呼吸中枢驱动量化呼吸困难的初步研究

发布时间：2018-04-23 15:47

本文选题：呼吸中枢驱动 + 呼吸困难　；参考：《广州医科大学》2013年博士论文

【摘要】：目的：呼吸困难主要依赖主观量表并结合患者的自身感受进行评价，缺乏客观量化呼吸困难的方法。本研究目的就是探讨多导食道电极记录的膈肌肌电（呼吸中枢驱动）量化呼吸困难的可行性。方法：选择10例健康青年人、13例健康中老年人和14例慢性阻塞性肺疾病（COPD）稳定期患者，均进行常规肺功能检测。应用心肺运动试验诱发呼吸困难，通过多导食道电极记录膈肌肌电反映呼吸中枢驱动，实时记录运动过程中膈肌功能及呼呼吸困难变化。试验中呼吸困难程度分为无（0）、轻度（1）、中度（2）、重度（3）、极重度（4）5个分级，并协同Borg量表作为评价呼吸困难的依据，分析膈肌肌电与呼吸困难之间相关性。以膈肌肌电占最大值百分比进行膈肌肌电标化来反映呼吸中枢驱动，并进一步比较呼吸中枢驱动与呼吸困难严重度的关系，观察标化值百分比与呼吸困难严重度之间的数量关系。试验中所有膈肌肌电值均应用均方根来计算。结果：健康青年组、健康中老年组和COPD组膈肌肌电与呼吸困难呈直线相关（r=0.977±0.026，0.973±0.025，0.958±0.051，均P 0.05），另外，在健康青年组和中老年组呼吸困难五级分度法与膈肌肌电相关性显著优于Borg量表法，然而，COPD组两种方法与膈肌肌电相关性却没有统计学差异。健康青年组、健康中老年组和COPD组在出现呼吸困难时相对应的呼吸中枢驱动分别为：（22.2±9.0）%、（41.0±7.7）%、（44.0±17.0）%；呼吸中枢驱动在呼吸困难程度分级各分度之间的数量差异均有统计学意义（P 0.05），，然而，由于呼吸困难各分度（比如中度、重度和极重度）所对应的呼吸中枢驱动有重叠。结论：多导食道电极记录的膈肌肌电（呼吸中枢驱动）可以量化健康人和COPD患者的呼吸困难程度。
[Abstract]:Objective: to evaluate dyspnea by subjective scale and self-feeling of patients without objective method of quantifying dyspnea. The aim of this study was to investigate the feasibility of quantifying dyspnea by diaphragm electromyography (respiratory center drive) recorded by multichannel esophageal electrodes. Methods: routine pulmonary function tests were performed in 10 healthy young people and 13 healthy middle-aged and elderly patients and 14 stable patients with chronic obstructive pulmonary disease (COPD). Cardiopulmonary exercise test was used to induce dyspnea. Diaphragm electromyography was recorded by multichannel esophageal electrode to reflect the respiratory center drive. The changes of diaphragm function and dyspnea during exercise were recorded in real time. In the experiment, the degree of dyspnea was divided into 5 grades, including no dyspnea, mild dyspnea, moderate dyspnea, moderate dyspnea, severe dyspnea and severe dyspnea. The correlation between diaphragmatic myoelectricity and dyspnea was analyzed by using Borg scale as the basis for the evaluation of dyspnea. The diaphragm electromyography was standardized to reflect the respiratory center drive, and the relationship between the respiratory center drive and the severity of dyspnea was further compared. The quantitative relationship between the percentage of standardized values and the severity of dyspnea was observed. All diaphragm myoelectric values were calculated using RMS. Results: there was a linear correlation between diaphragmatic myography and dyspnea in healthy young group, healthy middle-aged group and COPD group. The correlation between diaphragm myography and diaphragm electromyography in healthy young group and middle and old age group was significantly better than that in Borg scale method, which was 0.977 卤0.026 卤0.973 卤0.025 卤0.958 卤0.051, respectively. In addition, the correlation between the five grades of dyspnea in healthy young group and middle and old age group was significantly better than that in Borg scale method. However, there was no statistical difference between the two methods and diaphragm electromyography in COPD group. In the healthy youth group, the healthy middle-aged group and the COPD group, the corresponding respiratory center drive in the case of dyspnea was 22.2 卤9.0% and 41.0 卤7.7% respectively, and the number of respiratory center drive in the different grades of dyspnea was significantly different (P 0.05), however, there were significant differences in the number of respiratory center drivers among the different grades of dyspnea, however, there were significant differences in the number of respiratory center drivers between different grades of dyspnea (P < 0.05). Because of dyspnea, the respiratory center drive corresponding to the degree of dyspnea (e. G. Moderate, severe and extremely severe) overlaps. Conclusion: diaphragm electromyography recorded by multichannel esophagus electrode (respiratory center drive) can quantify the degree of dyspnea in healthy people and COPD patients.
【学位授予单位】：广州医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R563.8

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