Swaminathan S, Paton J Y, Ward S L, Jacobs R A, Sargent C W, Keens T G
Division of Neonatology and Pediatric Pulmonology, Childrens Hospital of Los Angeles, CA 90027.
J Pediatr. 1989 Dec;115(6):898-903. doi: 10.1016/s0022-3476(89)80739-5.
Infants with myelomeningocele have abnormalities in ventilatory control. To determine whether these persist into later life, we studied 14 patients with myelomeningocele and Arnold-Chiari malformation (age 18.0 +/- 0.8 (SE) years), and compared them with 14 control subjects (age 24.0 +/- 0.9 years). Pulmonary function and ventilatory muscle strength did not differ between patients with myelomeningocele and control subjects. Hypercapnic ventilatory responses were significantly lower in the group with myelomeningocele (1.98 L/min/mm Hg) compared with control values (3.33 L/min/mm Hg; p less than 0.01). Hypoxic ventilatory responses (-1.4 L/min/%oxygen saturation of hemoglobin in arterial blood) were not significantly different from control values (-2.14 L/min/%oxygen saturation). In control subjects the hypercapnic and hypoxic ventilatory responses were highly correlated with each other within subjects (r = 0.84; p less than 0.002) but not in those with myelomeningocele (r = 0.34; not significant). We concluded that adolescents and young adults with myelomeningocele have abnormalities in control of ventilation during sleep and wakefulness. We speculate that the Arnold-Chiari malformation interferes with central chemosensitivity (hypercapnic ventilatory response) and central integration of chemoreceptor output.
患有脊髓脊膜膨出的婴儿存在通气控制异常。为了确定这些异常是否会持续到成年期，我们研究了14例患有脊髓脊膜膨出和阿诺德 - 奇阿利畸形的患者（年龄18.0±0.8（标准误）岁），并将他们与14名对照受试者（年龄24.0±0.9岁）进行比较。脊髓脊膜膨出患者与对照受试者之间的肺功能和通气肌肉力量没有差异。与对照值（3.33L/min/mm Hg；p<0.01）相比，脊髓脊膜膨出组的高碳酸血症通气反应显著降低（1.98L/min/mm Hg）。低氧通气反应（-1.4L/min/%动脉血氧饱和度）与对照值（-2.14L/min/%动脉血氧饱和度）没有显著差异。在对照受试者中，高碳酸血症和低氧通气反应在个体内高度相关（r = 0.84；p<0.002），但在脊髓脊膜膨出患者中不相关（r = 0.34；无显著性）。我们得出结论，患有脊髓脊膜膨出的青少年和年轻人在睡眠和清醒时的通气控制存在异常。我们推测阿诺德 - 奇阿利畸形会干扰中枢化学敏感性（高碳酸血症通气反应）和化学感受器输出的中枢整合。
