Lu Z, Tang X, Huang X
Department of Neurology, 1st Affiliated Hospital of Hubei Medical University, Wuhan 430060, China.
Chin Med J (Engl). 1998 Jun;111(6):496-9.
To investigate preliminarily the value of phrenic nerve conduction (PNC) and diaphragmatic motor evoked potentials (MEPs) in the evaluation of various respiratory dysfunction (RDF).
Thirty-four patients with various RDF, (19 patients with neurogenical diseases and 15 patients with respiratory disorders) were investigated. Fifty healthy volunteers served as controls. The phrenic nerve was cutaneously stimulated by electrical pulse current at the midpoint of the posterior border of the sternomastoid muscle, and the diaphragmatic muscle compound action potentials (DCAP) were recorded between the 7th and 8th intercostal space and xiphoid process. When the magnetic transcranial stimulation (MTS) of the cortex was given, the recordings were made under the condition of maximal deep inspiration.
All patients with myopathies had normal PNC. The patients with Guillain Barre syndrome (GBS), hereditary motor and sensory neuropathy (HMSN) and myasthenic crisis had abnormal PNC. The findings in PNC studies remarkably correlated with RDF, while serial examinations were performed in the patients with GBS and myasthenia gravis (MG). In 7 patients with sleep apnea syndrome (SAS), 4 had abnormal PNC, and 2 of 3 patients with chronic obstructive pulmonary diseases (COPD), and 1 of 5 patients with chest tightness or breathlessness on the supine position showed decreased amplitude. When MEPs were recorded, 3 of 5 patients showed abnormal SAS (1 had no response, 2 lower amplitude). Three patients with COPD had normal MEP.
PNC studies could not only evaluate neuromuscular RDF and predict the outcome of diseases, but also supply additional information about diaphragmatic dysfunction for the RDF caused by respiratory disorders. The results of PNC and diaphragmatic MEP may differentiate the types of SAS.
初步探讨膈神经传导（PNC）及膈肌运动诱发电位（MEP）在评估各种呼吸功能障碍（RDF）中的价值。
对34例各种RDF患者（19例神经源性疾病患者和15例呼吸系统疾病患者）进行研究。50名健康志愿者作为对照。在胸锁乳突肌后缘中点处用电脉冲电流经皮刺激膈神经，并在第7和第8肋间间隙与剑突之间记录膈肌复合动作电位（DCAP）。当对皮质进行磁刺激（MTS）时，在最大深吸气状态下进行记录。
所有肌病患者的PNC均正常。吉兰 - 巴雷综合征（GBS）、遗传性运动和感觉神经病（HMSN）及肌无力危象患者的PNC异常。在对GBS和重症肌无力（MG）患者进行系列检查时，PNC研究结果与RDF显著相关。在7例睡眠呼吸暂停综合征（SAS）患者中，4例PNC异常；在3例慢性阻塞性肺疾病（COPD）患者中，2例异常；在5例仰卧位时有胸闷或呼吸急促的患者中，1例波幅降低。记录MEP时，5例SAS患者中有3例异常（1例无反应，2例波幅降低）。3例COPD患者的MEP正常。
PNC研究不仅可以评估神经肌肉性RDF并预测疾病转归，还可为呼吸系统疾病引起的RDF提供有关膈肌功能障碍的额外信息。PNC和膈肌MEP结果可区分SAS的类型。
