Fiaccadori E, Zambrelli P, Tortorella G
Istituto di Clinica Medica e Nefrologia, Università degli Studi, Parma.
Minerva Anestesiol. 1995 Mar;61(3):93-9.
a) To present the pathophysiological concepts behind undernutrition-related effects on respiratory muscle composition and function; b) to review the existing literature on the possible role of undernutrition-related effects on respiratory muscles as pathogenetic factors of ventilatory failure.
Selected recent references and pertinent literature in the english language dealing with the effects of undernutrition on respiratory muscle composition and function in the experimental and clinical settings.
Peer-reviewed clinical or basic research journals.
Derangements of respiratory muscle function (fatigue and weakness) play a role in the pathogenesis of respiratory failure, as they are able to determine respiratory muscle pump failure and ventilatory insufficiency. Undernutrition negatively influences respiratory muscle function both through a direct effect of loss of contractile elements, and also indirectly, by worsening or inducing muscle composition derangements. Respiratory muscles are not spared by the process of wasting associated to undernutrition, and both experimental and clinical data are consistent with a decrease in respiratory muscle mass due to fiber size reduction. As respiratory muscle weakness in course of undernutrition is more than proportional to muscle mass decrease, the presence of alterations in the remaining muscle cell is likely. Derangements in both respiratory and skeletal muscle composition with particular regard to high energy phosphate compound depletion (low cell ATP and phosphocreatine content) and to cationic depletion (low muscle magnesium and potassium content), have been reported in patients with respiratory failure due to acute ot chronic lung disease; undernourished patients had the more severe derangements of muscle composition.
Undernutrition is associated with important alterations in respiratory muscle structure and function. Undernutrition-related effects on respiratory muscles, by inducing respiratory muscle weakness through derangements in muscle energy production, transport and utilization, could represent important "metabolic" factors in the pathogenesis of ventilatory failure.
a）阐述营养不良对呼吸肌组成和功能产生影响背后的病理生理概念；b）综述现有文献，探讨营养不良对呼吸肌的相关影响作为通气衰竭致病因素的可能作用。
选取近期英文参考文献及相关文献，涉及营养不良在实验和临床环境中对呼吸肌组成和功能的影响。
经同行评审的临床或基础研究期刊。
呼吸肌功能紊乱（疲劳和无力）在呼吸衰竭的发病机制中起作用，因为它们能够导致呼吸肌泵衰竭和通气不足。营养不良通过收缩成分丧失的直接作用以及间接通过加重或诱发肌肉组成紊乱对呼吸肌功能产生负面影响。呼吸肌无法幸免于与营养不良相关的消瘦过程，实验和临床数据均表明由于纤维尺寸减小，呼吸肌质量会下降。由于营养不良过程中呼吸肌无力与肌肉质量下降不成比例，剩余肌肉细胞可能存在改变。在急性或慢性肺病导致呼吸衰竭的患者中，已报告呼吸肌和骨骼肌组成均出现紊乱，尤其是高能磷酸化合物耗竭（细胞ATP和磷酸肌酸含量低）和阳离子耗竭（肌肉镁和钾含量低）；营养不良患者的肌肉组成紊乱更为严重。
营养不良与呼吸肌结构和功能的重要改变有关。营养不良对呼吸肌的相关影响，通过肌肉能量产生、运输和利用的紊乱导致呼吸肌无力，可能是通气衰竭发病机制中的重要“代谢”因素。
