口腔压或气道内压与食管内压和跨膈压的关系

目的探讨口腔压(Pmo)或气道内压(Ptr)与食管内压(Pes)和跨膈压(Pd i)的关系。方法对17例因腹部手术需要全身麻醉(简称全麻)的患者,观察全麻前的最大吸气压(M IP)、最大食管内压(Pesm ax)、最大跨膈压(Pd im ax)、颤搐性口腔压(TwPmo)、颤搐性食管内压(TwPes)和颤搐性跨膈压(TwPd i)以及全麻期间的颤搐性气道内压(TwPtrnar)、颤搐性食管内压(TwPesnar)和颤搐性跨膈压(TwPd inar),以了解它们的变异性和相互关系。结果(1)M IP与Pd im ax、TwPmo与TwPd i、TwPtrnar与TwPd inar、M IP与Pesm ax、TwPmo与TwPes和TwPtrnar与TwPesnar的线性相关系数(r)分别为0.976±0.030、0.816±0.155、0.923±0.446、0.981±0.185、0.829±0.168和0.955±0.292。(2)M IP、Pesm ax、Pd im ax、TwPmo、TwPes和TwPd i的变异系数(CV)分别为(14.2±4.7)%、(15.2±4.3)%、(15.5±4.1)%、(30.4±15.9)%、(10.8±5.1)%和(9.9±4.0)%,其中TwPmo最高(与其他观测指标比较P均<0.05),TwPes和TwPd i最低(与其他观测指标比较P均<0.05),而M IP、Pesm ax和Pd im ax间比较差异均无统计学意义(P均>0.05)。(3)TwPtrnar与TwPd inar、TwPesnar间动态变化的r值分别为0.839、0.894(P均=0.000)。结论M IP和TwPmo均可能低估膈肌功能,需重复测定,取其最高值,TwPtrnar能客观评价膈肌功能的动态变化。

The relationship between mouth pressure or tracheal pressure and esophagus pressure and diaphragmatic pressure

OBJECTIVE: To investigate the relationship between mouth pressure (Pmo) or tracheal pressure (Ptr) and esophagus pressure (Pes) or transdiaphragmatic pressure. METHODS: Seventeen patients were involved in the study. Maximal inspiratory pressure (MIP), maximal transdiaphragmatic pressure (Pdi(max)), maximal esophagus pressure (Pes(max)), twitch mouth pressure (TwPmo), twitch transdiaphragmatic pressure (TwPdi) and twitch esophagus pressure (TwPes) were measured before narcotization as a normal procedure for the abdominal operation and twitch tracheal pressure (TwPtr(nar)), twitch esophagus pressure (TwPes(nar)) and twitch transdiaphragmatic pressure (TwPdi(nar)) were dynamically monitored during narcotization. RESULTS: (1) The correlation coefficient (r) values between Pdi(max) and MIP, TwPdi and TwPmo, TwPdi(nar) and TwPtr(nar), Pes(max) and MIP, TwPes and TwPmo, TwPes(nar) and TwPtr(nar) were 0.976 +/- 0.030, 0.816 +/- 0.155, 0.923 +/- 0.446, 0.981 +/- 0.185, 0.829 +/- 0.168 and 0.955 +/- 0.292, respectively. (2) The coefficient variation (CV) of MIP, Pes(max), Pdi(max), TwPmo, TwPes and TwPdi were (14.2 +/- 4.7)%, (15.2 +/- 4.3)%, (15.5 +/- 4.1)%, (30.4 +/- 15.9)%, (10.8 +/- 5.1)% and (9.9 +/- 4.0)%, respectively. The CV of TwPmo was the highest (compare with others, all P < 0.05) and that of TwPes and TwPdi was the lowest (compare with others, all P < 0.05). There was no significant difference among MIP, Pes(max) and Pdi(max) (P > 0.05). (3) The r value between the changing values of TwPtr(nar) and TwPdi(nar) or TwPes(nar) during narcotization were 0.839 or 0.894 (P = 0.000, respectively). CONCLUSION: The measurement of MIP and TwPmo should be repeated and the highest value should be chosen in order to reduce the possibility of underestimating the function of diaphragm, which could be dynamically monitored by TwPtr(nar).