短期营养支持对缓解期COPD患者呼吸肌功能的影响

将５３例缓解期营养不良的住院ＣＯＰＤ患者分为营养治疗组２９例，对照组２４例。营养治疗组采用２周的短期营养支持治疗，应用２０％脂肪乳剂和７％复方氨基酸注射液隔日静脉滴注。结果表明，营养治疗组最大吸气压（ＭＩＰ）、最大呼气压（ＭＥＰ）和６ｍｉｎ行走距离明显增加，而体重和肺功能指标，如用力肺活量和第１秒用力呼气容积无明显改变。对照组上述指标均无明显变化。提示短期营养支持治疗可以明显改善缓解期ＣＯＰＤ患者的呼吸肌肌力，提高运动能力。     

基因重组生长激素在撤机困难并呼吸肌疲劳的慢性阻塞性肺疾病患者中的应用

目的：探讨基因重组生长激素（rhGH）在接受机械通气的慢性阻塞性肺疾病（COPD）并呼吸肌疲劳、撤机困难患者中临床应用。方法：选择28例在我院ICU住院的COPD并呼吸衰竭患者，所有患者均接受机械通气治疗，且临床表现为呼吸肌疲劳明显、撤机困难。将患者分为rhGH组和对照组各14例，rhGH组每天皮下注射rhGH 0．1U／kg，对照组接受生理盐水皮下注射，直至撤离呼吸机。对比两组患者死亡率、接受机械通气时间及治疗前后血清总蛋白、白蛋白、血糖变化的差异。同时比较rhGH组的预测死亡率及实际死亡率的差异。结果：与对照组相比，rhGH组接受机械通气时间明显缩短（P〈0．05），血白蛋白浓度显著升高（P〈0．05），实际死亡率较预测死亡率显著降低，但血糖变化没有明显差异。结论：rhGH应用于COPD并呼吸衰竭、呼吸肌疲劳的患者，可显著缩短机械通气时间及降低患者死亡率，同时改善患者营养状态，有助于呼吸机撤离。     

Body mass index is negatively correlated with respiratory muscle weakness and interleukin-6 production after coronary artery bypass grafting

Purpose

The present study was performed to clarify the relationships between body mass index (BMI), interleukin-6 (IL-6) production, and respiratory muscle weakness in patients undergoing coronary artery bypass grafting (CABG).

Materials and Methods

The correlations among BMI, changes in maximum inspiratory and expiratory pressure (ΔMIP, ΔMEP) on postoperative days (POD) 1 and 7, postoperative IL-6, and rapid turnover proteins (retinol-binding protein, prealbumin, and transferrin) on POD1 were assessed in 154 consecutive patients undergoing elective CABG. The patients were divided into quartiles of BMI, Q1 (BMI, <20.8 kg/m²) to Q4 (BMI, ≥25.25 kg/m²), and compared among groups.

Results

There were significant correlations between ΔMIP and BMI (POD1, r = −0.369; POD7, r = −0.285) and IL-6 (POD1, r = 0.423; POD7, r = 0.431), and between ΔMEP and BMI (POD1, r = −0.252; POD7, r = −0.228) and IL-6 (POD1, r = 0.252; POD7, r = 0.384). Interleukin-6 showed a significant negative correlation with BMI (r = −0.374) and retinol-binding protein (r = −0.382). Interleukin-6 was highest in Q1 and lowest in Q4. Higher BMI indicated greater respiratory muscle strength than lower BMI.

Conclusions

Preoperative BMI is correlated with respiratory muscle strength and cytokine production after CABG. The findings of this study suggest that BMI may be a valuable predictor for respiratory management in CABG patients.     

Nasal inspiratory pressure as an indirect measurement of respiratory muscle strength measured during SNIP and Psn methods in healthy subjects and subjects with motor neurone disease

Objective To investigate the difference in nasal inspiratory pressure as an indirect measurement of inspiratory muscle strength when the established sniff nasal inspiratory method (SNIP) is compared with a novel method of SNIP application known as Psn.

