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目的探讨口腔压(Pmo)或气道内压(Ptr)与食管内压(Pes)和跨膈压(Pd i)的关系。方法对17例因腹部手术需要全身麻醉(简称全麻)的患者,观察全麻前的最大吸气压(M IP)、最大食管内压(Pesm ax)、最大跨膈压(Pd im ax)、颤搐性口腔压(TwPmo)、颤搐性食管内压(TwPes)和颤搐性跨膈压(TwPd i)以及全麻期间的颤搐性气道内压(TwPtrnar)、颤搐性食管内压(TwPesnar)和颤搐性跨膈压(TwPd inar),以了解它们的变异性和相互关系。结果(1)M IP与Pd im ax、TwPmo与TwPd i、TwPtrnar与TwPd inar、M IP与Pesm ax、TwPmo与TwPes和TwPtrnar与TwPesnar的线性相关系数(r)分别为0.976±0.030、0.816±0.155、0.923±0.446、0.981±0.185、0.829±0.168和0.955±0.292。(2)M IP、Pesm ax、Pd im ax、TwPmo、TwPes和TwPd i的变异系数(CV)分别为(14.2±4.7)%、(15.2±4.3)%、(15.5±4.1)%、(30.4±15.9)%、(10.8±5.1)%和(9.9±4.0)%,其中TwPmo最高(与其他观测指标比较P均<0.05),TwPes和TwPd i最低(与其他观测指标比较P均<0.05),而M IP、Pesm ax和Pd im ax间比较差异均无统计学意义(P均>0.05)。(3)TwPtrnar与TwPd inar、TwPesnar间动态变化的r值分别为0.839、0.894(P均=0.000)。结论M IP和TwPmo均可能低估膈肌功能,需重复测定,取其最高值,TwPtrnar能客观评价膈肌功能的动态变化。
Objective To investigate the relationship between oral pressure (Pmo) or airway pressure (Ptr) and esophageal pressure (Pes) and diaphragmatic pressure (Pd i). Methods Seventeen patients undergoing general anesthesia (abdominal anesthesia) under general anesthesia were enrolled in this study. The maximal inspiratory pressure (M IP), maximal esophageal pressure (Pesm ax), maximal diaphragmatic pressure (Pd im ax) , TwPmo, TwPes, and TwPd i, as well as twitch airway pressure (TwPtrnar) during general anesthesia, twitch esophageal TwPesnar and TwPd inar to understand their variability and interrelationships. Results (1) The linear correlation coefficients (r) between M IP and Pd im ax, TwPmo and TwPd i, TwPtrnar and TwPd inar, M IP and Pesm ax, TwPmo and TwPes and TwPtrnar and TwPesnar were 0.976 ± 0.030 and 0.816 ± 0.155 , 0.923 ± 0.446, 0.981 ± 0.185, 0.829 ± 0.168 and 0.955 ± 0.292. (2) The CVs of M IP, Pesm ax, Pd im ax, TwPmo, TwPes and TwPd i were (14.2 ± 4.7)%, (15.2 ± 4.3)%, (15.5 ± 4.1)% and ± 15.9%, (10.8 ± 5.1)% and (9.9 ± 4.0)%, respectively, with the highest TwPmo (P <0.05, P <0.05), and the lowest TwPes and TwPd i (P <0.05 compared with other observed indicators) , While there was no significant difference between M IP, Pesm ax and Pd im ax (all P> 0.05). (3) The r values of dynamic changes between TwPtrnar and TwPd inar and TwPesnar were 0.839,0.894 (P = 0.000). Conclusions Both M IP and TwPmo may underestimate the function of the diaphragm. Repeated measurements should be taken to obtain the highest values. TwPtrnar can objectively evaluate the dynamic changes of diaphragmatic function.