Hughes P D, Polkey M I, Moxham J, Green M
Respiratory Muscle Laboratory, Royal Brompton Hospital, London, UK.
Eur Respir J. 1999 Feb;13(2):379-84. doi: 10.1183/09031936.99.13237999.
Diaphragm paralysis is a recognized complication of neuralgic amyotrophy that causes severe dyspnoea. Although recovery of strength in the arm muscles, when affected, is common, there are little data on recovery of diaphragm function. This study, therefore, re-assessed diaphragm strength in cases of bilateral diaphragm paralysis due to neuralgic amyotrophy that had previously been diagnosed at the authors institutions. Fourteen patients were recalled between 2 and 11 yrs after the original diagnosis. Respiratory muscle and diaphragm strength were measured by volitional manoeuvres as maximal inspiratory pressure and sniff transdiaphragmatic pressure. Cervical magnetic phrenic nerve stimulation was used to give a nonvolitional measure of diaphragm strength: twitch transdiaphragmatic pressure. Only two patients remained severely breathless. Ten of the 14 patients had evidence of some recovery of diaphragm strength, in seven cases to within 50% of the lower limit of normal. The rate of recovery was variable: one patient had some recovery after 2 yrs, and the rest took 3 yrs or more. In conclusion, in most patients with diaphragm paralysis due to neuralgic amyotrophy, some recovery of the diaphragm strength occurs, but the rate of recovery may be slow.
膈肌麻痹是神经痛性肌萎缩的一种公认并发症，可导致严重呼吸困难。虽然受影响时手臂肌肉力量恢复很常见，但关于膈肌功能恢复的数据很少。因此，本研究对作者所在机构先前诊断为神经痛性肌萎缩所致双侧膈肌麻痹病例的膈肌力量进行了重新评估。在初次诊断后2至11年召回了14例患者。通过意志动作测量呼吸肌和膈肌力量，即最大吸气压力和嗅吸跨膈压。采用颈磁膈神经刺激来非意志性测量膈肌力量：抽搐跨膈压。只有两名患者仍严重气喘。14例患者中有10例有膈肌力量部分恢复的证据，7例恢复到正常下限的50%以内。恢复速度各不相同：1例患者在2年后有部分恢复，其余患者则需要3年或更长时间。总之，在大多数因神经痛性肌萎缩导致膈肌麻痹的患者中，膈肌力量会出现部分恢复，但恢复速度可能较慢。