Design A prospective, correlational design using two different techniques in random order at the same session.

Setting Multidisciplinary clinic in a regional hospital.

Participants Fifty-two normal healthy individuals from hospital staff and family members, as controls, and a group of 25 subjects with motor neurone disease (MND) recruited from a specialised MND clinic.

Interventions In both SNIP and Psn, a measuring nasal bung is placed in one nostril. In SNIP, the contralateral nostril is unoccluded, and in Psn, the contralateral nostril is occluded.

Main outcome measures Inspiratory nasal pressure (cmH₂O). Six consecutive measurements of SNIP and Psn were carried out on each subject through both the right and left nostrils, each conducted by the same operator.

Results Data were analysed from 52 control subjects and 25 subjects with MND. Five patients were unable to produce acceptable and reproducible SNIP data, and one control subject was unable to perform Psn. Bland and Altman plots were used to determine the level of agreement between the two sets of measurements. The two methods of nasal inspiratory testing showed a relatively good level of agreement; the inspiratory pressure measured using SNIP was lower than that measured using Psn [mean difference: control subjects −12.3 cmH₂O (limits of agreement 9.2 to −32.9); subjects with MND −20.3 cmH₂O (limits of agreement −4.6 to −45.1)]. These results suggest that both methods of application are useful in the detection of respiratory muscle strength. However, Psn yielded significantly higher values.

Conclusion Psn may be used to complement SNIP in the evaluation of respiratory muscle testing of patients, particularly in those patients who have significant bulbar weakness throughout disease progression. Thus, Psn may be more informative in advanced disease. However, the lack of published reference values to date for Psn may limit its utility as a diagnostic or serial measurement tool in the short term.     

Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomized controlled trial

BackgroundChronic kidney disease is a complex disease that impacts multiple organs and systems (including musculoskeletal and cardiorespiratory) leading to reduction of functional capacity.ObjectiveThe aim of this study was to investigate the effect of a short period of high intensity inspiratory muscle training on maximum inspiratory pressure, functional capacity and endothelial function of chronic kidney disease patients on hemodialysis.MethodsThis randomized controlled trial enrolled 25 patients who were allocated into two groups: intervention (IMTG = 14) and control (CG = 11) groups. Intervention patients received the exercise protocol over a period of 5 weeks, 6 times per week, with each session consisting of 5 sets of 10 repetitions with an initial load of 50% progressing to 70% of maximum inspiratory pressure , measured weekly. The primary outcome was inspiratory muscle strength and the secondary outcomes were functional capacity and endothelial function evaluated before and after the training protocol.ResultsThe inspiratory muscle training induced a marked improvement in maximum inspiratory pressure which was evident after the training period (mean difference 19.0 cmH₂O – 95%CI 0.4–37.5; IMTG: 102 ± 25.7 cmH₂O vs CG: 83 ± 19.2; p = 0.046). The magnitude of maximum inspiratory pressure improvement was 33.5% at the end of the protocol for the IMTG. Functional capacity and endothelial function did not vary between or within groups.ConclusionA short period of high-intensity inspiratory muscle training for five weeks was able to improve inspiratory muscle strength of chronic kidney disease patients on hemodialysis (ClinicalTrials.gov registration NCT03082404).     

The addition of respiratory muscle strength training to facilitate swallow and pulmonary rehabilitation following massive tissue loss and severe deconditioning: A case series

