Gosselink R, Troosters T, Decramer M
Division of Respiratory Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven Belgium.
J Cardiopulm Rehabil. 2000 Nov-Dec;20(6):353-60. doi: 10.1097/00008483-200011000-00004.
The authors determined the degree of respiratory and peripheral muscle weakness in patients with moderate to severe chronic obstructive pulmonary disease (COPD). Differences in severity of muscle weakness among muscle groups may provide treatment options, such as selective muscle training, to adapt the exercise prescription in pulmonary rehabilitation programs. In addition, this information may add to the knowledge on the mechanisms of muscle weakness.
Respiratory and peripheral muscle force were quantified in 22 healthy elderly subjects and 40 consecutive COPD patients (forced expiratory volume in 1 second, percent of predicted value [% pred] 41 +/- 19; transfer factor for carbon monoxide, % pred 47 +/- 26) admitted to a pulmonary rehabilitation program. Lung function, diffusing capacity, isometric force of four peripheral muscle groups (handgrip, elbow flexion, shoulder abduction, and knee extension), neck flexion force, and maximal inspiratory and expiratory pressures were measured.
Patients had reduced respiratory muscle strength (mean 64% of control subjects' value [% control]) and peripheral muscle strength (mean 75% control) compared to normal subjects. Inspiratory muscle strength (59 +/- 18% control) was significantly lower than expiratory muscle strength (69 +/- 25% control) and peripheral muscle strength (P < 0.01). Neck flexion force (80 +/- 19% control) was better preserved than maximal inspiratory pressure and shoulder abduction force (70 +/- 15% control, P < 0.01). Handgrip force (78 +/- 16% control) and elbow flexion force (78 +/- 14% control) were significantly less affected than shoulder abduction force (70 +/- 15% control, P < 0.01). Finally, shoulder abduction force and knee-extension force (72 +/- 24% control) were not significantly different.
Muscle weakness in stable COPD patients does not affect all muscles to a similar extent. Inspiratory muscle force is affected more than peripheral muscle force, whereas proximal upper limb muscle strength was impaired more than distal upper limb muscle strength.
作者测定了中重度慢性阻塞性肺疾病（COPD）患者的呼吸肌和外周肌肉无力程度。不同肌群间肌肉无力严重程度的差异可能为治疗提供选择，如选择性肌肉训练，以调整肺康复计划中的运动处方。此外，这些信息可能会增加对肌肉无力机制的认识。
对22名健康老年受试者和40例连续入选肺康复计划的COPD患者（一秒用力呼气量，预测值百分比[%pred]41±19；一氧化碳弥散量，%pred 47±26）的呼吸肌和外周肌肉力量进行量化。测量肺功能、弥散能力、四个外周肌群（握力、肘屈曲、肩外展和膝伸展）的等长肌力、颈屈肌力以及最大吸气和呼气压力。
与正常受试者相比，患者的呼吸肌力量（平均为对照组值的64%[%对照]）和外周肌肉力量（平均为对照组的75%）降低。吸气肌力量（59±18%对照）显著低于呼气肌力量（69±25%对照）和外周肌肉力量（P<0.01）。颈屈肌力（80±19%对照）比最大吸气压力和肩外展肌力（70±15%对照，P<0.01）保留得更好。握力（78±16%对照）和肘屈肌力（78±14%对照）受影响程度明显小于肩外展肌力（70±15%对照，P<0.01）。最后，肩外展肌力和膝伸展肌力（72±24%对照）无显著差异。
稳定期COPD患者的肌肉无力对所有肌肉的影响程度并不相似。吸气肌力量比外周肌肉力量受影响更大，而近端上肢肌肉力量比远端上肢肌肉力量受损更严重。
