Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
Handb Clin Neurol. 2022;189:15-40. doi: 10.1016/B978-0-323-91532-8.00002-1.
While the traditional lung function tests are used to assess lung capacity and pulmonary function, they cannot evaluate respiratory driving function and the integrity of the conduction pathway from the central nervous system to the respiratory motor neuron in the spinal cord and to the diaphragm. The inspiratory trigger is sent from the central nervous system through the phrenic nerve and drives the diaphragm to generate inspiratory movement. Therefore, phrenic nerve stimulation and diaphragmatic electromyography are two fundamental methods to assess respiratory function. There are several useful tools to assess respiratory motor system including electrical or magnetic phrenic nerve stimulation, diaphragmatic needle electromyography, and diaphragmatic ultrasound. By these means, physicians can assess current respiratory status in different neurological diseases that affect respiratory muscles, follow-up of the severity of respiratory impairment, help to predict the chance of successfully weaning from ventilatory support, and confirm clinical diagnoses such as diaphragmatic myoclonus. Although some of these tests require special training, applying these neurophysiological assessments in clinical practice is highly recommended.
虽然传统的肺功能检查用于评估肺容量和肺功能，但它们不能评估呼吸驱动功能以及中枢神经系统到脊髓呼吸运动神经元和膈肌的传导通路的完整性。吸气触发是由中枢神经系统通过膈神经发出的，驱动膈肌产生吸气运动。因此，膈神经刺激和膈肌肌电图是评估呼吸功能的两种基本方法。有几种有用的工具可用于评估呼吸运动系统，包括电或磁膈神经刺激、膈神经针肌电图和膈肌超声。通过这些方法，医生可以评估不同影响呼吸肌的神经疾病中的当前呼吸状况、呼吸损害严重程度的随访、帮助预测成功脱离通气支持的机会，并确认如膈肌肌阵挛等临床诊断。虽然其中一些测试需要特殊培训，但强烈建议将这些神经生理学评估应用于临床实践。
