健康青老年人在静息及运动中呼吸中枢驱动的变化

发布时间：2018-04-01 02:34

本文选题：肺功能　切入点：呼吸中枢驱动　出处：《广州医学院》2011年硕士论文

【摘要】：第一部分肺功能与呼吸中枢驱动目的肺功能随年龄的增高而不断地下降。老年人肺功能下降是因为呼吸中枢驱动下降还是肺结构的改变尚不清楚。这一研究用多导食道电极记录的膈肌肌电评价健康青年及老年人的最大呼吸中枢驱动及静息状态下的呼吸中枢驱动,探讨健康老年肺功能下降与呼吸中枢驱动变化的关系。方法随机选择8例健康老年人(57.3±5.0岁)及8例性别匹配的健康青年人(28.3±3.4岁),检测其肺功能,并通过多导食道电极记录膈肌肌电反映呼吸中枢驱动。观察静息状态下及最大用力吸气时的膈肌肌电。结果老年组的肺活量(VC)3.21±0.51(L)显著低于青年组(4.0±0.84 L, P0.05 );老年人最大努力吸气动作时的膈肌肌电与青年人相似(172.2±54.6μV vs 175.0±55.7μV, P=0.921)。老年人安静状态下的潮气量及每分通气量与青年人相似,但其呼吸中枢驱动占最大值的百分数显著高于青年人(27.8%±12.9% vs 16.4%±7.2%, P0.05)。老年人呼吸中枢驱动有效性比青年人小一倍(62.7%±23.2% vs 128.6%±96.2%). 结论老年人的呼吸中枢驱动储备低于青年人;肺功能随年龄减退并不是因为呼吸中枢驱动下降,而是因为肺结构改变所致。第二部分健康青老年人运动时呼吸中枢驱动及其有效性的变化目的本研究通过多导食道电极记录的膈肌肌电评价健康青年及老年人在递增踏车运动过程中的呼吸中枢驱动,探讨健康老年人呼吸中枢驱动及其有效性是否与青年人不同。方法随机选择9例健康老年人(59.3±7.8岁)及9例性别匹配的健康青年人(27.6±3.0岁),通过多导食道电极、食道囊分别记录老年和青年在递增运动过程中的膈肌肌电、食道压、通气及氧耗等,以膈肌肌电作为反映呼吸中枢驱动的指标。结果受试者在静息状态下重复多次最大努力吸气动作,老年组的食道压(62.4±17.4 cmH_20)小于青年组的食道压(79.5±8.1 cmH_20),有统计学差异(P0.05);两组受试者在整个实验过程中所获得的最大膈肌肌电相似(218.2±54.3μV vs 220.2±48.6μV, P=0.935)。在运动过程中,两组EMGdi%max(%)均随运动负荷的增加而逐渐增大,直至运动末两组的呼吸中枢驱动均显著低于最大值,且运动结束时老年组EMGdi%max(%)为64.9%±7.8%,高于青年组55.7%±8.9% ,有统计学差异(P0.05)。运动末老年组的呼吸中枢驱动有效性差于青年组(101.1%±18.8% vs 158.9%±35.7%, P0.01)。结论多导食道电极记录的膈肌肌电可以准确地评价正常人在运动状态的呼吸中枢驱动;两组受试者运动末呼吸中枢驱动均未达到最大值,提示健康人存在呼吸中枢抑制以避免呼吸肌疲劳;老年人肺功能变差所致的运动末呼吸中枢驱动高于青年人,是造成老年人运动耐量差于青年人的其中一个因素;呼吸中枢驱动及其有效性差于青年人,与老年肺功能变差有关。呼吸中枢驱动有效性可能是反映肺通气效率的有效指标。
[Abstract]:Part I Pulmonary function and respiratory central driveObjective Pulmonary function decreases with age.It is unclear whether the decline in lung function in the elderly is due to decreased respiratory center drive or changes in lung structure.In this study, the diaphragm electromyography recorded by multichannel esophageal electrode was used to evaluate the maximal respiratory center drive and resting respiratory center drive in healthy young and old people, and to explore the relationship between lung function decline and respiratory center drive changes in healthy elderly people.Methods the pulmonary function of 8 healthy elderly patients (57.3 卤5.0 years old) and 8 healthy young people (28.3 卤3.4 years old) were measured, and the diaphragm electromyography was recorded by multichannel esophageal electrode to reflect the respiratory center drive.The diaphragm myoelectric activity was observed at rest and maximum inspiratory force.Results the vital capacity of the elderly group was 3.21 卤0.51L) significantly lower than that of the young group (4.0 卤0.84L, P0.05), and the diaphragmatic myoelectric activity of the elderly was similar to that of the young people (172.2 卤54.6 渭 V vs 175.0 卤55.7 渭 V, P0. 921).The tidal volume and ventilation volume per minute in the elderly were similar to those in the young people, but the percentage of respiratory center drive in the maximum value was significantly higher than that in the young people (27.8% 卤12.9% vs 16.4% 卤7.2%, P0.05%).The effectiveness of respiratory drive in the elderly was twice as high as that in the young (62.7% 卤23.2% vs 128.6% 卤96.2C).Conclusion the respiratory central drive reserve of the elderly is lower than that of the young, and the decline of lung function with age is not due to the decrease of respiratory drive, but to the change of lung structure.The second part: changes of respiratory center drive and its effectiveness during exercise in healthy young and aged peopleObjective to evaluate the respiratory center drive of healthy young people and old people in the process of increasing treadmill exercise by means of diaphragm electromyography recorded by multichannel esophagus electrode, and to explore whether the respiratory center drive and its effectiveness in healthy old people are different from those in young people.Methods A total of 9 healthy elderly patients (59.3 卤7.8 years old) and 9 sex-matched healthy young people (27.6 卤3.0 years old) were randomly selected. The diaphragm myoelectric activity and esophageal pressure were recorded by multichannel esophageal electrode and esophageal sac in elderly and young people during progressive exercise.Ventilation and oxygen consumption were measured by diaphragm electromyography.Results the subjects repeated their best efforts to inhale several times in the resting state.The esophageal pressure (62.4 卤17.4 cmH20) in the elderly group was lower than that in the young group (79.5 卤8.1 cmH20), there was significant difference between the two groups (P 0.05), and the maximal diaphragm electromyography obtained in the two groups was similar to 218.2 卤54.3 渭 V vs 220.2 卤48.6 渭 V, P0.935.At the end of exercise, the respiratory center drive of the two groups was significantly lower than the maximum value, and at the end of the exercise, the EMGdimax value was 64.9% 卤7.8%, which was higher than that of the young group (55.7% 卤8.9%). There was a significant difference between the two groups (P 0.05).The efficacy of respiratory drive in the elderly group at the end of exercise was significantly lower than that in the young group (101.1% 卤18.8% vs 158.9% 卤35.7g, P 0.01).Conclusion the diaphragm electromyography recorded by multichannel esophagus electrode can accurately evaluate the respiratory central drive of normal subjects in the state of movement, and neither of the two groups has reached the maximum value at the end of exercise.It is suggested that respiratory center inhibition exists in healthy people to avoid respiratory muscle fatigue, and that the respiratory center drive at the end of exercise due to the deterioration of lung function in the elderly is higher than that in young people, which is one of the factors contributing to the poor exercise tolerance of the elderly compared with young people.Respiratory center drive and its effectiveness were lower than that of young people, which was related to the deterioration of lung function in the elderly.Respiratory center drive effectiveness may be an effective indicator of pulmonary ventilation efficiency.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R332

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