Man W D-C, Moxham J, Polkey M I
Respiratory Muscle Laboratory, Guy's, King's and St Thomas' School of Medicine, King's College Hospital, London, UK.
Eur Respir J. 2004 Nov;24(5):846-60. doi: 10.1183/09031936.04.00029004.
Respiratory and skeletal muscle function is of interest in many areas of pulmonary and critical care medicine. The capacity of the respiratory muscle pump to respond to the load imposed by disease is the basis of an understanding of ventilatory failure. Over the last four decades, considerable progress has been made in quantifying the capacity of the respiratory muscles, in terms of strength, endurance and fatigue. With the development of magnetic stimulation, it has recently become possible to nonvolitionally assess the respiratory muscles in a clinically acceptable way. This is of particular interest in the investigation of patients receiving critical care, those with neuromuscular disease, and in children where volitional efforts are either not possible or likely to be sub-maximal. Furthermore, the adaptation of these techniques to quantify the strength of peripheral muscles, such as the quadriceps, has allowed the effects of muscle training or rehabilitation, uninfluenced by learning effect, to be assessed. This article focuses on the physiological basis of magnetic nerve stimulation, and reviews how the technique has been applied to measure muscle strength and fatigue, with particular emphasis upon the diaphragm. The translation of magnetic stimulation into a clinical tool is described, and how it may be of diagnostic, prognostic and therapeutic value in several areas of pulmonary medicine. In particular, the use of magnetic stimulation in neuromuscular disease, the intensive care setting, chronic obstructive pulmonary disease and paediatrics will be discussed.
呼吸和骨骼肌功能在许多肺部和重症医学领域都备受关注。呼吸肌泵应对疾病所施加负荷的能力是理解通气衰竭的基础。在过去的四十年里，在量化呼吸肌在力量、耐力和疲劳方面的能力上取得了相当大的进展。随着磁刺激技术的发展，最近已经能够以临床可接受的方式非自主地评估呼吸肌。这在对重症监护患者、患有神经肌肉疾病的患者以及那些无法进行自主努力或自主努力可能未达到最大程度的儿童的研究中尤为重要。此外，这些技术适用于量化外周肌肉（如股四头肌）的力量，使得能够在不受学习效应影响的情况下评估肌肉训练或康复的效果。本文重点介绍磁神经刺激的生理基础，并回顾该技术如何用于测量肌肉力量和疲劳，特别强调膈肌。描述了磁刺激如何转化为临床工具，以及它在肺部医学的几个领域中如何具有诊断、预后和治疗价值。特别是，将讨论磁刺激在神经肌肉疾病、重症监护环境、慢性阻塞性肺疾病和儿科中的应用。
