Urmey W, Loring S, Mead J, Slutsky A S, Sarkarati M, Rossier A, Brown R
J Appl Physiol (1985). 1986 Feb;60(2):618-22. doi: 10.1152/jappl.1986.60.2.618.
In quadriplegia, the anteroposterior diameter of the rib cage (RC) decreases during inspiration. Our aim was to characterize this paradoxical motion further and to determine to what extent it was due to a diminished inspiratory effect of the diaphragm on the RC because of abdominal muscle paralysis. In six quadriplegics, upper and lower RC (URC, LRC) displacements were studied in various postures with and without extrinsic abdominal support. LRC was in its relaxed configuration at all lung volumes studied in three subjects before and four subjects during abdominal compression. URC distorted most and, despite improvement during abdominal compression, was never in the relaxed configuration during tidal inspiration. Thoracic distortability was further studied by noting the effect on URC and LRC of a cephalad force applied to the RC at the costal margin. This produced distortion similar to that observed during spontaneous inspiration. It was concluded that during spontaneous inspiration in quadriplegics lack of abdominal support does not entirely explain the RC distortion which occurs, and high abdominal pressure results in diminished RC distortion, an effect which we attribute to an increase in the area of diaphragmatic apposition to the RC.
在四肢瘫痪患者中，胸廓的前后径在吸气时会减小。我们的目的是进一步描述这种反常运动，并确定其在多大程度上是由于腹肌麻痹导致膈肌对胸廓的吸气作用减弱所致。在六名四肢瘫痪患者中，研究了在有和没有外部腹部支撑的各种姿势下上、下胸廓（URC、LRC）的位移。在三名受试者腹部受压前以及四名受试者腹部受压期间，在所有研究的肺容积下，LRC均处于松弛状态。URC变形最大，尽管在腹部受压时有所改善，但在潮式吸气时从未处于松弛状态。通过记录在肋缘处向胸廓施加头侧力对URC和LRC的影响，进一步研究了胸廓的可变形性。这产生的变形与自发吸气时观察到的变形相似。得出的结论是，在四肢瘫痪患者的自发吸气过程中，缺乏腹部支撑并不能完全解释所发生的胸廓变形，而高腹压会导致胸廓变形减小，我们将这种效应归因于膈肌与胸廓贴合面积的增加。
