Leduc Dimitri, De Troyer André
Laboratory of Cardiorespiratory Physiology, Brussels School of Medicine, Saint-Pierre University Hospital, Brussels, Belgium.
J Appl Physiol (1985). 2006 Mar;100(3):858-63. doi: 10.1152/japplphysiol.00739.2005. Epub 2005 Nov 17.
Inflation induces a marked decrease in the lung-expanding ability of the diaphragm, but its effect on the parasternal intercostal muscles is uncertain. To assess this effect, the phrenic nerves and the external intercostals were severed in anesthetized, vagotomized dogs, such that the parasternal intercostals were the only muscles active during inspiration, and the endotracheal tube was occluded at different lung volumes. Although the inspiratory electromyographic activity recorded from the muscles was constant, the change in airway opening pressure decreased with inflation from -7.2+/-0.6 cmH2O at functional residual capacity to -2.2+/-0.2 cmH2O at 20-cmH2O transrespiratory pressure (P<0.001). The inspiratory cranial displacement of the ribs remained virtually unchanged, and the inspiratory caudal displacement of the sternum decreased moderately. However, the inspiratory outward rib displacement decreased markedly and continuously; at 20 cmH2O, this displacement was only 23+/-2% of the value at functional residual capacity. Calculations based on this alteration yielded substantial decreases in the change in airway opening pressure. It is concluded that, in the dog, 1) inflation affects adversely the lung-expanding actions of both the parasternal intercostals and the diaphragm; and 2) the adverse effect of inflation on the parasternal intercostals is primarily related to the alteration in the kinematics of the ribs. As a corollary, it is likely that hyperinflation also has a negative impact on the parasternal intercostals in patients with chronic obstructive pulmonary disease.
肺膨胀会导致膈肌扩张肺的能力显著下降,但其对胸骨旁肋间肌的影响尚不确定。为评估这种影响,在麻醉、迷走神经切断的犬身上切断膈神经和肋间外肌,使胸骨旁肋间肌成为吸气时唯一活跃的肌肉,并在不同肺容积下阻塞气管插管。尽管记录到的肌肉吸气肌电图活动保持恒定,但气道开口压力的变化随肺膨胀而降低,从功能残气量时的-7.2±0.6 cmH₂O降至经呼吸压20 cmH₂O时的-2.2±0.2 cmH₂O(P<0.001)。肋骨的吸气性头侧移位几乎保持不变,胸骨的吸气性尾侧移位适度减少。然而,肋骨的吸气性向外移位明显且持续下降;在20 cmH₂O时,这种移位仅为功能残气量时数值的23±2%。基于这种改变的计算得出气道开口压力变化大幅降低。得出的结论是,在犬中,1)肺膨胀对胸骨旁肋间肌和膈肌的肺扩张作用均产生不利影响;2)肺膨胀对胸骨旁肋间肌的不利影响主要与肋骨运动学的改变有关。由此推论,对于慢性阻塞性肺疾病患者,肺过度膨胀可能也会对胸骨旁肋间肌产生负面影响。