单纯累及延髓肌重症肌无力患者的呼吸阻抗与呼吸肌力损害的相关性分析  

The correlation between the decline of respiratory muscle strength and impedance in patients with bulbar myasthenia gravis(MG)

作　　者：周怡[1] 田芳芳[1] 李小凤[1] 

机构地区：[1]解放军第309医院呼吸科,北京100091

出　　处：《中国现代医学杂志》2014年第31期107-109,共3页China Journal of Modern Medicine

摘　　要：目的探讨单纯累及延髓呼吸肌重症肌无力(MG)患者呼吸阻抗与最大呼吸压的变化;分析咀嚼肌和吞咽肌损害时呼吸阻抗表现与最大呼吸压改变的关系。方法检测68例MG患者(A组)和27例健康人(B组)最大呼吸压和脉冲震荡技术(IOS)的呼吸阻抗,分组测试单纯累及延髓呼吸肌MG和Ⅰ型MG患者的呼吸阻抗,评估呼吸肌损害时二者的关系。结果发现A组患者最大吸气压(MIP)、最大呼气压(MEP)降低,总呼吸阻抗(R5)、中心呼吸阻抗(R20)增高,中央呼吸阻抗(Rc),周围呼吸阻抗(Rp),响应频率(Fres)和外周弹性阻力(X5)绝对值增高,差异有统计学意义(P<0.05)。在Ⅰ型MG和单纯累及延髓呼吸肌MG组间比较中,发现后者的R20和Rc绝对值增高更明显(P<0.05)。发现单纯累及延髓呼吸肌MG组MIP与Rc、R20的增高负相关,MEP与Fres负相关,差异有统计学意义(P<0.05)。图谱分析呼吸阻抗增高发生率出现的部位在二型差异有统计学意义。结论重症肌无力患者肺功能的表现为总/中心呼吸阻抗和周围呼吸阻抗及周围弹性阻力增高;而单纯累及延髓呼吸肌重症肌无力患者的中心呼吸阻抗增高比Ⅰ型重症肌无力患者更明显,前者的最大呼吸压主要与中心呼吸阻抗改变相关。IOS图谱分析呼吸阻抗增高部位在这二型的表现是不同的。[Objective] To explore the changes of maximum inspieatory or expiratory pressure and respiratory impedance in patients with bulbar MG, and analyze the relationship between PIM, PEM and respiratory impedance in these patients. [Methods] For 68 patients with MG （group A） and 27cases of healthy people（group B）,whose res- piratory impedance were measured by impulse oscillometry system （IOS） and PIM, PEM, then measured respiratory impedance in patients with bnlbar MG and Ⅰ type MG by groups, the relationship between them was evaluated, [ Results ] Compared with group B, level of PIM, PEM, the level of R5, R20 decreased in group A patients and ab- solute valve of Rc, Rp, Fres, X5 had increased, the difference was significant （P 〈0.05）. With patients in Ⅰ type MG, the level of absolute valve of Rc and R20 was more significantly increased（P 〈0.05） in bulbar MG. The level of MIP, was negatively correlated to Rc, R20 in bulbar MG and MEP was negatively correlated to Fres, the difference was significantly （P 〈0.05）. [ Conclusion ] The level of total respiratory impedance, resistance in center and elastic resistance in periphery increased in MG. The level of resistance in center in bulbar MG significantly increased than the level of Ⅰ type MG. The level of MIP, MEP are correlated to resistance in center and resistance in periphery, respira- tory impedance by IOS can evaluate the respiratory muscle strength in patients with MG.

关 键 词：单纯累及延髓呼吸肌重症肌无力 呼吸阻抗 

分 类 号：R746.1[医药卫生—神经病学与精神病学]