经食管电极和表面电极两种途径进行膈神经刺激的比较

Surface electrodes versus esophageal electrodes in diaphragm nerve stimulation

目的:探索表面电极进行单侧膈神经刺激测量膈神经传导时间和膈肌动作电位的可行性,并与经典方法食管电极记录进行比较。方法:实验于2005-01/06在广州医学院第一附属医院进行。15名健康志愿者使用表面电极通过单侧磁刺激膈神经测定膈神经传导时间及诱发的膈肌复合肌肉动作电位的幅值,并用配对t检验与标准的经食管电极检测所得结果进行比较。采用直线相关分析进行双侧膈神经传导时间及膈肌动作电位与年龄、身高、体质量和腹围的相关性分析。结果:15名受试者全部完成测试进入结果分析。①膈神经传导时间:表面电极测定的结果与经食管电极结果相似[左侧:(6.68±0.76),(6.63±0.52)ms;右侧:(6.14±0.67),(6.02±0.48)ms,P>0.05]。②膈肌动作电位幅值:表面电极测定的结果显著低于经食管电极测定结果[左侧:(1.14±0.36),(2.31±0.87)mV;右侧:(1.05±0.52),(2.17±0.90)mV,P均<0.001]。③经食管电极和表面电极测定的左侧膈肌动作电位幅值无显著相关性(P=0.174),右侧有显著相关性(P=0.025)。④两种途径测定的双侧膈神经传导时间及膈肌动作电位幅值与年龄、身高、体质量及腹围均无相关性。结论:①采用单侧磁刺激膈神经时,表面电极测得的膈神经传导时间与食管电极检测结果相似,但膈肌动作电位显著降低。②年龄、身高、体质量及腹围对表面电极和食管电极检测结果的影响均较小。

AIM： To probe into the feasibility of measuring phrenic nerve conduction time （PNCT） and elicited diaphragmatic muscle action potential by unilateral diaphragm nerve stimulation （DNS） with surface electrodes. METHODS： The experiment was conducted in the First Affiliated Hospital of Guangzhou Medical College from January to June 2005, Fifteen healthy volunteers were involved in the study, PNCT and amplitude of diaphragm diaphragmatic muscle action potential elicited by unilateral magnetic stimulation （UMS） of the phrenic nerve were measured with surface electrodes, and the results were compared with those measured by pairing t test and standard esophageal electrodes. Bivariate correlation analysis was adopted to analyzed the correlation between bilateral PNCT, diaphragmatic muscle action potential and the age, body height, body mass as well as the abdomen circumference of patients. RESULTS： A total of 15 Subjects, who had accomplished all tests, were involved in the analysis of results.（1）PNCT： the results measured by surface electrode were similar to those measured with esophageal electrode [left： （6.68±0.76）, （6.63±0.52） ms. Right： （6.14±0.67）, （6.02±0.48） ms,P 〉 0.05]. （2）The amplitude of diaphragmatic muscle action potential： those measured by surface electrode were obviously lower than those measured by esophageal electrode [left： （1.14±0.36）, （2.31 ±0.87） mV. Right： （1.05 ±0.52）, （2.17±0.90） mV,P 〈 0.001].（3）The amplitudes of left diaphragm diaphragmatic muscle action potential measured by esophageal electrode were not significantly correlated with those measured by surface electrode （P=0.174）, while there were significant correlation in the left diaphragmatic muscle action potential （P=0.025）. （4）PNCT and the amplitude of diaphragmatic muscle action potential were not related with age, body height, body mass and abdomen circumference no matter measured with esophageal or surface electrodes. CONCLUSION： （1）With unilateral magnetic stimulation of phrenic nerve, the PNCT measured with surface electrodes is similar to that with esophageal electrodes. However, the diaphragmatic muscle action potential measured with surface electrodes is lower significantly than that with esophageal electrodes.（2）There are little effects of age, body height, body mass and abdomen circumference on results measured by esophageal electrode and surface electrode.