De Troyer A, Peche R, Yernault J C, Estenne M
Chest Service, Erasme University Hospital, Belgium.
Am J Respir Crit Care Med. 1994 Jul;150(1):41-7. doi: 10.1164/ajrccm.150.1.8025770.
The present studies were designed to assess the pattern of activity and the frequency of activation of the neck muscles in patients with chronic obstructive pulmonary disease (COPD). Using concentric needle electrodes, we thus recorded the electromyograms of the scalene, sternocleidomastoid, and trapezius muscles during resting breathing in 40 stable patients with severe chronic airflow obstruction (FEV1 = 0.69 +/- 0.18 L) and hyperinflation (FRC = 228 +/- 40% of predicted); 17 patients were hypercapnic at rest. When breathing in the seated posture, all patients (100%) had strong inspiratory contraction of the scalenes. In contrast, no patient showed inspiratory activity in the trapezius, and only four patients (10%) showed definite, invariable inspiratory activity in the sternocleidomastoid. These two muscles were silent in the supine posture as well, even though the adoption of this posture was associated with an increase in dyspnea in most patients. We conclude, therefore, that in contrast to conventional thinking, most stable patients with severe COPD do not use the sternocleidomastoids or the trapezii when breathing at rest. Additional measurements indicated that the sternocleidomastoid inspiratory activity previously recorded in such patients was in general caused by a cross-contamination from surrounding muscles.
本研究旨在评估慢性阻塞性肺疾病（COPD）患者颈部肌肉的活动模式和激活频率。因此，我们使用同心针电极，记录了40例稳定的重度慢性气流阻塞（FEV1 = 0.69 +/- 0.18 L）和肺过度充气（FRC = 预测值的228 +/- 40%）患者静息呼吸时斜角肌、胸锁乳突肌和斜方肌的肌电图；17例患者静息时存在高碳酸血症。当患者坐姿呼吸时，所有患者（100%）的斜角肌均有强烈的吸气收缩。相比之下，没有患者的斜方肌表现出吸气活动，只有4例患者（10%）的胸锁乳突肌表现出明确、恒定的吸气活动。即使大多数患者采取仰卧姿势会加重呼吸困难，但这两块肌肉在仰卧姿势时也处于静息状态。因此，我们得出结论，与传统观点相反，大多数稳定的重度COPD患者静息呼吸时并不使用胸锁乳突肌或斜方肌。额外的测量表明，此前在此类患者中记录到的胸锁乳突肌吸气活动通常是由周围肌肉的交叉干扰引起的。
