Ortega Ruiz F, Madrazo Osuna J, Sánchez Riera H, Olloqui Martín E, Fernández Guerra J, Elías Hernández T, Montemayor Rubio T
Servicios de Neumología, Hospital Universitario Virgen del Rocío, Sevilla.
Arch Bronconeumol. 1996 Jan;32(1):23-8. doi: 10.1016/s0300-2896(15)30834-6.
With the purpose of defining the pattern of abdominal respiratory muscle activity in patients with chronic obstructive pulmonary disease (COPD), we studied the electromyogram of the rectus abdominis (RA), the external oblique (EO) and transversus (TM) muscles in 14 patients with different degrees of airways obstruction (FEV1: 41 +/- 12%; FEV1/FVC: 45 +/- 10%; RV: 198 +/- 38%; PaO2: 75.8 +/- 12 y PaCO2: 41.4 +/- 5.7 mmHg). The EMG was obtained by insertion of bipolar electrodes guided by an ultrasound image of the abdominal wall to locate the position of the muscles. The measurements were recorded in supine decubitus position in 5 situations: a) breathing at tidal volume; b) slow expiration until RV; c) with inspiratory load; d) with expiratory load, and e) during relaxed breathing with the arms raised. Recordings were also made in the same situations with 10 patients sitting. Eight patients presented phasic expiratory activity during relaxed breathing (TM activity alone or accompanied by EO). We found no significant differences in degree of hyperinflation or in arterial gases between patients with phasic expiratory activity and those without. There were significant differences between these 2 groups, however, as to degree of airways obstruction, for absolute values of FEV1 (p < 0.02) and in raw values (p < 0.04). Slow breathing until RV recruited muscular activity in 13 patients; the muscles did not operate in unison, however, with TM acting first. Recruitment was also observed when inspiratory and expiratory loads were placed, although in this case the 3 muscles acted simultaneously. Phasic activity was observed in only 2 patients for recordings made with arms raised, at which time there was greater tonic muscle activity. The phasic activity pattern recorded when patients were sitting was very similar to that obtained in supine position. In summary, some patients with stable COPD have phasic expiratory activity of the abdominal muscles when resting. These muscles do not appear to act as a unit and this phasic expiratory activity is related to severity of upper airways obstruction.
为了明确慢性阻塞性肺疾病（COPD）患者腹部呼吸肌活动模式，我们研究了14例不同程度气道阻塞患者（第一秒用力呼气容积[FEV1]：41±12%；FEV1/用力肺活量[FVC]：45±10%；残气量[RV]：198±38%；动脉血氧分压[PaO2]：75.8±12，动脉血二氧化碳分压[PaCO2]：41.4±5.7 mmHg）腹直肌（RA）、腹外斜肌（EO）和腹横肌（TM）的肌电图。肌电图通过在腹壁超声图像引导下插入双极电极以定位肌肉位置来获取。测量在仰卧位的5种情况下进行记录：a）潮气呼吸；b）缓慢呼气至残气量；c）施加吸气负荷；d）施加呼气负荷；以及e）双臂上举时的平静呼吸。也对10例坐位患者在相同情况下进行记录。8例患者在平静呼吸时出现阶段性呼气活动（单独的TM活动或伴有EO活动）。我们发现有阶段性呼气活动的患者与无此活动的患者在肺过度充气程度或动脉血气方面无显著差异。然而，这两组在气道阻塞程度、FEV1绝对值（p<0.02）和原始值（p<0.04）方面存在显著差异。缓慢呼气至残气量时，13例患者募集了肌肉活动；然而，肌肉并非协同作用，TM最先起作用。施加吸气和呼气负荷时也观察到募集，不过此时3块肌肉同时起作用。双臂上举记录时仅2例患者观察到阶段性活动，此时肌肉紧张性活动更强。患者坐位时记录到的阶段性活动模式与仰卧位时非常相似。总之，一些稳定期COPD患者在静息时有腹部肌肉的阶段性呼气活动。这些肌肉似乎并非作为一个整体起作用，且这种阶段性呼气活动与上气道阻塞的严重程度相关。
