Rafferty Gerrard F, Mustfa Naveed, Man William D, Sylvester Karl, Fisher Antony, Plaza Miguel, Davenport Mark, Blaney Sean, Moxham John, Greenough Anne
Department of Child Health, Guy's, King's, and St. Thomas' School of Medicine, London, UK.
Pediatr Pulmonol. 2005 Aug;40(2):141-7. doi: 10.1002/ppul.20241.
Children with diaphragm dysfunction may be unable to maintain adequate ventilation. Accurate diagnosis is important, but can only be achieved using an appropriate test and reference range. The aim of this study, therefore, was to measure diaphragm contractility and examine the influence of age and maturation, using magnetic phrenic nerve stimulation in healthy children. Anterolateral magnetic stimulation (MS) of the phrenic nerves was performed using a 43-mm figure-eight coil in 23 children (14 male; mean age, 7.8 years; range, 1.8-15.7) anesthetized for minor surgery with sevoflurane gas. The airway was maintained with a cuffed laryngeal mask airway (LMA) which was briefly occluded during MS. Diaphragm contractility was assessed by measuring the airway pressure (TwPaw) elicited by MS. TwPaw responses were obtained in all subjects, with mean (SD) TwPaw 18.2 (6.8) cm H2O bilateral, 7.3 (3.2) cm H2O left unilateral, and 8.6 (3.1) cm H2O right unilateral. Subgroup analysis was performed in 17 of the children who were prepubertal. Their mean (SD) TwPaw was 17.3 (6.8) cm H2O bilateral, 7.1 (3.7) cm H2O left unilateral, and 8.3 (3.3) right unilateral. The mean (SD) intrapatient coefficients of variation for bilateral and left and right unilateral TwPaw were 8.4% (5.2), 6.7% (3.5), and 11.7% (10.3), respectively. Bilateral and left and right unilateral TwPaw were significantly related to age (P < 0.05). In healthy prepubertal children, diaphragm contractility is primarily influenced by age.
患有膈肌功能障碍的儿童可能无法维持足够的通气。准确的诊断很重要，但只有使用适当的测试和参考范围才能实现。因此，本研究的目的是通过对健康儿童进行膈神经磁刺激来测量膈肌收缩力，并研究年龄和成熟度的影响。在23名接受七氟醚气体麻醉进行小手术的儿童（14名男性；平均年龄7.8岁；范围1.8 - 15.7岁）中，使用43毫米的八字形线圈对膈神经进行前外侧磁刺激（MS）。通过带套囊的喉罩气道（LMA）维持气道，在磁刺激期间短暂阻塞该气道。通过测量磁刺激引起的气道压力（TwPaw）来评估膈肌收缩力。所有受试者均获得了TwPaw反应，双侧平均（标准差）TwPaw为18.2（6.8）cm H2O，左侧单侧为7.3（3.2）cm H2O，右侧单侧为8.6（3.1）cm H2O。对17名青春期前儿童进行了亚组分析。他们双侧平均（标准差）TwPaw为17.3（6.8）cm H2O，左侧单侧为7.1（3.7）cm H2O，右侧单侧为8.3（3.3）cm H2O。双侧以及左侧和右侧单侧TwPaw的患者内变异系数平均值分别为8.4%（5.2）、6.7%（3.5）和11.7%（10.3）。双侧以及左侧和右侧单侧TwPaw与年龄显著相关（P < 0.05）。在健康的青春期前儿童中，膈肌收缩力主要受年龄影响。
