Niccolai Valentina, van Duinen Marlies A, Griez Eric J
Academic Anxiety Center, Mondriaan Zorggroep, School of Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.
Can J Psychiatry. 2008 Nov;53(11):737-44. doi: 10.1177/070674370805301105.
Because hyperventilation, dyspnea, and a feeling of choking are often core features of a panic attack, respiration has been one of the most widely studied physiological parameters in panic disorder (PD) patients. A respiratory subgroup of PD, with distinct etiological pathways, has also been suggested. Investigation of the recovery phase following a respiratory challenge may be a reliable way to establish respiratory impairment in PD patients. The objective of the present study was to investigate the recovery phase from a 35% carbon dioxide challenge in PD patients and in healthy controls, and to test the hypothesis of a different respiratory pattern in patients, compared to control subjects.
Eleven nonmedicated PD patients with or without agoraphobia, 11 medicated PD patients, and 11 control subjects took part in a 35% carbon dioxide and 65% oxygen inhalation challenge. Respiratory rate, partial pressure of carbon dioxide, heart rate, and blood pressure were recorded during the baseline phase (10 minutes) and the recovery phase (10 minutes). Visual Analogue Scale of Anxiety and Panic Symptom List scores were collected pre- and post-challenge.
Nonmedicated patients had increased variability in respiratory rate and partial pressure of carbon dioxide during recovery, compared with control subjects and medicated PD patients. Also, PD patients tended to have higher heart rates and to need more time to recover from the challenge than control subjects.
Results suggest that PD patients have less effective homeostatic control after their physiological equilibrium has been disrupted by a respiratory stressor.
由于换气过度、呼吸困难和窒息感通常是惊恐发作的核心特征，呼吸一直是惊恐障碍（PD）患者中研究最广泛的生理参数之一。也有人提出存在一个具有独特病因途径的PD呼吸亚组。研究呼吸激发试验后的恢复阶段可能是确定PD患者呼吸功能损害的可靠方法。本研究的目的是调查PD患者和健康对照者在35%二氧化碳激发试验后的恢复阶段，并检验与对照受试者相比患者存在不同呼吸模式的假设。
11名有或无广场恐惧症的未服药PD患者、11名服药的PD患者和11名对照受试者参加了35%二氧化碳和65%氧气吸入激发试验。在基线期（10分钟）和恢复阶段（10分钟）记录呼吸频率、二氧化碳分压、心率和血压。在激发试验前后收集焦虑视觉模拟量表和惊恐症状清单评分。
与对照受试者和服药的PD患者相比，未服药患者在恢复过程中呼吸频率和二氧化碳分压的变异性增加。此外，与对照受试者相比，PD患者的心率往往更高，从激发试验中恢复所需的时间更长。
结果表明，PD患者在其生理平衡被呼吸应激源破坏后，体内稳态控制效果较差。