IntroductionImpaired respiratory and swallow function in patients with intensive care unit–acquired deconditioning, such as associated with massive tissue loss, is not uncommon and can require prolonged rehabilitation.AimThe aim of the study was to examine the effect of combined inspiratory and expiratory respiratory muscle strength training (RMST) on respiratory and swallow function in two critical care patients with marked deconditioning after massive tissue loss.MethodsCase 1 was a 19-year-old male patient with 80% body surface area burns; case 2 was a 45-year-old man with group A streptococcus myositis necessitating quadruple amputation. Both required prolonged intensive care and mechanical ventilation. Both received routine intensive pulmonary and swallow rehabilitation before the trial; however, chronic aspiration and poor secretion clearance remained. At 25 and 26 weeks after initial injury, RMST was performed using EMST150 (expiratory) and Threshold IMT (inspiratory) devices, respectively. At baseline and throughout treatment, data collected included peak expiratory flow (PEF), anthropometry measures, aspiration risk (Penetration-Aspiration Scale [PAS]), pharyngeal clearance (Yale Pharyngeal Residue Scale), secretions (New Zealand Secretion Scale [NZSS]), and functional diet (Functional Oral Intake Scale [FOIS]) via endoscopy.Results/discussionAt baseline, the PEF score of case 1 was 41% (predicted age–height norm) and the PEF score of case 2 was 14%, indicating severe expiratory compromise. Both had extreme energy requirements (3300 kcal/day; 3500 kcal/day). The baseline swallowing scores of case 1 and 2 were as follows: PAS, 8 and 8; Yale, 9 and 10; NZSS, 4 and 7; and FOIS, 1 and 1, respectively, indicating profound dysphagia. At week 3 of 7 of RMST, swallow function improved to allow both to commence oral intake, followed by tracheostomy decannulation. At weeks 10 and 11, full dysphagia resolution was achieved (FOIS = 7; PAS = 1, Yale = 2, NZSS = 0), with PEF at 70% and 48% predicted respectively. Both patients continued RMST, and at discharge from the acute facility, PEF was 84% and 80% predicted respectively.ConclusionThe addition of RMST assisted swallow and pulmonary rehabilitation in both cases and was clinically viable to deliver. Controlled validation trials are now required.     

膈肌超声评估早产儿呼吸功能的应用价值

目的 探讨膈肌超声在早产儿呼吸功能评估中的应用价值。方法：选取2017 年11月—2018年5月于荆州市中心医院新生儿科接受治疗的早产儿50例,出生胎龄＞28周,矫正胎龄＜37周,出生体质量1.6-3.1千克。其中呼吸功能异常组30例,呼吸功能正常组20例。选取医院同期出生的日龄在7天内的正常足月儿30例作为参照组。对每个组别的双侧膈肌位移(DE)、膈肌厚度(DT)、膈肌厚度变化率(DTF)进行测量,然后再进行组内左、右两侧及组间同侧对比分析。 结果：三组内左、右膈肌移动度(DE)及膈肌厚度变化率(DTF)差异均无统计学意义(P＞0.05)。早产儿呼吸正常组左、右侧膈肌移动度均高足月儿组和早产儿呼吸异常组,且三组间左、右膈肌移动度差异均有统计学意义(P＜0.05)；足月儿双侧DTF均高于早产儿呼吸正常组和早产儿呼吸异常组,足月儿与早产儿呼吸正常组、足月儿与早产儿呼吸异常组膈肌厚度变化率差异有统计学意义(P＜0.05),而早产儿呼吸正常组及早产儿呼吸异常组之间差异无统计学意义(P＞0.05)。结论：膈肌超声能及早发现早产儿膈肌功能的变化,为临床提供早产儿呼吸功能相关的辅助诊断信息,从而指导临床治疗策略的制订和完善。     

