Ferrara A, Refini M, Perrella A, Pieroni M, Rondelli R
Cattedra di Fisiopatologia Respiratoria, Università degli Studi di Siena.
Minerva Med. 1988 Jul;79(7):517-26.
On earlier occasions healthy subjects, and normal weight cold patients and obese subjects not suffering from hypoventilation were subjected to respiratory function tests in different postures using the plethysmographic and helium dilution methods. This protocol was then applied to a series of obese patients with the functional characteristics of alveolar hypoventilation identified in preliminary functional tests. The study revealed: a) significant differences between plethysmographic and helium dilution findings; b) not significant volumetric differences produces by different postures (standing or squatting) especially as far as Total Lung Capacity and the main lung volume parameters are concerned. These results confirm the findings of others (Sharp et al., 1986) that diaphragmatic adjustment to changes in posture is inadequate in the obese with bronchial obstruction in whom absence of the fibre-length compensation phrenophrenic reflex and by the muscle flattening cause by the alveolar hyperinsufflation. On the basis of these data and others already published an index of "diaphragmatic passivity" based on the ratio between TLC in squatting and TLC in standing x 100 is proposed as an indicator of the lung volume available for use. This simple system would indicate the functional condition of the diaphragm and provide information for the functional assessment of patients proposed for rehabilitation treatment during follow-up.
在早期，对健康受试者、体重正常的感冒患者以及未患通气不足的肥胖受试者，使用体积描记法和氦稀释法在不同体位下进行呼吸功能测试。然后将该方案应用于一系列肥胖患者，这些患者在初步功能测试中已确定具有肺泡通气不足的功能特征。研究发现：a) 体积描记法和氦稀释法的结果存在显著差异；b) 不同体位（站立或蹲位）产生的容积差异不显著，尤其是就肺总量和主要肺容积参数而言。这些结果证实了其他人（夏普等人，1986年）的研究发现，即对于患有支气管阻塞的肥胖者，膈肌对体位变化的调节不足，在这些患者中，缺乏纤维长度补偿的膈神经反射以及肺泡过度充气导致的肌肉扁平化。基于这些数据和已发表的其他数据，提出了一个“膈肌被动性”指数，该指数基于蹲位时的肺总量与站立时的肺总量之比乘以100，作为可用肺容积的指标。这个简单的系统将表明膈肌的功能状况，并为随访期间拟进行康复治疗的患者的功能评估提供信息。
