Manikian B, Cantineau J P, Bertrand M, Kieffer E, Sartene R, Viars P
Department of Anesthesiology, G.H. Pitic-Salpetriere, Paris, France.
Anesthesiology. 1988 Mar;68(3):379-86. doi: 10.1097/00000542-198803000-00010.
The effects on diaphragmatic function of a thoracic epidural block were assessed in 13 patients after upper abdominal surgery (UAS). Lung volumes and tidal changes in chest wall circumferences and gastric (delta Pgas) and esophageal (delta Pes) pressures were measured pre- and postoperatively. Volume displacement of the abdomen divided by tidal volume (delta VAB/VT) and delta Pgas/delta Pes were taken as indices of the diaphragmatic contribution to tidal breathing. These respiratory variables were obtained in the postoperative period, before and after epidural injection of 0.5% plain bupivacaine to achieve a block up to the T4 segment. UAS was constantly associated with a decrease in VT, delta VAB/VT, delta Pgas/delta Pes, and forced vital capacity (FVC). Epidural block was associated with an increase in VT, delta VAB/VT, and FVC. delta Pgas and delta Pgas/delta Pes returned to their preoperative values. It is concluded that: 1) diaphragmatic dysfunction observed after UAS is partially reversed by thoracic epidural block; and 2) that inhibitory reflexes of phrenic activity arising from the abdominal compartment (abdominal wall and/or viscera) could be involved in this diaphragmatic dysfunction.
在13例上腹部手术后（UAS）的患者中评估了胸段硬膜外阻滞对膈肌功能的影响。术前和术后测量了肺容量、胸壁周长的潮气量变化以及胃内压（ΔPgas）和食管内压（ΔPes）。腹部容积位移除以潮气量（ΔVAB/VT）以及ΔPgas/ΔPes被用作膈肌对潮式呼吸贡献的指标。这些呼吸变量是在术后硬膜外注射0.5%的单纯布比卡因以达到T4节段阻滞之前和之后获得的。UAS始终与潮气量（VT）、ΔVAB/VT、ΔPgas/ΔPes以及用力肺活量（FVC）的降低相关。硬膜外阻滞与VT、ΔVAB/VT和FVC的增加相关。ΔPgas和ΔPgas/ΔPes恢复到术前值。结论为：1）UAS后观察到的膈肌功能障碍可通过胸段硬膜外阻滞部分逆转；2）来自腹腔（腹壁和/或内脏）的膈神经活动抑制反射可能与这种膈肌功能障碍有关。
