Sarmento Antonio, Fregonezi Guilherme, Dourado-Junior Mario Emílio Teixeira, Aliverti Andrea, de Andrade Armele Dornelas, Parreira Verônica Franco, Resqueti Vanessa
PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Brazil.
Ambulatório de Neurologia, EBSERH, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
Respir Physiol Neurobiol. 2019 Jan;259:16-25. doi: 10.1016/j.resp.2018.06.012. Epub 2018 Jun 30.
To assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall tidal volume (V), breathing pattern and cough peak flow (CPF).
Phase angle (θ) between upper (RCp) and lower ribcage (RCa) and abdomen (AB), as well as percentage of inspiratory time for the lower ribcage (IP) and abdomen (IP) moving in opposite directions were quantified using optoelectronic plethysmography in 12 ALS patients during quiet breathing and coughing. Paradoxical motion of the compartments was based on threshold values of θ and IP, obtained in twelve age and sex matched healthy persons.
During quiet breathing, significantly higher RCa and AB θ (p < .05), IP (p = 0.001) and IP (p < 0.05) were observed in ALS patients as compared to controls. In ALS patients, correlations between RCa and AB θ with forced vital capacity (FVC) (r=-0.773, p < 0.01), vital capacity (r=-0.663, p < 0.05) and inspiratory capacity (IC) (r=-0.754, p < 0.01), as well as between RCp and RCa θ with FVC (r=-0.608, p < 0.05) and CPF (r=-0.601, p < 0.05) were found. During coughing, correlations between RCp and AB θ with CPF (r=-0.590, p < 0.05), IC (r=-0.748, p < 0.01) and V (r=-0.608, p < 0.05), as well as between RCa and AB θ with CPF (r=-0.670, p < 0.05), IC (r=-0.713, p < 0.05) and peak expiratory flow (r=-0.727, p < 0.05) were also observed in ALS patients. ALS patients with paradoxical motion presented lower vital capacity and FVC (p < 0.05) compared to those without paradoxical motion.
Middle stage ALS patients exhibit TAA and paradoxical motion during quiet spontaneous breathing and coughing. In addition, diaphragmatic weakness (i.e. decrease in excursion of the RCa and AB compartments) was observed earlier in the lower ribcage rather than the abdominal compartment in this population.
评估中晚期肌萎缩侧索硬化症（ALS）患者的胸腹不同步（TAA）及矛盾运动情况，并探讨其与胸壁潮气量（V）、呼吸模式及咳嗽峰流速（CPF）的关系。
采用光电体积描记法，对12例ALS患者静息呼吸和咳嗽时上胸廓（RCp）与下胸廓（RCa）及腹部（AB）之间的相位角（θ）以及下胸廓（IP）和腹部（IP）反向运动的吸气时间百分比进行量化。各腔室的矛盾运动基于12名年龄和性别匹配的健康人所获得的θ和IP阈值。
与对照组相比，ALS患者在静息呼吸时，RCa和AB的θ（p<0.05）、IP（p = 0.001）和IP（p<0.05）显著更高。在ALS患者中，观察到RCa和AB的θ与用力肺活量（FVC）（r = -0.773，p<0.01）、肺活量（r = -0.663，p<0.05）和吸气量（IC）（r = -0.754，p<0.01）之间存在相关性，以及RCp和RCa的θ与FVC（r = -0.608，p<0.05）和CPF（r = -0.601，p<0.05）之间存在相关性。咳嗽时，ALS患者中还观察到RCp和AB的θ与CPF（r = -0.590，p<0.05）、IC（r = -0.748，p<0.01）和V（r = -0.608，p<0.05）之间存在相关性，以及RCa和AB的θ与CPF（r = -0.670，p<0.05）、IC（r = -0.713，p<0.05）和呼气峰流速（r = -0.727，p<0.05）之间存在相关性。有矛盾运动的ALS患者的肺活量和FVC低于无矛盾运动的患者（p<0.05）。
中晚期ALS患者在静息自主呼吸和咳嗽时表现出TAA和矛盾运动。此外，在该人群中，下胸廓而非腹部腔室更早出现膈肌无力（即RCa和AB腔室的活动度降低）。
