Loveridge B, Sanii R, Dubo H I
Spinal Cord Research Centre, University of Manitoba, Winnipeg, Canada.
Paraplegia. 1992 Jul;30(7):479-88. doi: 10.1038/sc.1992.102.
The alterations in lung function and breathing pattern were examined in 6 quadriplegics at 3, 6 and greater than 12 months post injury, and were compared to 6 able bodied controls. Subjects were studied in both the seated and supine positions. Functional residual capacity (FRC), forced vital capacity (FVC), inspiratory capacity (IC), and maximum mouth pressure (Pimax) at FRC were measured. Total lung capacity (TLC) and residual volume (RV) were calculated. Resting breathing pattern was assessed for 20 minutes from a spirogram derived from summed rib cage and abdominal strain gauge signals. At 3 months in quadriplegics, TLC was reduced (p less than 0.05), RV increased (p less than 0.01) and FRC was normal in sitting; in supine, only TLC was reduced (p less than 0.05); Pimax was decreased (p less than 0.01) in both positions in quadriplegics at 3 months, but increased over the first year in the seated position (p less than 0.01). There were no alterations in breathing pattern at any time interval in quadriplegics in supine. In contrast, at 3 months post injury in sitting, expiratory time (Te) was shortened (p less than 0.05), tidal volume (Vt) was decreased, and heart rate elevated as compared to controls (p less than 0.05). Inspiratory time (Ti) was not significantly shortened at 3 months in quadriplegics, but a lengthening of Ti occurred between 3 and 6 months (p less than 0.025) resulting in increased Vt, and heart rate decreased to normal. Vt/Ti was reduced, and did not alter with time. The lengthening of Ti/Ttot observed in supine in control subjects (p less than 0.025), was not observed in quadriplegics. Quadriplegics sighed as frequently in supine as did controls at all stages post injury, whereas they decreased sighing frequency in sitting at 3 and 6 months post injury (p less than 0.05). The improvement in resting breathing pattern observed in quadriplegics in sitting with time, may be due to increased accessory muscle function, improved chest wall stability and thoracoabdominal coupling, or a combination of these factors. It is also possible that the alterations in breathing pattern were a response to cardiovascular adjustments occurring in the same time frame. Quadriplegics retain the sigh reflex, but do not take as many big breaths in sitting as they do in supine, probably due to the increased work of breathing in the seated posture.
对6名四肢瘫痪患者在受伤后3个月、6个月和超过12个月时的肺功能和呼吸模式改变进行了检查，并与6名健全对照者进行了比较。受试者在坐位和仰卧位均接受研究。测量了功能残气量（FRC）、用力肺活量（FVC）、吸气量（IC）以及FRC时的最大口腔压力（Pimax）。计算了肺总量（TLC）和残气量（RV）。根据胸廓和腹部应变仪信号总和得出的肺活量图评估静息呼吸模式20分钟。在四肢瘫痪患者中，3个月时，坐位时TLC降低（p<0.05），RV增加（p<0.01），FRC正常；仰卧位时，仅TLC降低（p<0.05）；四肢瘫痪患者在3个月时，两个体位的Pimax均降低（p<0.01），但在坐位时第一年有所增加（p<0.01）。四肢瘫痪患者仰卧位在任何时间间隔均未出现呼吸模式改变。相比之下，在受伤后3个月坐位时，与对照者相比，呼气时间（Te）缩短（p<0.05），潮气量（Vt）降低，心率升高（p<0.05）。四肢瘫痪患者在3个月时吸气时间（Ti）未显著缩短，但在3至6个月之间Ti延长（p<0.025），导致Vt增加，心率降至正常。Vt/Ti降低，且未随时间改变。对照者仰卧位观察到的Ti/Ttot延长（p<0.025），在四肢瘫痪患者中未观察到。四肢瘫痪患者仰卧位在受伤后各阶段叹气频率与对照者相同，而在受伤后3个月和6个月坐位时叹气频率降低（p<0.