HI-6和阿托品并呼吸机治疗氧化乐果中毒呼吸肌麻痹的实验研究

目的：探讨不同剂量HI－6和阿托品联合呼吸机治疗氧化乐果中毒所致呼吸肌麻痹的疗效。方法：实验大鼠给予2LD50的氧化乐果染毒，以10mg/kg阿托品对抗胆碱能症状。当大鼠出现呼吸频率减慢、呼吸困难时即行气管插管并辅助机械通气。A组阿托品继续原剂量治疗，B、C、D组HI－6依次按50mg/kg、80mg/kg、10mg/kg于呼吸机治疗即刻及治疗后1、2、3h肌肉注射，阿托品减至首剂量的1／3－2／3，以维持阿托品化为度。经联合治疗1、2、3h后试行脱机，以任何一次脱机超过60min视为联合治疗成功。一次脱机后大鼠存活超过60min或第3次脱机后迅速死亡，均需取游离膈神经膈肌标本经MS－302生理药理分析仪作膈肌功能测定。结果：A组膈肌功能恢复不佳，无一只大鼠脱机成功；B、C两组膈肌功能恢复良好，3h脱机成功率分别为80％和60％，明显高于A组（P＜0．01）。D组膈肌功能测定虽较好，但脱机成功率很低，外加乙酰胆碱（ACh）后，B、C、D组膈肌功能均随时间延长而逐渐变小。结论：只有适量HI－6联合阿托品并辅助呼吸机治疗氧化乐果中毒所致的呼吸肌麻痹，才能加速中毒大鼠膈肌功能恢复，降低中毒大鼠病死率。     

呼吸肌功能锻炼对慢性阻塞性肺疾病缓解期患者生活质量及肺功能的影响

目的 探讨呼吸肌功能锻炼对慢性阻塞性肺疾病(COPD)缓解期患者生活质量及肺功能的影响.方法 选取COPD缓解期患者110例,由专科护士指导其进行呼吸肌功能锻炼.记录锻炼前后患者的呼吸及心跳频率变化情况、FEV1％、FEVl/FVC、肺活量、最大通气量、时间通气量以及氧分压.由医护人员及患者共同完成生活质量评定量表的测评.结果 经过呼吸肌功能锻炼,患者的呼吸频率及心跳频率较锻炼前均有所下降,呼吸功能得到有效改善,生活质量得到有效提升.各项指标锻炼前后比较差异显著.结论 呼吸肌功能锻炼可以有效改善COPD缓解期患者生活质量及肺功能,值得临床推广.     

大鼠急性氧化乐果中毒呼吸衰竭与救治

目的　探讨氧化乐果中毒致呼吸肌麻痹的形成过程，寻找防治呼吸肌麻痹的合理方案。方法　所有实验大鼠均给予同等程度(2LD     

The influence of nutrition on neonatal respiratory muscle function

Advances in neonatal intensive care have resulted in increasing survival of very small babies, who often require prolonged periods of mechanical ventilation. These babies have limited nutritional reserves, and are difficult to feed by either parenteral or enteral routes. This review article discusses the interaction between undernutrition and respiratory muscle function in the critically ill preterm baby.     

膈肌和肋间肌增厚率及肋间肌代偿指数评估老年机械通气患者呼吸肌功能

目的 观察超声监测膈肌增厚率（DTF）、肋间肌增厚率（ICMTF）及肋间肌代偿指数（ICMTF/DTF）评估老年机械通气患者呼吸肌功能的价值。方法 对危重监护病房的34例老年机械通气患者（机械通气组）根据其机械通气时间分为长期（时间≥30 d）通气亚组（n=15）与短期（3 d≤时间<30 d）通气亚组（n=19）;另以28名既往无肺部及严重心脏疾病的自主呼吸老年志愿者为自主呼吸组。采用床旁超声监测受试者呼吸周期内膈肌吸气末厚度（DTei）、呼气末厚度（DTee）及肋间肌吸气末厚度（ICMTei）和呼气末厚度（ICMTee）,计算DTF、ICMTF及ICMTF/DTF,比较组间及亚组间各指标差异,分析其评价呼吸肌功能的价值。结果 长期通气亚组DTei、DTee和DTF均明显低于短期通气亚组（P均<0.05）,而两亚组均明显低于自主呼吸组（P均<0.05）;长期通气亚组ICMTei、ICMTee、ICMTF和ICMTF/DTF均明显高于自主呼吸组（P均<0.05）,且ICMTei高于短期通气亚组（P<0.05）,而两亚组间ICMTee、ICMTF和ICMTF/DTF差异均无统计学意义（P均>0.05）。所有受试者DTF与ICMTF呈负相关（r=-0.405,P<0.05）。结论 采用DTF、ICMTF和ICMTF/DTF均可有效评估呼吸肌功能。