不同平面脊髓损伤患者膈肌运动和肺功能的相关分析
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摘要
目的:探讨不同平面脊髓损伤患者的肺功能和膈肌运动的特点及其影响因素。方法:选取我院105例脊髓损伤患者进行研究,分析颈、胸、腰段各平面脊髓损伤患者的肺功能指标,包括第1秒用力呼气容积(FEV1)、用力呼气肺活量(FVC)、最大通气量(MVV)、肺活量(VC)和膈肌运动功能(右侧隔肌平静呼吸和用力呼吸时的运动幅度),并对肺功能与性别、年龄、吸烟史、损伤平面、残损分级、ASIA感觉/运动评分、膈肌运动幅度的相关性进行分析。结果:不同平面脊髓损伤肺功能指标差异具有统计学意义(P<0.05);不同平面脊髓损伤平静呼吸和深呼吸时右侧膈肌运动幅度、ASIA感觉/运动评分差异具有统计学意义(P<0.05);回归分析显示肺功能下降与损伤平面、残损分级、膈肌运动、ASIA感觉/运动评分和性别、吸烟史具有相关性(P<0.05)。结论:脊髓损伤患者(特别是颈髓损伤患者)均存在不同程度肺功能障碍,而损伤平面、残损分级、ASIA感觉/运动评分和膈肌运动是影响脊髓损伤患者肺功能的重要指标。
Objective:To study the characteristics of pulmonary function and diaphragm movement in patients with spinal cord injury of different levels.Methods:All 105 patients with spinal cord injury in our hospital were studied.Forced expiratory volume in one second(FEV 1),forced expiratory vital capacity(FVC),maximal ventilatory volume(MVV),vital capacity(VC)and diaphragmatic motion(amplitude of movement of the right septum when breathing peacefully and forcefully)were analyzed.The correlation between pulmonary function and gender,age,smoking history,injury level,injury degree,ASIA sensory/motor score,diaphragm range of motion was analyzed.Results:There were significant differences in VC,FVC,MVV and FEV1(P<0.05).There was significant difference in the motion amplitude of right diaphragm and the ASIA sensory/motor score(P<0.05).Regression analysis showed that there was a significant correlation between pulmonary function decline and injury level,injury degree,diaphragm movement,ASIA sensory/motor score,sex,smoking history(P<0.05).Conclusion:There are different degrees of pulmonary dysfunction in patients with spinal cord injury(especially in patients with cervical spinal cord injury),but injury level,injury degree,ASIA motion score and diaphragm movement are important indexes which affect the lung function of patients with spinal cord injury.
Objective:To study the characteristics of pulmonary function and diaphragm movement in patients with spinal cord injury of different levels.Methods:All 105 patients with spinal cord injury in our hospital were studied.Forced expiratory volume in one second(FEV 1),forced expiratory vital capacity(FVC),maximal ventilatory volume(MVV),vital capacity(VC)and diaphragmatic motion(amplitude of movement of the right septum when breathing peacefully and forcefully)were analyzed.The correlation between pulmonary function and gender,age,smoking history,injury level,injury degree,ASIA sensory/motor score,diaphragm range of motion was analyzed.Results:There were significant differences in VC,FVC,MVV and FEV1(P<0.05).There was significant difference in the motion amplitude of right diaphragm and the ASIA sensory/motor score(P<0.05).Regression analysis showed that there was a significant correlation between pulmonary function decline and injury level,injury degree,diaphragm movement,ASIA sensory/motor score,sex,smoking history(P<0.05).Conclusion:There are different degrees of pulmonary dysfunction in patients with spinal cord injury(especially in patients with cervical spinal cord injury),but injury level,injury degree,ASIA motion score and diaphragm movement are important indexes which affect the lung function of patients with spinal cord injury.
引文
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[7] Rochester D F.The diaphragm:contractile properties and fatigue[J].Clin Invest,1985,75(5):1397-1402.
[8] He B,Nan G.Pulmonary edema and hemorrhage after acute spinal cord injury in Rats[J].The Spine Journal,2016,16(4):547-551.
[9] Jiang W,Li MQ,He F,et al.Protective Effects of Asiatic Acid A-gainst Spinal Cord Injury-Induced Acute Lung Injury in Rats[J].Inflammation,2016,39(6):1853-1861.
[10]Sedy J,Zicha J,NedvídkováJ,Et al.The role of sympathetic nerv-ous system in the development of Neurogenic pulmonary edema in spinal cord-injured rats[J].Journa L of Applied Physiology,2012,112(1):1-8.
[11]Berlowitz DJ,Wadsworth B,Ross J.Respiratory problems and management in people with spinal cord injury[J].Breathe(Sheff),2016,12(4):328-340.
[12]Tamplin J,Berlowitz DJ.A systematic review and meta-analysis of the effects of respiratory muscle training on pulmonary function in tetraplegia[J].Spinal Cord,2014,52(3):175-180.
[13]Linn WS,Spungen AM,Gong J,et al;Forced vital cpacity in two large outpatient populations with chronic spinal cord injury[J].Spinal Cord,2001,39(5):263-268.
[2]刘艳玲,马全胜,王寒明,等.第三颈椎(C3)损伤患者的肺功能康复1例[J].中国实用内科杂志,2014,34(S1):49-50.
[3]李建军,王方永.脊髓损伤神经学分类国际标准(2011年修订)[J].中国康复理论与实践,2011,(10):963-972.
[4] Pellegrino R,Viegi G,Brusasco V.Interpretative strategies for lung function tests[J].Eur Respir J,2005,26(5):948-968.
[5]郭佳宝,朱毅.吸气肌训练的临床研究进展[J].中国康复医学杂志,2014,29(9):888-892.
[6] Postma K,Haisma JA,Hopman MT,et al.Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation:a randomized controlled trial[J].Phys Ther,2014,94(12):1709-1719.
[7] Rochester D F.The diaphragm:contractile properties and fatigue[J].Clin Invest,1985,75(5):1397-1402.
[8] He B,Nan G.Pulmonary edema and hemorrhage after acute spinal cord injury in Rats[J].The Spine Journal,2016,16(4):547-551.
[9] Jiang W,Li MQ,He F,et al.Protective Effects of Asiatic Acid A-gainst Spinal Cord Injury-Induced Acute Lung Injury in Rats[J].Inflammation,2016,39(6):1853-1861.
[10]Sedy J,Zicha J,NedvídkováJ,Et al.The role of sympathetic nerv-ous system in the development of Neurogenic pulmonary edema in spinal cord-injured rats[J].Journa L of Applied Physiology,2012,112(1):1-8.
[11]Berlowitz DJ,Wadsworth B,Ross J.Respiratory problems and management in people with spinal cord injury[J].Breathe(Sheff),2016,12(4):328-340.
[12]Tamplin J,Berlowitz DJ.A systematic review and meta-analysis of the effects of respiratory muscle training on pulmonary function in tetraplegia[J].Spinal Cord,2014,52(3):175-180.
[13]Linn WS,Spungen AM,Gong J,et al;Forced vital cpacity in two large outpatient populations with chronic spinal cord injury[J].Spinal Cord,2001,39(5):263-268.