Department of Neurology, Wakayama Medical University, Wakayama, Japan.
Amyotroph Lateral Scler Frontotemporal Degener. 2013 Mar;14(2):127-31. doi: 10.3109/17482968.2012.729595. Epub 2012 Oct 30.
Our objective was to evaluate diaphragm thicknesses during respiration by ultrasonography, and compare with conventional measurements of respiratory functions in patients with amyotrophic lateral sclerosis (ALS). Thirty-six consecutive ALS patients and 19 age-matched healthy volunteers participated. Ultrasonography of the diaphragm in the zone of apposition was performed. Maximal diaphragm thickness during the maximal inspiratory effort (DTmax) and minimum diaphragm thickness at the end expiratory position (DTmin) were measured using ultrasonography. The thickening ratio (TR), defined as the ratio of DTmin to DTmax, was calculated. All patients underwent conventional pulmonary function testing. Arterial blood gas analysis was also performed. The diaphragm was clearly identifiable by ultrasonography. DTmax, DTmin and the TR were all significantly decreased in ALS patients with %VC (vital capacity) < 80, compared with those in either ALS patients with %VC ≥ 80 or healthy controls. DTmax, DTmin and the TR were all significantly correlated with %VC. In addition, significant inverse correlations were found between all three parameters and pCO(2). The inter-observer reliability of measurements of diaphragm thickness was high. In conclusion, sonography of the diaphragm can provide additional or complementary information for assessing respiratory functions in patients with ALS.
我们的目的是通过超声评估呼吸时的膈肌厚度，并与肌萎缩侧索硬化症（ALS）患者的常规呼吸功能测量进行比较。共有 36 名连续的 ALS 患者和 19 名年龄匹配的健康志愿者参与了研究。在贴附区对膈肌进行超声检查。使用超声测量最大吸气努力时的膈肌最大厚度（DTmax）和呼气末位的膈肌最小厚度（DTmin）。计算增厚比（TR），定义为 DTmin 与 DTmax 的比值。所有患者均进行常规肺功能测试。还进行了动脉血气分析。膈肌在超声下可清晰识别。与 %VC（肺活量）≥ 80 的 ALS 患者或健康对照组相比，%VC < 80 的 ALS 患者的 DTmax、DTmin 和 TR 均显著降低。DTmax、DTmin 和 TR 均与 %VC 显著相关。此外，所有三个参数与 pCO2 之间存在显著的负相关。膈肌厚度测量的观察者间可靠性较高。总之，膈肌超声可提供 ALS 患者呼吸功能评估的额外或补充信息。
