慢性阻塞性肺疾病急性加重期患者的膈神经电生理研究

Electrophysiological Studies of Phrenic Nerve in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:探讨慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者膈神经运动传导(PNC)及磁刺激膈肌运动诱发电位(dMEP)的特点。方法:借助Keypoint4肌电诱发电位仪和Magpro Compact型磁刺激器对13例因呼吸衰竭而行机械通气的AECOPD患者进行PNC和dMEP检测。选取20例同期健康体检者为对照组。结果:与对照组比较,AECOPD组脱机前PNC潜伏期延长,波幅对数值减低,经C7棘突磁刺激dMEP潜伏期、经皮层磁刺激dMEP潜伏期和中枢运动传导时间(CMCT)延长,经C7棘突磁刺激dMEP波幅对数值减低(P<0.01),经皮层磁刺激dMEP波幅对数值差异无统计学意义(P>0.05)。AECOPD组患者脱机后复检,除经皮层磁刺激dMEP潜伏期、CMCT与对照组差异无统计学意义外,其余与脱机前情况相似。结论:PNC及磁刺激dMEP联合应用对评价AECOPD患者膈神经、膈肌及呼吸中枢运动传导功能状态有一定参考价值。

Objective： To investigate the characteristics of phrenic nerve motor conduction （PNC） and motor evoked potentials of diaphragm（dMEP） elicited through magnetic stimulation in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） who experienced acute respiratory failure. Methods： PNC and dMEP were performed with Keypoint 4 electromyography device and Magpro Compact magnetic stimulator in 13 AECOPD patients who experienced acute respiratory failure and required mechanical ventilation. Twenty healthy subjects were chosen as the control group. Results： The latency of PNC was longer, and the common logarithm of the amplitude of PNC was lower in AECOPD group than those of control group （P 〈 0.01）. The latencies of cervical and cortical dMEP, central motor conduction time（CMCT） were longer in AECOPD group than those of control group （P 〈 0.01 for each）. The common logarithm of the amplitude of cervical dMEP was significantly decreased in AECOPD group compared with that of control group （P 〈 0.01）. There was no statistical difference in the common logarithm of the amplitude of cortical dMEP between two groups（P 〉 0.05）. Patients of AECOPD group were reex- amined after weaning, it was found that the differences between two groups were the same as before weaning in latency and the common logarithm of the amplitude of PNC, the latency and the common logarithm of the amplitude of cervical dMEP and the common logarithm of the amplitude of cortical dMEP. There were no statistical differences between before and after the treatment with mechanical ventilation in AECOPD group except for the latency of cortical dMEP and CMCT. Conclusion： The combined use of PNC and dMEP may help evaluate the function of phrenic nerve, diaphragm and respiratory central mo- tor conduction in AECOPD patients.