通过膈神经的颈部磁刺激对膈肌力量进行临床评估。
Clinical assessment of diaphragm strength by cervical magnetic stimulation of the phrenic nerves.
作者信息
Hamnegård C H, Wragg S D, Mills G H, Kyroussis D, Polkey M I, Bake B, Moxham J, Green M
机构信息
Respiratory Muscle Laboratory, National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
出版信息
Thorax. 1996 Dec;51(12):1239-42. doi: 10.1136/thx.51.12.1239.
BACKGROUND
Accurate assessment of diaphragm strength can be difficult. Transdiaphragmatic pressure (PDI) measurements during volitional manoeuvres are useful but it may be difficult to ensure maximum patient effort. Magnetic stimulation of the phrenic nerves is easy to perform and the results are reproducible in normal subjects. The purpose of the present study was to evaluate the usefulness of magnetic stimulation of the phrenic nerves in the assessment of diaphragm weakness in patients.
METHODS
Sixty-six patients referred for assessment of respiratory muscle strength and 23 normal subjects were studied. Twitch PDI (TwPDI) following magnetic stimulation of the phrenic nerves and sniffPDI were obtained in all individuals. TWPDI following bilateral electrical stimulation of the phrenic nerves was also obtained in eight patients.
RESULTS
Mean (SD) TwPdi for the normal subjects was 31 (6) cm H2O and 18 (11) cm H2O for the patients. TwPDI and sniffPDI were correlated (r = 0.77). Seven of the 37 patients (19%) with a reduced sniffPDI had a TwPDI within the normal range whereas two of the 32 patients (6%) with a reduced TwPDI had a normal sniffPDI. TwPDI was similar with magnetic and electrical stimulation.
CONCLUSIONS
TwPDI following magnetic stimulation of the phrenic nerves is a clinically useful measurement when assessing diaphragm weakness.
背景
准确评估膈肌力量可能具有挑战性。在自主动作期间测量跨膈压（PDI）很有用，但可能难以确保患者尽最大努力。膈神经磁刺激操作简便，在正常受试者中结果具有可重复性。本研究的目的是评估膈神经磁刺激在评估患者膈肌无力中的作用。
方法
对66例因呼吸肌力量评估而转诊的患者和23名正常受试者进行了研究。所有个体均获得了膈神经磁刺激后的抽搐PDI（TwPDI）和吸气PDI。8例患者还获得了双侧膈神经电刺激后的TwPDI。
结果
正常受试者的平均（标准差）TwPdi为31（6）cmH₂O，患者为18（11）cmH₂O。TwPDI和吸气PDI具有相关性（r = 0.77）。37例吸气PDI降低的患者中有7例（19%）的TwPDI在正常范围内，而32例TwPDI降低的患者中有2例（6%）的吸气PDI正常。磁刺激和电刺激后的TwPDI相似。
结论
膈神经磁刺激后的TwPDI在评估膈肌无力时是一种临床有用的测量方法。
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