肺炎婴幼儿膈肌疲劳的临床研究

Clinical Study of Diaphragmatic Muscle Fatigue in Children with Pneumonia

目的探讨肺炎患儿膈肌疲劳的发生情况及其与呼吸衰竭的关系。方法用2K-V1型智能电阻抗呼吸图仪分别测定126例肺炎患儿(肺炎组)和60例健康儿童(健康对照组)膈肌功能,观察其胸腹运动曲线是否同步、主波方向是否一致;并计算胸腹运动曲线峰值错位时间与呼吸周期的比值(M值),依据胸腹运动曲线二维图计算最大X值到最小X值连线与X轴的夹角α值,根据一维图中胸腹运动曲线的变化及二维图中M值与α角度的变化判断其膈肌疲劳程度。结果 126例患儿中98例有膈肌疲劳,其中68例为Ⅰ型膈肌疲劳,30例为Ⅱ型膈肌疲劳。Ⅰ型膈肌疲劳患儿一维图呈胸腹部矛盾呼吸运动曲线,二维图顺时针方向运行,M值为(46.1±8.4)%,α角为(136.7±12.0)度;Ⅱ型膈肌疲劳患儿一维图呈胸腹呼吸运动曲线峰值错位,二维图逆时针方向运行,M值为(17.2±3.2)%,α角为(48.2±9.5)度;健康对照组M值为(4.3±1.0)%,α角为(31.7±5.2)度;Ⅰ型膈肌疲劳患儿、Ⅱ型膈肌疲劳患儿及健康儿童M值、α角比较差异均有统计学意义(Pa<0.01)。膈肌疲劳程度与临床诊断呼吸衰竭呈高度相关,与年龄呈负相关。结论电阻抗呼吸图仪可作为肺炎患儿膈肌疲劳的临床诊断方法,膈肌疲劳与肺炎患儿呼吸衰竭有关。

Objective To explore the occurrence of diaphragmatic muscle fatigue（DMF） in children with pneumonia and its relationship with respiratory failure.Methods One hundred and twenty-six cases of pneumonia（pneumonia group） and 60 healthy children（healthy control group） were selected,and 2K-V1 type intelligence electric impedance respirograph was used to measure diaphragmatic function of the children in both groups to find if the ribcage-abdomen motion was synchronic and to calculate M levels.The abdomen impedance values as X-axis were calculated,which were regarded,and the chest impedance values as Y-axis were calcaulated,which described two-dimensional chart of ribcage-abdomen motion curve and the α angle which was between connection of maximum X value to the smallest X value and the X-axis were calculated.According to the changes of chest-abdominal curve in one-dimensional chart and the changes of M value and α angle,the degree of the diaphragmatic muscle fatigue was judged.Results There were 98 cases of DMF in the 126 children with pneumonia,and 68 cases of which were type Ⅰ DMF,and 30 cases were type Ⅱ DMF.One-dimensional chart showed contradictory chest-abdominal respiratory motional curve,and two-dimensional chart moved in a clockwise direction.M value was（46.1±8.4）%,α angle was（136.7±12.0） degrees in children with type Ⅰ DMF;One-dimensional chart showed that the peak value of chest-abdominal respiratory motional curve dislocates,and two-dimensional chart moved in a counter-clockwise direction.M value was（17.2 ± 3.2）%,α angle was（48.2 ± 9.5） degrees in children with type Ⅱ DMF;the control group had M value（4.3 ± 1.0）%,α angle was（31.7 ± 5.2） degree.There were significant differences in M value and α angle between type Ⅰ DMF children,type Ⅱ DMF children and healthy children（Pa0.01）.Degree of diaphragmatic fatigue was highly correlated with clinical diagnostic respiratory failure and negatively correlated with age.Conclusions The electric impedance respirograph is a very valuable diagnostic method for diaphragmatic muscle fatigue of pneumonia.There is a significant correlation between DMF and respiratory failure.