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目的:初步探讨膈神经传导(PNC)及膈运动诱发电位(MEP)对评价各种呼吸功能障碍的价值。方法:对34例病人(各种神经肌肉疾病19例、呼吸系统疾病15例)在胸锁乳突肌后缘中点用电刺激膈神经,于第7—8肋间和剑突处记录膈肌复合动作电位;用磁圈置于对侧头皮进行刺激,在深吸气状态下记录膈MEP。结果:肌病患者的PNC均正常;格林巴利综合征、重症肌无力危象以及遗传性运动感觉神经病者的PNC均异常,动态观察结果均表现为PNC与呼吸功能障碍显著相关;7例睡眠呼吸暂停综合征中4例PNC异常;3例慢性阻塞性肺病有2例主要表现为膈肌电位波幅低;憋气、平卧时呼吸困难者患者5例中仅1例表现为单侧膈肌电位波幅低;5例作MEP的睡眠呼吸暂停综合征者3例异常、3例慢性阻塞性肺病者的隔MEP均正常。结论:PNC不仅可客观地评价神经肌肉性呼吸功能障碍、预示疾病过程,而且还可为呼吸系统病变所致呼吸功能障碍提供膈肌功能障碍的其它信息;结合PNC及隔MEP两者的结果可能有助于判断睡眠呼吸暂停综合征的病变类型。
Objective: To investigate the value of phrenic nerve conduction (PNC) and phrenic motor evoked potential (MEP) in evaluating various respiratory dysfunction. Methods: Thirty-four patients (19 cases of various neuromuscular diseases and 15 cases of respiratory diseases) underwent electrical stimulation of the phrenic nerve at the midpoint of the posterior margin of the sternocleidomastoid muscle, recording the diaphragm Compound action potentials; magnetic ring placed on the contralateral scalp stimulation, recorded in the deep inspiratory diaphragm MEP. Results: The PNC of myopathy patients were normal. The PNC of Guillain-Barre syndrome, myasthenia gravis crisis and hereditary motor sensory neuropathy were abnormal. The dynamic observation results showed that PNC was significantly associated with respiratory dysfunction. PNC abnormalities in 4 cases of apnea syndrome; 3 cases of chronic obstructive pulmonary disease in 2 cases mainly for the low amplitude of diaphragm potential; suffocation, supine dyspnea patients in 5 cases, only 1 case of unilateral diaphragm potential amplitude was low ; 5 cases of sleep apnea syndrome MEP were abnormal in 3 cases, 3 patients with chronic obstructive pulmonary disease MEP were normal. Conclusions: PNC not only objectively evaluates neuromuscular respiratory dysfunction, predicts disease progression, but also provides additional information on diaphragmatic dysfunction for respiratory dysfunction caused by respiratory disease; the results of both PNC and MEP may be To help determine the type of sleep apnea syndrome.