Scanlon P D, Loring S H, Pichurko B M, McCool F D, Slutsky A S, Sarkarati M, Brown R
West Roxbury, VA Medical Center, MA 02132.
Am Rev Respir Dis. 1989 Mar;139(3):615-20. doi: 10.1164/ajrccm/139.3.615.
We measured lung and chest wall compliance as well as rib cage and abdominal dimensions in the supine position in five acute C4-7 quadriplegics. Studies were performed serially from 1 to 12 months after injury. Results were compared with those of control groups of chronic (greater than 1 yr after injury) quadriplegics and normal volunteers. We found that lung compliance was lower in acute and chronic quadriplegics (0.129 +/- 0.023 and 0.176 +/- 0.043 L/mm Hg, respectively) than in normal subjects (0.278 +/- 0.086 L/mm Hg) and that these changes apparently occurred within 1 month of injury. Specific lung compliance appeared to be reduced to a lesser degree, suggesting that the changes in lung compliance were partly due to reduced lung volumes and partly to altered mechanical properties of the lung. During respiratory maneuvers, abdomen and rib cage dimensional changes demonstrated rib cage distortion. This distortion was less severe in chronic than in acute quadriplegics. The improvement in chest wall stability was likely due to increased strength of cervical accessory muscles of respiration and improved coupling of the various rib cage elements in chronic quadriplegics.
我们对5例急性C4 - 7节段四肢瘫痪患者在仰卧位时的肺和胸壁顺应性以及胸廓和腹部尺寸进行了测量。在受伤后1至12个月内进行了系列研究。将结果与慢性（受伤后超过1年）四肢瘫痪患者和正常志愿者的对照组进行了比较。我们发现，急性和慢性四肢瘫痪患者的肺顺应性（分别为0.129±0.023和0.176±0.043 L/mm Hg）低于正常受试者（0.278±0.086 L/mm Hg），并且这些变化显然在受伤后1个月内就已发生。比顺应性似乎降低程度较小，这表明肺顺应性的变化部分是由于肺容积减小，部分是由于肺机械性能改变。在呼吸动作期间，腹部和胸廓尺寸变化显示出胸廓变形。这种变形在慢性四肢瘫痪患者中比在急性四肢瘫痪患者中较轻。胸壁稳定性的改善可能是由于慢性四肢瘫痪患者呼吸辅助颈肌力量增加以及胸廓各组成部分的耦合改善所致。
