發(fā)布時(shí)間：2018-03-31 22:16

  本文選題：膈肌　切入點(diǎn)：顫搐性跨膈壓　出處：《廣州醫(yī)學(xué)院》2012年碩士論文

【摘要】：目的 利用頸后磁刺激膈神經(jīng)，探討在不同磁刺激量水平，氣道完全阻斷和氣道開(kāi)放兩種狀態(tài)下膈肌特性的差異，了解膈肌力量-速度-磁刺激量的關(guān)系，綜合地評(píng)估膈肌特性的動(dòng)態(tài)變化。 方法 選擇8例健康男性作為受試對(duì)象，經(jīng)鼻插入多導(dǎo)食道電極、胃食道囊管和體表電極以測(cè)量膈肌CMAP、食道壓和胃壓，用自制的氣道阻斷和觸發(fā)裝置，在不同的磁刺激量刺激雙側(cè)膈神經(jīng)，在不同的時(shí)間重復(fù)3次刺激，測(cè)量口腔出現(xiàn)顫搐性吸氣流速時(shí)和氣道完全阻斷時(shí)的Pmou,t、Pdi,t、口腔吸氣流速和IC的重復(fù)性以及系統(tǒng)地比較不同氣道狀態(tài)對(duì)Pdi,t的影響。 結(jié)果 在100%磁刺激時(shí)Pdi,t、Pmou,t、Fin,t和Pmou,t/Pdi,t比值的變異較小，同IC一樣均小于5%，變異不受時(shí)間的影響，而受磁刺激量的影響。用自制的氣道阻斷和觸發(fā)裝置可以得到穩(wěn)定的Pmou,t、Pdi,t、口腔吸氣流速和Pmou,t/Pdi,t比值，分別為19.16±5.68cmH2O、15.55±4.01cmH2O、2.46±0.58L/s、0.82±0.08，它們各自的自身變異系數(shù)是4.89%,4.41%,3.90%,2.40%和3.33%。Pdi,t與Pmou,t具有顯著的相關(guān)性(r=0.96,P 0.0001），Pdi,t與Fin,t具有一定的相關(guān)性(r=0.52，P 0.05）。應(yīng)用氣道阻斷裝置可以系統(tǒng)地研究膈肌力量-速度-磁刺激量的關(guān)系，，在100%磁刺激水平時(shí)氣道開(kāi)放的Pdi,t比氣道完全阻斷小3.82cmH2O（P=0.04），其余3個(gè)磁刺激水平無(wú)差異。 結(jié)論 1.自制的氣道阻斷和觸發(fā)裝置可以在頸后磁刺激膈神經(jīng)時(shí)記錄到穩(wěn)定的Pmou,t和Pdi,t。 2.在重復(fù)磁刺激時(shí)Pdi,t、Pmou,t、Fin,t、IC和Pmou,t/Pdi,t比值均是重復(fù)性較好的指標(biāo)，可用來(lái)綜合評(píng)估膈肌功能的動(dòng)態(tài)變化。 3. Pdi,隨著磁刺激量的增加而增加，沒(méi)有達(dá)到刺激平臺(tái)。在100%磁刺激水平時(shí)氣道開(kāi)放的Pdi,t比氣道完全阻斷小3.82cmH2O，其余3個(gè)磁刺激水平無(wú)差異。
[Abstract]:Purpose. Using posterior cervical magnetic stimulation of phrenic nerve, the differences of diaphragm characteristics under different levels of magnetic stimulation, complete obstruction of airway and open airway were discussed, and the relationship between diaphragm strength, velocity and magnetic stimulation was studied. The dynamic changes of diaphragm characteristics were evaluated synthetically. Method. Eight healthy men were selected as subjects. Multiple esophageal electrodes, gastroesophageal sac tubes and body surface electrodes were inserted through the nose to measure diaphragm CMAP, esophageal pressure and gastric pressure, and self-made airway blocking and triggering devices were used. The bilateral phrenic nerve was stimulated with different amount of magnetic stimulation, and the stimulation was repeated three times at different time. The repeatability of inspiratory velocity and IC in oral cavity and the effect of different airway states on Pditit were measured when there was convulsive inspiratory velocity in oral cavity and when the airway was completely blocked. Results. Under 100% magnetic stimulation, the variation of the ratio of Pditit and Pmout / P / Pdit was smaller than that of IC, and the variation was not affected by time. Under the influence of magnetic stimuli, stable Pdit was obtained by using self-made airway blocking and triggering device, and the inspiratory velocity of mouth and the ratio of Pdit / Pdit of mouthpiece were obtained. They were 19.16 鹵5.68 cm H _ 2O 15.55 鹵4.01 cm H _ 2O 2.46 鹵0.58 L / s 0.82 鹵0.08, and their coefficients of variation were 4.89 ~ 4.41 ~ 3.90 ~ 2.40% and 3.33 ~ 0.96 ~ (-1) P ~ (0.000) P ~ (0.000) ~ (-1) P ~ (0.05) respectively. The relationship between muscle strength, velocity and magnetic stimulation could be systematically studied by using the airway blocking device. At 100% magnetic stimulation level, the open airway Pdit was 3.82 cm H _ 2O _ 2 P _ (0.04) less than that of complete airway blockade, but the other three magnetic stimulation levels were not different. Conclusion. 1. Stable pmout and Pditit could be recorded by self-made airway blocking and triggering device during magnetic stimulation of phrenic nerve. 2. The ratio of Pditit / Pmout / Pdit / Pdit is a good reproducibility index, which can be used to evaluate the dynamic changes of diaphragm function. 3. Pdil, which increased with the increase of the amount of magnetic stimulation, did not reach the stimulation platform. At 100% magnetic stimulation level, the open Pdit of the airway was 3.82 cmH2O smaller than that of the airway completely blocked, but there was no difference in the other three levels of magnetic stimulation.
【學(xué)位授予單位】：廣州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R563.9

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本文編號(hào)：1692704