颈后磁刺激膈肌功能的研究

发布时间：2018-03-31 22:16

本文选题：膈肌　切入点：颤搐性跨膈压　出处：《广州医学院》2012年硕士论文

【摘要】：目的利用颈后磁刺激膈神经，探讨在不同磁刺激量水平，气道完全阻断和气道开放两种状态下膈肌特性的差异，了解膈肌力量-速度-磁刺激量的关系，综合地评估膈肌特性的动态变化。方法选择8例健康男性作为受试对象，经鼻插入多导食道电极、胃食道囊管和体表电极以测量膈肌CMAP、食道压和胃压，用自制的气道阻断和触发装置，在不同的磁刺激量刺激双侧膈神经，在不同的时间重复3次刺激，测量口腔出现颤搐性吸气流速时和气道完全阻断时的Pmou,t、Pdi,t、口腔吸气流速和IC的重复性以及系统地比较不同气道状态对Pdi,t的影响。结果在100%磁刺激时Pdi,t、Pmou,t、Fin,t和Pmou,t/Pdi,t比值的变异较小，同IC一样均小于5%，变异不受时间的影响，而受磁刺激量的影响。用自制的气道阻断和触发装置可以得到稳定的Pmou,t、Pdi,t、口腔吸气流速和Pmou,t/Pdi,t比值，分别为19.16±5.68cmH2O、15.55±4.01cmH2O、2.46±0.58L/s、0.82±0.08，它们各自的自身变异系数是4.89%,4.41%,3.90%,2.40%和3.33%。Pdi,t与Pmou,t具有显著的相关性(r=0.96,P 0.0001），Pdi,t与Fin,t具有一定的相关性(r=0.52，P 0.05）。应用气道阻断装置可以系统地研究膈肌力量-速度-磁刺激量的关系，，在100%磁刺激水平时气道开放的Pdi,t比气道完全阻断小3.82cmH2O（P=0.04），其余3个磁刺激水平无差异。结论 1.自制的气道阻断和触发装置可以在颈后磁刺激膈神经时记录到稳定的Pmou,t和Pdi,t。 2.在重复磁刺激时Pdi,t、Pmou,t、Fin,t、IC和Pmou,t/Pdi,t比值均是重复性较好的指标，可用来综合评估膈肌功能的动态变化。 3. Pdi,随着磁刺激量的增加而增加，没有达到刺激平台。在100%磁刺激水平时气道开放的Pdi,t比气道完全阻断小3.82cmH2O，其余3个磁刺激水平无差异。
[Abstract]:Purpose. Using posterior cervical magnetic stimulation of phrenic nerve, the differences of diaphragm characteristics under different levels of magnetic stimulation, complete obstruction of airway and open airway were discussed, and the relationship between diaphragm strength, velocity and magnetic stimulation was studied. The dynamic changes of diaphragm characteristics were evaluated synthetically. Method. Eight healthy men were selected as subjects. Multiple esophageal electrodes, gastroesophageal sac tubes and body surface electrodes were inserted through the nose to measure diaphragm CMAP, esophageal pressure and gastric pressure, and self-made airway blocking and triggering devices were used. The bilateral phrenic nerve was stimulated with different amount of magnetic stimulation, and the stimulation was repeated three times at different time. The repeatability of inspiratory velocity and IC in oral cavity and the effect of different airway states on Pditit were measured when there was convulsive inspiratory velocity in oral cavity and when the airway was completely blocked. Results. Under 100% magnetic stimulation, the variation of the ratio of Pditit and Pmout / P / Pdit was smaller than that of IC, and the variation was not affected by time. Under the influence of magnetic stimuli, stable Pdit was obtained by using self-made airway blocking and triggering device, and the inspiratory velocity of mouth and the ratio of Pdit / Pdit of mouthpiece were obtained. They were 19.16 卤5.68 cm H _ 2O 15.55 卤4.01 cm H _ 2O 2.46 卤0.58 L / s 0.82 卤0.08, and their coefficients of variation were 4.89 ~ 4.41 ~ 3.90 ~ 2.40% and 3.33 ~ 0.96 ~ (-1) P ~ (0.000) P ~ (0.000) ~ (-1) P ~ (0.05) respectively. The relationship between muscle strength, velocity and magnetic stimulation could be systematically studied by using the airway blocking device. At 100% magnetic stimulation level, the open airway Pdit was 3.82 cm H _ 2O _ 2 P _ (0.04) less than that of complete airway blockade, but the other three magnetic stimulation levels were not different. Conclusion. 1. Stable pmout and Pditit could be recorded by self-made airway blocking and triggering device during magnetic stimulation of phrenic nerve. 2. The ratio of Pditit / Pmout / Pdit / Pdit is a good reproducibility index, which can be used to evaluate the dynamic changes of diaphragm function. 3. Pdil, which increased with the increase of the amount of magnetic stimulation, did not reach the stimulation platform. At 100% magnetic stimulation level, the open Pdit of the airway was 3.82 cmH2O smaller than that of the airway completely blocked, but there was no difference in the other three levels of magnetic stimulation.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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