本文選題：呼吸中樞驅(qū)動(dòng) + 呼吸困難　； 參考：《廣州醫(yī)科大學(xué)》2013年博士論文

【摘要】：目的：呼吸困難主要依賴主觀量表并結(jié)合患者的自身感受進(jìn)行評(píng)價(jià)，缺乏客觀量化呼吸困難的方法。本研究目的就是探討多導(dǎo)食道電極記錄的膈肌肌電（呼吸中樞驅(qū)動(dòng)）量化呼吸困難的可行性。 方法：選擇10例健康青年人、13例健康中老年人和14例慢性阻塞性肺疾�。–OPD）穩(wěn)定期患者，均進(jìn)行常規(guī)肺功能檢測(cè)。應(yīng)用心肺運(yùn)動(dòng)試驗(yàn)誘發(fā)呼吸困難，通過多導(dǎo)食道電極記錄膈肌肌電反映呼吸中樞驅(qū)動(dòng)，實(shí)時(shí)記錄運(yùn)動(dòng)過程中膈肌功能及呼呼吸困難變化。試驗(yàn)中呼吸困難程度分為無（0）、輕度（1）、中度（2）、重度（3）、極重度（4）5個(gè)分級(jí)，并協(xié)同Borg量表作為評(píng)價(jià)呼吸困難的依據(jù)，分析膈肌肌電與呼吸困難之間相關(guān)性。以膈肌肌電占最大值百分比進(jìn)行膈肌肌電標(biāo)化來反映呼吸中樞驅(qū)動(dòng)，并進(jìn)一步比較呼吸中樞驅(qū)動(dòng)與呼吸困難嚴(yán)重度的關(guān)系，觀察標(biāo)化值百分比與呼吸困難嚴(yán)重度之間的數(shù)量關(guān)系。試驗(yàn)中所有膈肌肌電值均應(yīng)用均方根來計(jì)算。 結(jié)果：健康青年組、健康中老年組和COPD組膈肌肌電與呼吸困難呈直線相關(guān)（r=0.977±0.026，0.973±0.025，0.958±0.051，均P 0.05），另外，在健康青年組和中老年組呼吸困難五級(jí)分度法與膈肌肌電相關(guān)性顯著優(yōu)于Borg量表法，然而，COPD組兩種方法與膈肌肌電相關(guān)性卻沒有統(tǒng)計(jì)學(xué)差異。健康青年組、健康中老年組和COPD組在出現(xiàn)呼吸困難時(shí)相對(duì)應(yīng)的呼吸中樞驅(qū)動(dòng)分別為：（22.2±9.0）%、（41.0±7.7）%、（44.0±17.0）%；呼吸中樞驅(qū)動(dòng)在呼吸困難程度分級(jí)各分度之間的數(shù)量差異均有統(tǒng)計(jì)學(xué)意義（P 0.05），，然而，由于呼吸困難各分度（比如中度、重度和極重度）所對(duì)應(yīng)的呼吸中樞驅(qū)動(dòng)有重疊。 結(jié)論：多導(dǎo)食道電極記錄的膈肌肌電（呼吸中樞驅(qū)動(dòng)）可以量化健康人和COPD患者的呼吸困難程度。
[Abstract]:Objective: to evaluate dyspnea by subjective scale and self-feeling of patients without objective method of quantifying dyspnea. The aim of this study was to investigate the feasibility of quantifying dyspnea by diaphragm electromyography (respiratory center drive) recorded by multichannel esophageal electrodes. Methods: routine pulmonary function tests were performed in 10 healthy young people and 13 healthy middle-aged and elderly patients and 14 stable patients with chronic obstructive pulmonary disease (COPD). Cardiopulmonary exercise test was used to induce dyspnea. Diaphragm electromyography was recorded by multichannel esophageal electrode to reflect the respiratory center drive. The changes of diaphragm function and dyspnea during exercise were recorded in real time. In the experiment, the degree of dyspnea was divided into 5 grades, including no dyspnea, mild dyspnea, moderate dyspnea, moderate dyspnea, severe dyspnea and severe dyspnea. The correlation between diaphragmatic myoelectricity and dyspnea was analyzed by using Borg scale as the basis for the evaluation of dyspnea. The diaphragm electromyography was standardized to reflect the respiratory center drive, and the relationship between the respiratory center drive and the severity of dyspnea was further compared. The quantitative relationship between the percentage of standardized values and the severity of dyspnea was observed. All diaphragm myoelectric values were calculated using RMS. Results: there was a linear correlation between diaphragmatic myography and dyspnea in healthy young group, healthy middle-aged group and COPD group. The correlation between diaphragm myography and diaphragm electromyography in healthy young group and middle and old age group was significantly better than that in Borg scale method, which was 0.977 鹵0.026 鹵0.973 鹵0.025 鹵0.958 鹵0.051, respectively. In addition, the correlation between the five grades of dyspnea in healthy young group and middle and old age group was significantly better than that in Borg scale method. However, there was no statistical difference between the two methods and diaphragm electromyography in COPD group. In the healthy youth group, the healthy middle-aged group and the COPD group, the corresponding respiratory center drive in the case of dyspnea was 22.2 鹵9.0% and 41.0 鹵7.7% respectively, and the number of respiratory center drive in the different grades of dyspnea was significantly different (P 0.05), however, there were significant differences in the number of respiratory center drivers among the different grades of dyspnea, however, there were significant differences in the number of respiratory center drivers between different grades of dyspnea (P < 0.05). Because of dyspnea, the respiratory center drive corresponding to the degree of dyspnea (e. G. Moderate, severe and extremely severe) overlaps. Conclusion: diaphragm electromyography recorded by multichannel esophagus electrode (respiratory center drive) can quantify the degree of dyspnea in healthy people and COPD patients.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.8

【共引文獻(xiàn)】

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