膈肌功能研究进展

膈肌将人体胸腔、腹腔分隔,参与生命活动多个方面,在维持呼吸运动、稳定姿势、增加腹内压及促进淋巴回流等活动中均发挥重要作用。膈肌功能障碍可通过肺功能检查、力学指标检测、影像学检查以及电生理学检查等多种评估方法进行识别。针对膈肌功能障碍,可从膈肌训练、膈肌手法治疗及膈神经（膈肌）电刺激等多方面进行治疗干预。膈肌在生命活动中具有重要作用,却常被忽视,因此全面深入认识膈肌才能更好地利用膈肌,这样不仅能改善患者心肺功能,而且还能提高其运动耐力及日常生活活动能力。     

体外膈肌起搏对机械通气兔膈肌功能障碍的保护作用及机制研究

目的 探讨体外膈肌起搏对机械通气兔膈肌功能障碍的保护作用及其机制.方法 85只成年新西兰兔按随机数字表法分为空白对照组(blank control group,BC)、自主呼吸组(spontaneous breathing group,SB)、容量控制通气组(volume control ventilation gro...     

脊髓损伤患者膈肌功能与肺功能的相关性研究

目的 评估在不同平面脊髓损伤患者中膈肌功能与肺功能的相关性。方法 选取77例脊髓损伤术后患者,根据损伤部位分为颈椎组22例、胸椎组30例和腰椎组25例。比较三组患者治疗前后的用力肺活量（FVC）、第一秒用力呼气量（FEV1）、最大通气量（MVV）以及膈肌活动度（DE）、膈肌增厚分数（DTF）,并分析评估患者膈肌超声参数与肺功能指标的相关性。结果 治疗前,颈椎组的FVC、FEV1、MVV、DTF和DE均明显低于胸椎组,差异均有统计学意义（t分别=4.90、6.76、5.39、9.88、2.52,P均<0.05）,胸椎组的FVC和FEV1、DE明显低于腰椎组,差异均有统计学意义（t分别=2.99、5.02、4.83,P均<0.05）。治疗4周后,颈椎组和胸椎组患者的FVC、FEV1、MVV、DTF、DE与治疗前比较,均有不同程度的改善（t分别=2.68、8.57、3.31、2.56、2.48、2.12、4.77、2.11、2.28、2.77,P均<0.05）。腰椎组FVC、FEV1、MVV、DE也均较治疗前有所改善,差异均有统计学意义（t分别=2.52、2.17、2.79...     

膈肌功能的定量化方法

跨膈压的测定可间接反映呼吸肌肌力，故跨膈压可作为呼吸肌肌力训练前后的客观指标。本实验选择２３例无呼吸系统疾病的正常人，测定其跨膈压及最大跨膈压值，得到结果为：跨膈压值为２．２５±０．９７ｋＰａ，最大跨膈压值为５．０９±２．２４ｋＰａ，４０岁以下年龄组Ｐｄｉｍａｘ值较４０岁以上组高８．３９％，男性较女性高２７．４％，但统计学上无显著差异（Ｐ＞０．０５）。     

创伤性膈肌损伤和膈疝的护理体会

随着社会的发展 ,创伤性膈肌损伤和膈疝的发病率呈增长的趋势 ,由于本病一般病情危急、复合伤多 ,要求护理人员必须及时准确地做好各种术前、术后的护理工作。现就我院自 1984～ 1998年共收治2 5例膈疝患者的护理体会总结如下。1　资料与方法1 1　一般资料2 5例均为男性 ,年龄 6～ 4 2岁。车祸 6例 ,土方压伤 4例 ,高处坠落伤 1例 ,穿透伤 14例。1 2　临床表现入院时诉气促、胸痛和呼吸困难 13例 ,腹痛 8例 ,其它 4例 ;受伤时间最长达 3年 ,患者常因伤后胸腹部种种不适 ,治疗欠佳而求治 ;合并伤 :血气胸12例 ,肠破裂 5例 ,肝破裂 2例 ,四肢…     

创伤性膈肌损伤和膈疝的漏误诊分析

近年来创伤性膈肌损伤和隔迹有增加趋势．在早期常缺乏特征性表现，且常被胸腹腔脏器的损伤症状所掩盖，故易发生漏诊、误诊，本前确诊率仅在50％左右[1]。我院1984～1994年10年间收治创伤性隔肌损伤和隔迹22例，其中漏诊或误诊9例，现作。分析。临床资料一、一般资料9例均为男     

膈肌功能测定与膈肌超声评估进展

膈肌是人体中最主要的呼吸肌,除协助呼吸外,还与腹肌共同参与人体排便、排尿、分娩、呕吐等动作的完成.手术、麻醉、呼吸机的使用等带来的医源性伤害,以及膈肌本身的一些原发性和继发性疾病诱发的损伤会影响膈肌的功能,导致患者术后肺部并发症发生、术后呼吸困难、脱机困难等.在膈肌功能测定中,经膈神经磁刺激所诱发出的颤搐性跨膈压被认为...     

