Nishino T, Shimoyama N, Ide T, Isono S
Department of Anesthesiology, School of Medicine, Chiba University, Japan.
Anesthesiology. 1999 Dec;91(6):1633-8. doi: 10.1097/00000542-199912000-00014.
Pain and dyspnea frequently coexist in many clinical situations. However, whether the two different symptoms interact with each other has not been elucidated. To elucidate the interaction between pain and dyspneic sensations, the authors investigated separately the effects of pain on dyspnea and the effects of dyspnea on pain in 15 healthy subjects.
Subjects were asked to rate their sensation of pain or dyspnea using a visual analog scale (VAS) during pain stimulation produced by tourniquet inflation (inflation cuff pressure: 350 mmHg) around the calf, and/or the respiratory loading consisted of a combination of resistive load (77 cm H2O x l(-1) x s(-1)) and hypercapnia induced by extra mechanical dead space (255 ml). In addition to changes in VAS scores, changes in ventilatory airflow and airway pressure were continuously measured.
Pain stimulation and loaded breathing increased VAS scores, ventilation, and occlusion pressure (P0.1). The addition of a pain stimulus during loaded breathing increased the dyspneic VAS score (median 56 [interquartile range 50-62] vs. 64 [55-77]: before vs. after addition of pain stimulus, P < 0.05) with concomitant increases in minute ventilation (10.8 [10.1-13.3] vs. 12.4 [11.0-14.8] l/min, P < 0.05) and P0.1 (5.5 [4.9-7.2] vs. 6.8 [5.8-9.0] cm H2O, P < 0.05). The addition of respiratory loading during pain stimulation did not cause a significant change in pain VAS score (40 [33-55] vs. 31 [30-44]: before vs. after addition of respiratory loading), although both additional burdens increased further minute ventilation (10.0 [8.8-10.9] vs. 12.0 [10.6-13.2] l/min, P < 0.05) and P0.1 (2.5 [2.0-3.0] vs. 6.2 [4.9-7.0] cm H2O, P < 0.05).
The authors' findings suggest that pain intensifies the dyspneic sensation, presumably by increasing the respiratory drive, whereas dyspnea may not intensify the pain sensation.
在许多临床情况下，疼痛和呼吸困难常常同时存在。然而，这两种不同症状是否相互作用尚未阐明。为了阐明疼痛与呼吸困难感觉之间的相互作用，作者对15名健康受试者分别研究了疼痛对呼吸困难的影响以及呼吸困难对疼痛的影响。
在通过小腿周围的止血带充气（充气袖带压力：350 mmHg）产生疼痛刺激期间，和/或由阻力负荷（77 cm H₂O·L⁻¹·s⁻¹）与额外机械死腔（255 ml）诱导的高碳酸血症组成的呼吸负荷期间，要求受试者使用视觉模拟量表（VAS）对其疼痛或呼吸困难的感觉进行评分。除了VAS评分的变化外，还连续测量通气气流和气道压力的变化。
疼痛刺激和负荷呼吸增加了VAS评分、通气量和闭塞压（P0.1）。在负荷呼吸期间添加疼痛刺激增加了呼吸困难的VAS评分（中位数56 [四分位间距50 - 62] 对64 [55 - 77]：添加疼痛刺激前对后，P < 0.05），同时分钟通气量（10.8 [10.1 - 13.3] 对12.4 [11.0 - 14.8] L/min，P < 0.05）和P0.1（5.5 [4.9 - 7.2] 对6.8 [5.8 - 9.0] cm H₂O，P < 0.05）增加。在疼痛刺激期间添加呼吸负荷并未导致疼痛VAS评分的显著变化（40 [33 - 55] 对31 [30 - 44]：添加呼吸负荷前对后），尽管两种额外负担都进一步增加了分钟通气量（10.0 [8.8 - 10.9] 对12.0 [10.6 - 13.2] L/min，P < 0.05）和P0.1（2.5 [2.0 - 3.0] 对6.2 [4.9 - 7.0] cm H₂O，P < 0.05）。
作者的研究结果表明，疼痛可能通过增加呼吸驱动力来加剧呼吸困难的感觉，而呼吸困难可能不会加剧疼痛感觉。
