磁刺激诱发的膈肌复合动作电位的多导食道电极记录及其在重症监护室患者中的应用  

Measurement of diaphragm compound muscle action potential with magnetic stimulation of the phrenic nerve and multipair esophageal electrode in intensive care unit

作　　者：罗远明[1] 陈荣昌 钟南山[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所

出　　处：《中华结核和呼吸杂志》2005年第8期505-508,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨在重症监护室(ICU)里,用多导食道电极是否能满意地记录由磁刺激膈神经诱发的膈肌复合肌肉动作电位(CMAP)。方法运用1根具有5个记录导联的新型多导食道电极记录由电和磁刺激膈神经诱发的膈肌CMAP。10名正常人和10例因各种原因在ICU病房治疗的患者被纳入研究。结果不论在正常人还是ICU患者均可记录到高质量的信号。在正常人,电刺激诱发的膈神经传导时间(PNCT)、膈肌CMAP幅值[(7.2±0.8)ms、(1.52±0.40)mV]与磁刺激诱发的相似[(7.1±0.8)ms、(1.56±0.38)mV,P均>0.05]。ICU患者磁刺激诱发的膈肌CMAP幅值[(0.73±0.38)mV]显著小于正常人[(1.58±0.38)mV,P<0.01]。结论这一研究提示磁刺激可取代传统的电刺激去测量膈肌CMAP和PNCT。把磁刺激和多导食道电极结合在一起能有效地评价ICU患者的膈肌功能。Objective To investigate whether magnetic stimulation of the phrenic nerve and muhipair esophageal electrode can be used to measure diaphragm compound muscle action potential（CMAP） in intensive care unit（ICU）. Methods Ten normal subjects and 10 patients in ICU were studied. A newly designed multipair esophageal catheter with 5 pairs of electrodes was used to record the diaphragm CMAP elicited by magnetic stimulation and transcutaneous electrical stimulation of the phrenic nerve. Results Good quality CMAPs were obtained from normal subjects and patients in ICU. In normal subjects, the phrenic nerve conduction time （PNCT） and amplitude of the diaphragm CMAP measured with electrical stimulation [ （7. 2 ± 0. 8 ） ms, （ 1.52 ±0. 40） mV ] were similar to those measured with magnetic stimulation [ （7. 1 ±0. 8 ） ms, （ 1.56 ± 0. 38 ） mV, all P 〉 0. 05, pooled left and right values]. The amplitude of the diaphragm CMAP in patients[ （0. 73 ± 0. 38 ）mV ] was much smaller than that in normal subjects[ （ 1.58 ± 0. 38）mV, P 〈 0. 01, pooled left and right values ]. Conclusion This study suggests that magnetic stimulation combined with a muhipair esophageal electrode could be a useful technique in assessing diaphragm function in ICU.

关 键 词：膈肌 磁刺激 电刺激 膈神经 动作电位 电刺激诱发 ICU患者 复合动作电位 膈肌功能 电极记录 

分 类 号：R444[医药卫生—诊断学]