缺氧和营养不良对大鼠膈肌功能肌电图的影响及复方红景天对膈肌功能保护作用的观察

目的：探讨慢性缺氧和营养不良对膈肌功能和膈肌肌电图（ＥＭＧｄｉ）的影响以及复方红景天对膈肌功能的保护作用。方法：将３２ 只Ｗｉｓｔａｒ大鼠随机分为慢性缺氧组（放入常压缺氧箱内,氧浓度０．１１０±０．００５,每日８ 小时,Ａ 组）、营养不良组（每日进正常食量的１／２,Ｂ组）、缺氧加复方红景天组（缺氧方法同Ａ组,每日缺氧前灌服复方红景天１．０ ｇ／ｋｇ,Ｃ组）和正常对照组（Ｄ组）,每组８只。实验５ 周在麻醉下测体重、ＥＭＧｄｉ和膈肌功能;动物处死后测膈重。结果：Ｂ组体重低于Ａ、Ｃ、Ｄ组５０％ ,膈肌显著变薄,面积缩小,重量减轻;Ａ、Ｂ组ＥＭＧｄｉ的高频份量与低频份量比值（Ｈ／Ｌ）、中心频率（Ｆｃ）和电刺激时膈肌最大收缩力、最大强直收缩、疲劳指数均较Ｃ、Ｄ组显著降低;强直收缩时间和疲劳时间较Ｃ、Ｄ组显著缩短,Ａ组与Ｃ、Ｄ组,Ｂ组与Ｃ、Ｄ组之间比较均有非常显著性差异（Ｐ均＜ ０．０１）;Ａ组与Ｂ组、Ｃ组与Ｄ组比较则无显著性差异。结论：慢性缺氧和营养不良能明显引起膈肌疲劳;复方红景天对缺氧性膈肌疲劳具有明显保护作用。     

Inhibition of monocyte chemoattractant protein-1 prevents diaphragmatic inflammation and maintains contractile function during endotoxemia

Introduction  

Respiratory muscle weakness is common in sepsis patients. Proinflammatory mediators produced during sepsis have been implicated in diaphragmatic contractile dysfunction, but the role of chemokines has not been explored. This study addressed the role of monocyte chemoattractant protein-1 (MCP-1, also known as CCL2), in the pathogenesis of diaphragmatic inflammation and weakness during endotoxemia.     

Prkdc participates in mitochondrial genome maintenance and prevents Adriamycin-induced nephropathy in mice

Adriamycin (ADR) is a commonly used chemotherapeutic agent that also produces significant tissue damage. Mutations to mitochondrial DNA (mtDNA) and reductions in mtDNA copy number have been identified as contributors to ADR-induced injury. ADR nephropathy only occurs among specific mouse inbred strains, and this selective susceptibility to kidney injury maps as a recessive trait to chromosome 16A1-B1. Here, we found that sensitivity to ADR nephropathy in mice was produced by a mutation in the Prkdc gene, which encodes a critical nuclear DNA double-stranded break repair protein. This finding was confirmed in mice with independent Prkdc mutations. Overexpression of Prkdc in cultured mouse podocytes significantly improved cell survival after ADR treatment. While Prkdc protein was not detected in mitochondria, mice with Prkdc mutations showed marked mtDNA depletion in renal tissue upon ADR treatment. To determine whether Prkdc participates in mtDNA regulation, we tested its genetic interaction with Mpv17, which encodes a mitochondrial protein mutated in human mtDNA depletion syndromes (MDDSs). While single mutant mice were asymptomatic, Prkdc/Mpv17 double-mutant mice developed mtDNA depletion and recapitulated many MDDS and ADR injury phenotypes. These findings implicate mtDNA damage in the development of ADR toxicity and identify Prkdc as a MDDS modifier gene and a component of the mitochondrial genome maintenance pathway.     

