Aubier M, Murciano D, Lecocguic Y, Viires N, Jacquens Y, Squara P, Pariente R
N Engl J Med. 1985 Aug 15;313(7):420-4. doi: 10.1056/NEJM198508153130705.
We studied the effects of hypophosphatemia on diaphragmatic function in eight patients with acute respiratory failure who were artificially ventilated. Their mean serum phosphorus level was 0.55 +/- 0.18 mmol per liter (normal value, 1.20 +/- 0.10). The contractile properties of the diaphragm were assessed by measuring the transdiaphragmatic pressure generated at functional residual capacity during bilateral supramaximal electrical stimulation of the phrenic nerves. Diaphragmatic function was evaluated in each patient before and after correction of hypophosphatemia, which was achieved by administration of 10 mmol of phosphorus (as KH2PO4) as a continuous infusion for four hours. After phosphate infusion, the mean serum phosphorus level increased significantly (1.33 +/- 0.21 mmol per liter, P less than 0.0001). The increase in serum phosphorus was accompanied by a marked increase in the transdiaphragmatic pressure after phrenic stimulation (17.25 +/- 6.5 cm H2O as compared with 9.75 +/- 3.8 before phosphate infusion, P less than 0.001). Changes in the serum phosphorus level and transdiaphragmatic pressure were well correlated (r = 0.73). These results strongly suggest that hypophosphatemia impairs the contractile properties of the diaphragm during acute respiratory failure, and they emphasize the importance of maintaining normal serum inorganic phosphate levels in such patients.
我们研究了低磷血症对8例急性呼吸衰竭且接受人工通气患者膈肌功能的影响。他们的平均血清磷水平为每升0.55±0.18毫摩尔（正常值为1.20±0.10）。通过在双侧膈神经超最大电刺激期间测量功能残气量时产生的跨膈压来评估膈肌的收缩特性。在每例患者纠正低磷血症之前和之后评估膈肌功能，通过连续4小时输注10毫摩尔磷（以KH2PO4形式）来实现低磷血症的纠正。输注磷酸盐后，平均血清磷水平显著升高（每升1.33±0.21毫摩尔，P<0.0001）。血清磷的升高伴随着膈神经刺激后跨膈压的显著增加（与输注磷酸盐前的9.75±3.8相比为17.25±6.5厘米水柱，P<0.001）。血清磷水平和跨膈压的变化具有良好的相关性（r = 0.73）。这些结果强烈表明，低磷血症在急性呼吸衰竭期间损害膈肌的收缩特性，并且它们强调了在此类患者中维持正常血清无机磷水平的重要性。
