Marsh M J, Fox G F, Hoskyns E W, Milner A D
Department of Paediatrics, St. Thomas' Hospital, London, U.K.
Pediatr Pulmonol. 1994 Sep;18(3):163-9. doi: 10.1002/ppul.1950180308.
Initial observations on healthy term infants using the forced partial expiratory flow-volume technique with an inflatable jacket suggested that this technique was stimulating the Hering-Breuer deflationary reflex, a reflex which has not been systematically studied in man. To investigate this fully, esophageal pressure, jacket pressure, flow and volume at the mouth were recorded during the forced partial expiratory flow-volume maneuver on 10 infants (mean age, 3.1 days; birth weight, 3533 g; gestation, 39.8 weeks). A total of 186 measurements were performed at different points in the respiratory cycle. In 159 (85%) recordings inspiratory effort was evident with a fall in esophageal pressure within 166 msec; in some cases this occurred before the jacket was fully inflated. This was associated with a reduction of 23.4 cm H2O in mean intrathoracic pressure, which was 2.5 times that occurring during normal tidal breathing. In the remaining 27 measurements a plateau pressure was associated with closure of the upper airway. When the squeeze was applied at low lung volumes (end-expiration) the inspiratory effort occurred significantly earlier (133 msec) and stronger (reducing peak intrathoracic pressure to 15.8 cm H2O) than when applied at end-inspiration (181 msec with a reduction in intrathoracic pressure to 25.2 cm H2O). The observed inspiratory response was highly consistent, representing the deflationary reflex as described by Hering and Breuer in 1868. The stronger and more rapid onset of inspiration at low lung volume supports the claim made by Breuer that it has a protective role on functional residual capacity (FRC) in young infants.
对健康足月儿使用带有可充气夹克的强迫部分呼气流量-容积技术的初步观察表明，该技术正在刺激黑林-布雷尔肺牵张反射，这一反射在人类中尚未得到系统研究。为了全面研究这一问题，在对10名婴儿（平均年龄3.1天；出生体重3533克；妊娠39.8周）进行强迫部分呼气流量-容积动作期间，记录了食管压力、夹克压力、口腔处的流量和容积。在呼吸周期的不同时间点共进行了186次测量。在159次（85%）记录中，吸气努力明显，食管压力在166毫秒内下降；在某些情况下，这发生在夹克完全充气之前。这与平均胸内压降低23.4厘米水柱有关，这是正常潮式呼吸时胸内压降低值的2.5倍。在其余27次测量中，平台压力与上气道关闭有关。当在低肺容积（呼气末）施加挤压时，吸气努力出现得明显更早（133毫秒）且更强（将胸内压峰值降至15.8厘米水柱），而在吸气末施加挤压时（181毫秒，胸内压降至25.2厘米水柱）则不然。观察到的吸气反应高度一致，代表了1868年黑林和布雷尔所描述的肺牵张反射。在低肺容积时吸气更强且起始更快，这支持了布雷尔的观点，即它对幼儿的功能残气量（FRC）具有保护作用。
