Lanini Barbara, Gigliotti Francesco, Coli Claudia, Bianchi Roberto, Pizzi Assunta, Romagnoli Isabella, Grazzini Michela, Stendardi Loredana, Scano Giorgio
Fondazione Don C. Gnocchi, Department of Respiratory Disease, Via Imprunetana 124, 50020 Pozzolatico, Firenze, Italy.
Clin Sci (Lond). 2002 Nov;103(5):467-73. doi: 10.1042/cs1030467.
Dyspnoea is not a prominent complaint of resting patients with recent hemispheric stroke (RHS). We hypothesized that, in patients with RHS presenting abnormalities in respiratory mechanics, increased respiratory motor output could translate into an increased perception of dyspnoea. We studied eight wheelchair-bound patients with RHS (mean age 62.4 years), previously evaluated by computerized tomography scanning, and a control group of normal subjects, matched for age and sex. We assessed routine spirometry, inspiratory and expiratory muscle pressures, breathing pattern and dyspnoea using a modified Borg scale. In six patients, we also measured oesophageal pressure during the maximal sniff manoeuvre and tidal inspiratory swing, and mechanical characteristics of the lung in terms of dynamic elastance during both quiet breathing and a hypercapnic/hyperoxic rebreathing test. During room air breathing, ventilation and tidal volume were similar in patients and controls, while tidal inspiratory swings of oesophageal pressure, an index of inspiratory motor output, were greater in patients ( P =0.005). Patients also exhibited a greater dynamic elastance ( P =0.013). During rebreathing, dynamic elastance remained higher ( P =0.01) and a greater than normal inspiratory motor output was found ( P =0.03). Responses of ventilation and tidal volume to carbon dioxide tension were normal, and in all patients but one a lower Borg score for the unit change in carbon dioxide tension and ventilation was found. In conclusion, a higher than normal inspiratory motor output was unexpectedly associated with a blunted perception of dyspnoea in this subset of RHS patients. This is likely to be due to the modulation of the integration process of respiratory sensation.
呼吸困难并非近期发生半球性卒中（RHS）的静息患者的主要主诉。我们推测，在呼吸力学出现异常的RHS患者中，呼吸运动输出增加可能会转化为对呼吸困难感知的增加。我们研究了8名坐在轮椅上的RHS患者（平均年龄62.4岁），这些患者之前已通过计算机断层扫描进行评估，并设立了一个年龄和性别匹配的正常受试者对照组。我们使用改良的博格量表评估常规肺量测定、吸气和呼气肌肉压力、呼吸模式及呼吸困难情况。在6名患者中，我们还在最大吸气动作和潮气量吸气摆动期间测量了食管压力，以及在静息呼吸和高碳酸血症/高氧再呼吸试验期间根据动态弹性评估的肺机械特性。在室内空气呼吸期间，患者和对照组的通气量和潮气量相似，而作为吸气运动输出指标的食管压力潮气量吸气摆动在患者中更大（P = 0.005）。患者还表现出更大的动态弹性（P = 0.013）。在再呼吸期间，动态弹性仍然较高（P = 0.01），并且发现吸气运动输出大于正常水平（P = 0.03）。通气量和潮气量对二氧化碳张力的反应正常，并且除一名患者外，所有患者在二氧化碳张力和通气量单位变化时的博格评分较低。总之，在这一RHS患者亚组中，高于正常水平的吸气运动输出意外地与对呼吸困难的钝感相关。这可能是由于呼吸感觉整合过程的调节所致。
