Hecker B R, Bjurstrom R, Schoene R B
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111.
Anesthesiology. 1989 Jan;70(1):13-8. doi: 10.1097/00000542-198901000-00005.
Lower intercostal and abdominal muscles interact with other respiratory muscles to produce inspiration as well as expiration. Intercostal nerve blockade from T6-T12 was produced in seven healthy males to study its effect on: 1) supine pulmonary function, 2) inspiratory effort, 3) hypercapnic ventilatory response, including mouth occlusion pressures with and without an expiratory load, and 4) ventilation during progressive exercise on a cycle ergometer. Studies during control and blocked states were performed on different days. Lower chest and abdominal wall paralysis was documented with electromyography. Findings include a minimal decrease in peak expiratory flows with intercostal blockade (P = 0.02), but no other changes in supine resting pulmonary function tests, inspiratory effort, or hypercapnic ventilatory response slopes. Minute ventilation, respiratory rate, and VT/TI during exercise were also minimally increased, indicating an increase in the drive to breathe, which was unrelated to a change in metabolic rate. During exercise, total time to exhaustion was decreased following intercostal nerve blockade. Bilateral intercostal nerve blockade produced minimal decreases in peak expiratory flow at rest in supine subjects. During seated exercise, there was a slight increase in respiratory drive, probably due to minor alterations in the mechanics of breathing induced by intercostal blockade. The authors conclude that, in healthy young subjects, intercostal nerve blockade does not exert a clinically significant adverse affect on pulmonary mechanics and that ventilatory function is well-maintained even at extremes of ventilatory demand.
肋间肌下部和腹部肌肉与其他呼吸肌相互作用以产生吸气和呼气。对7名健康男性进行了T6 - T12肋间神经阻滞，以研究其对以下方面的影响：1）仰卧位肺功能；2）吸气努力；3）高碳酸通气反应，包括有无呼气负荷时的口腔闭塞压；4）在自行车测力计上进行渐进性运动时的通气。对照状态和阻滞状态下的研究在不同日期进行。通过肌电图记录下胸部和腹壁麻痹情况。研究结果包括肋间神经阻滞后呼气峰值流量略有下降（P = 0.02），但仰卧位静息肺功能测试、吸气努力或高碳酸通气反应斜率无其他变化。运动期间的分钟通气量、呼吸频率和潮气量/吸气时间也略有增加，表明呼吸驱动力增加，这与代谢率变化无关。运动期间，肋间神经阻滞后力竭总时间缩短。双侧肋间神经阻滞使仰卧位受试者静息时的呼气峰值流量略有下降。坐位运动期间，呼吸驱动力略有增加，可能是由于肋间神经阻滞引起的呼吸力学轻微改变所致。作者得出结论，在健康年轻受试者中，肋间神经阻滞对肺力学没有产生临床上显著的不利影响，并且即使在通气需求极端情况下，通气功能也能得到良好维持。
