适宜性电刺激膈神经的方法对高原慢性肺源性心脏病缓解期患者膈肌疲劳和肺功能的改善作用  

Effect of suitable electrostimulation on phrenic nerve in ameliorating diaphragmatic fatigue and pulmonary function in patients with stable chronic cor pulmonale at high altitude area

作　　者：杨生岳[1] 冯恩志[1] 沈君礼[1] 张瑛[1] 赵丽红[1] 吴雪梅[1] 张冬天[1] 

机构地区：[1]解放军第四医院兰州军区呼吸内科中心,青海省西宁市810014

出　　处：《中国临床康复》2005年第23期28-30,共3页Chinese Journal of Clinical Rehabilitation

基　　金：全军医学科研"十五"计划项目(01MB014)~~

摘　　要：目的:探讨体外膈肌起搏治疗高原慢性肺源性心脏病缓解期患者膈肌疲劳的效果,并比较不同脉冲幅度、治疗时间及次数的差异对呼吸功能的影响。方法:选择2001-02/2004-10解放军第四医院兰州军区呼吸内科中心住院的慢性肺源性心脏病缓解期患者84例,男52例,女32例。原发基础疾病为慢性阻塞性肺疾病且均知情同意。根据膈肌起搏治疗仪治疗情况随机分为2组,每组42例。脉冲幅度60V组:男26例,女16例;脉冲幅度100V组:男26例,女16例。①两组患者病情缓解1周后,停止所有治疗包括氧疗。采用膈肌起搏治疗仪进行治疗。脉冲幅度60V组为脉冲幅度60V,30min/次,1次/d;脉冲幅度100V组为脉冲幅度100V,40min/次,2次/d。2组均14d为1个疗程。②用电脑膈肌功能测定仪测定两组患者呼吸肌功能,包括最大吸气压、最大呼气压、最大跨膈压。用公式计算呼吸肌力量指数(呼吸肌力量指数=最大吸气压+最大呼气压/2。③采用血气分析仪测定动脉血氧分压和二氧化碳分压。用电脑肺功能仪测定第1秒用力呼气量占预计值百分比、用力肺活量、第1秒用力呼气量占用力肺活量百分比。④计量资料组间比较采用t检验,组内比较采用配对t检验。结果:慢性肺源性心脏病缓解期患者84例均进入结果分析。①脉冲幅度60V组患者:治疗后最大吸气压、最大呼气压、最大跨膈压、呼吸肌力量指数、第1秒用力呼气量占预计值百分比、用力肺活量、第1秒用力呼气量占用力肺活量百分比、氧分压明显高于治疗前[(5.04±0.62),(5.15±0.67),(5.38±0.67),(5.09±0.65)kPa,(46.5±5.8)%,(1.3±0.4)L,(47.9±5.3)%,(7.05±0.72)kPa;(4.12±0.66),(4.32±0.64),(4.28±0.51),(4.34±0.56)kPa,(41.2±6.1)%,(0.9±0.4)L,(43.5±5.6)%,(6.22±0.76)kPa,t=3.32～7.86,P<0.01]。②脉冲幅度100V组患者:治疗前后相近(P>0.05)。③最大吸气压、最大呼气压、最大跨膈压、呼吸肌力量指数、第1秒用力AIM: To investigate the effect of diaphragm pacemaker treatment in vitro on diaphragmatic fatigue in patients with stable chronic cor pulmonale at high altitude area, and compare the influence of different pulse amplitude, therapeutic time and number of times on their respiratory function. METHODS: Eight-four inpatients (52 males and 32 females) with stable chronic cor pulmonale in the center of respiratory medicine, the 4 Hospital of Lanzhou Military Area Command of Chinese PLA between February 2001 and October 2004 were voluntarily involved in the study, and their primary disease was chronic obstructive pulmonary disease. According the therapeutic status of diaphragm pacemaker, the patients were randomly divided into 2 groups with 42 cases in each group: pulse amplitude of 60 V group (26 males and 16 females) and pulse amplitude of 100 V group (26 males and 16 females). ① One week after remission of illness condition, all the treatments, including oxygen therapy, were stopped in both groups, and then the patients were treated with diaphragm pacemaker. In the pulse amplitude of 60 V group, the pulse amplitude was 60 V, 30 minutes for each time, once a day for 14 days as a course; In the pulse amplitude of 100 V group, the pulse amplitude was 100 V, 40 minutes for each time, twice a day for 14 days as a course. ② The function of respiratory muscle, including the maximum inspiratory pressure, the maximum expiratory pressure and the maximum transdiaphragmatic pressure, was determined with the computerized diaphragmatic function radiometer in both groups. The respiratory muscular strength index was calculated with formula (respiratory muscular strength index= maximum inspiratory pressure + maximum expiratory pressure/2). ③ The partial pressure of arterial oxygen and partial pressure of carbon dioxide were detected with blood gas analyzer. The percentage of the forced expiratory volume in the first second to the predicted value, forced vital capacity, the percentage of the forced expiratory volume to the forced

关 键 词：肺疾病 慢性阻塞性 肌疲劳 起搏器 人工 肺心病/治疗 呼吸功能试验 

分 类 号：R563[医药卫生—呼吸系统]