Comparison of ultrasonographic renal excursion to fluoroscopic diaphragmatic excursion for the assessment of diaphragmatic function in patients with high cervical cord injury

OBJECTIVE: To compare the renal excursion detected by ultrasonography with the diaphragmatic excursion recorded by fluoroscopy in estimating the diaphragmatic function in patients with high cervical cord injury. DESIGN: Prospective, blinded comparative study. SETTING: A rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Fifteen consecutively admitted patients with high cervical cord injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Chest radiographs, fluoroscopy of diaphragmatic motion, and ultrasonography of renal motion. RESULT: Of the 15 patients, 2 were diagnosed with hemidiaphragm paralysis using fluoroscopy and renal ultrasonography. The average diaphragmatic excursion was 59 mm (range, 30-83 mm) in 28 nonparalyzed hemidiaphragms. The average renal excursion was 49 mm (range, 28-61 mm). The correlation coefficient for fluoroscopic hemidiaphragm excursion and ultrasonographic renal excursion was .853. CONCLUSION: Ultrasonographic renal excursion and fluoroscopic diaphragmatic excursion correlated highly. With the fluoroscopy results as the criterion standard, the diagnostic sensitivity and specificity were both 100% for renal sonography. With the advantages of convenience of use, no radiation exposure, and high reproducibility, renal ultrasonography is recommended as a first-line screening and long-term follow-up tool for assessment of diaphragmatic function.     

Induction of diaphragmatic nitric oxide synthase after endotoxin administration in rats: role on diaphragmatic contractile dysfunction.

Nitric oxide (NO), a free radical that is negatively inotropic in the heart and skeletal muscle, is produced in large amounts during sepsis by an NO synthase inducible (iNOS) by LPS and/or cytokines. The aim of this study was to examine iNOS induction in the rat diaphragm after Escherichia Coli LPS inoculation (1.6 mg/kg i.p.), and its involvement in diaphragmatic contractile dysfunction. Inducible NOS protein and activity could be detected in the diaphragm as early as 6 h after LPS inoculation. 6 and 12 h after LPS, iNOS was expressed in inflammatory cells infiltrating the perivascular spaces of the diaphragm, whereas 12 and 24 h after LPS it was expressed in skeletal muscle fibers. Inducible NOS was also expressed in the left ventricular myocardium, whereas no expression was observed in the abdominal, intercostal, and peripheral skeletal muscles. Diaphragmatic force was significantly decreased 12 and 24 h after LPS. This decrease was prevented by inhibition of iNOS induction by dexamethasone or by inhibition of iNOS activity by N(G)-methyl-L-arginine. We conclude that iNOS was induced in the diaphragm after E. Coli LPS inoculation in rats, being involved in the decreased muscular force.     

自噬对肾小管细胞毒性损伤后线粒体功能的影响及相关机制研究

目的 研究自噬对肾小管细胞毒性损伤后线粒体功能的影响及相关机制.方法 将人近曲肾小管上皮细胞(HK-2)分为杂化siRNA组(对照无关序列片段siRNA转染细胞)、杂化siRNA+顺铂组(对照无关序列片段siR-NA转染细胞+10μmol/L顺铂溶液)、沉默Pink1+顺铂组(Pink1沉默转染细胞+10μmol/L顺...     

影响创伤性膈疝或膈肌损伤病死率的危险因素分析——附51例报告

目的：探讨影响创伤性膈疝（traumatic diaphragmatic hernia,TDH）或膈肌损伤痛死率的危险因素。方法：收集51例TDH或膈肌损伤患者的临床资料,对死亡者（死亡组）与存活者（存活组）的临床资料进行对照研究,对12种相关因素进行统计学分析。结果：51例中,死亡9例,病死率为18％,死于早期（入院24h内）失血性休克4例,死于术后严重并发症5例,其中严重感染并ARDS2例、严重感染1例、ARDS1例、MODS1例。经统计学分析,2组间的年龄、损伤严重度记分分值、围手术期输血量、入院时有休克表现、术后并发症、入院时收缩压、脾脏损伤等级共7个因素的比较差异有统计学意义（均为P〈0．01）,经多因素回归分析,围手术期输血量等于或大于1400mL、脾脏损伤等于或大于Ⅲ级等2个危险因素是TDH或膈肌损伤死亡的独立预测指标（比数比分别为41、74,P〈0．05—0．01）。结论：TDH或膈肌损伤患者术前有严重合并伤尤其是脾脏严重损伤,围手术期大量出血或术后出现严重并发症,提示预后较差。     

单纯型线粒体肌病超微结构研究

目的院通过对单纯型线粒体肌病超微结构特征的研究袁探讨该病的病因和可能的发病机制遥方法院对 9例线粒体肌病患者腓肠肌活检组织进行电镜超微病理观察遥结果院发现线粒体数量及形态改变显著袁线粒体数量 增多袁形态各异袁线粒体内类结晶包涵体形态多样遥结论院线粒体内类结晶包涵体可能是线粒体基质内呼吸链中的 不同蛋白质或酶的异常堆积的形态表现袁不同形态的类结晶包涵体代表了不同种蛋白质的堆积或同一种蛋白在 不同条件下的表现遥