慢性心衰病人呼吸急促的机制研究  

Mechanism of Breathlessness symptom with chronic heart failure

作　　者：张莉[1] 

机构地区：[1]西北政法大学门诊部,陕西西安710061

出　　处：《临床肺科杂志》2010年第12期1748-1750,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的通过对慢性心衰病人(CHF)吸气肌功能定量检测和分析,探讨导致CHF病人呼吸急促的主要诱因。方法采用吸气阻力法、食道内压测量法测定10例CHF患者和10名正常对照者吸气肌功能及耐力。结果 CHF组静息肺功能数值较低,但与正常对照组比较无明显差异;CHF组代表吸气肌肌力的食管最大内压(Poesmax)测试值较正常对照组低(P>0.05),吸气肌耐力时间(Tlim)较正常对照组明显降低(P<0.001),而且吸气肌负荷/肌力比值明显增高(P<0.01)。结论 CHF患者的吸气肌耐力时间显著缩短,主要是由于采用了适应性的呼吸模式,导致吸气肌负荷增加而不是吸气肌力量或耐力泵下降。Objective quantify the reduction in inspiratory muscle endurance and to examine the magnitude of the inspiratory muscle load to capacity ratio and assess its effects on Tlim.Methods Endurance was measured in 10 healthy controls and 10 patients with CHF using threshold loading at 40% maximal oesophageal pressure（Poesmax）.Oesophageal pressure-time product（PTPoes per cycle） and Poesmax were used as indices of inspiratory muscle load and capacity,respectively.Results Poesmax was slightly less in the CHFgroup,Tlim was greatly reduced and the observed PTPoes per cycle/Poesmax was increased.Most of this increased inspiratory muscle load was due to a maladaptive breathing pattern,with a reduction in expiratory time accompanied by an increased inspiratory time relative to total respiratory cycle.However,log Tlim,which incorporates the higher inspiratory muscle load to capacity ratio caused by this altered breathing pattern,was 85% predicted in seven of 10 patients.Conclusions Although a marked reduction in endurance time was observed in CHF,much of this reduction was explained by the increased inspiratory muscle load to capacity ratio,suggesting that the major contributor to task failure was a maladaptive breathing pattern rather than impaired inspiratory muscle endurance.

关 键 词：慢性心衰 吸气肌功能 吸气剂耐力 呼吸模式 

分 类 号：R541.6[医药卫生—心血管疾病]