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目的探讨肺炎患儿膈肌疲劳的发生情况及其与呼吸衰竭的关系。方法用2K-V1型智能电阻抗呼吸图仪分别测定126例肺炎患儿(肺炎组)和60例健康儿童(健康对照组)膈肌功能,观察其胸腹运动曲线是否同步、主波方向是否一致;并计算胸腹运动曲线峰值错位时间与呼吸周期的比值(M值),依据胸腹运动曲线二维图计算最大X值到最小X值连线与X轴的夹角α值,根据一维图中胸腹运动曲线的变化及二维图中M值与α角度的变化判断其膈肌疲劳程度。结果 126例患儿中98例有膈肌疲劳,其中68例为Ⅰ型膈肌疲劳,30例为Ⅱ型膈肌疲劳。Ⅰ型膈肌疲劳患儿一维图呈胸腹部矛盾呼吸运动曲线,二维图顺时针方向运行,M值为(46.1±8.4)%,α角为(136.7±12.0)度;Ⅱ型膈肌疲劳患儿一维图呈胸腹呼吸运动曲线峰值错位,二维图逆时针方向运行,M值为(17.2±3.2)%,α角为(48.2±9.5)度;健康对照组M值为(4.3±1.0)%,α角为(31.7±5.2)度;Ⅰ型膈肌疲劳患儿、Ⅱ型膈肌疲劳患儿及健康儿童M值、α角比较差异均有统计学意义(Pa<0.01)。膈肌疲劳程度与临床诊断呼吸衰竭呈高度相关,与年龄呈负相关。结论电阻抗呼吸图仪可作为肺炎患儿膈肌疲劳的临床诊断方法,膈肌疲劳与肺炎患儿呼吸衰竭有关。
Objective To investigate the incidence of diaphragmatic muscle fatigue in children with pneumonia and its relationship with respiratory failure. Methods The function of diaphragmatic muscle in 126 children with pneumonia (pneumonia group) and 60 healthy children (healthy control group) was determined by 2K-V1 intelligent impedance respirograph. Whether the chest-abdomen movement curve was synchronous or not and the main wave direction was consistent ; And calculate the ratio of peak dislocation time of chest and abdomen movement curve to respiratory cycle (M value), according to the two-dimensional map of the chest and abdomen motion curve, calculate the angle α between the maximum X value and the minimum X value connecting line and X axis, Figure changes in chest and abdomen movement curve and two-dimensional map of M and α angle changes to determine the degree of diaphragmatic fatigue. Results Among the 126 cases, 98 cases had diaphragmatic fatigue, of which 68 cases were type Ⅰ diaphragmatic fatigue and 30 cases were type Ⅱ diaphragmatic fatigue. One-dimensional diaphragmatic fatigue in type I diaphragmatic contralateral respiratory movement curve of chest and abdomen, two-dimensional map clockwise operation, M value was (46.1 ± 8.4)%, α angle was (136.7 ± 12.0) degrees; type Ⅱ diaphragmatic fatigue The one-dimensional map of chest and abdomen showed a peak displacement of the respiratory curve, and the two-dimensional map was run counterclockwise with a M value of (17.2 ± 3.2)% and an α angle of (48.2 ± 9.5) degrees. The M value of the healthy control group was (4.3 ± 1.0)%, α angle was (31.7 ± 5.2) degrees. There was significant difference in M value and α angle between children with type I diaphragmatic fatigue and type Ⅱ diaphragmatic fatigue (P <0.01). The degree of diaphragmatic fatigue was highly correlated with clinical diagnosis of respiratory failure and negatively correlated with age. Conclusion Electrical impedance breathing apparatus can be used as a clinical diagnosis of diaphragmatic muscle fatigue in children with pneumonia, diaphragmatic fatigue and respiratory failure in children with pneumonia.