中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2009年
2期
103-106
,共4页
阎锡新%宋贝贝%丁立君%司靓%关继涛
閻錫新%宋貝貝%丁立君%司靚%關繼濤
염석신%송패패%정립군%사정%관계도
呼吸,人工%膈%肌球蛋白重链
呼吸,人工%膈%肌毬蛋白重鏈
호흡,인공%격%기구단백중련
Respiration,Artificial%Diaphragm%Myofibril damage%Myosin heavy chain
目的 探讨控制性机械通气(CMV)对大鼠膈肌功能的影响,了解不适当控制性机械通气与膈肌功能不全和脱机困难的关系.方法 将24只雄性SD大鼠按随机数字表法分为3组:正常对照组、18 h CMV组和24 h CMV组.后两组分别给予18 h和24 h CMV,并测定膈肌跨膈压(Pdi)、最大跨膈压(Pdimax)、膈肌肌电图(EMGdi)等指标和膈肌肌球蛋白重链(MHC)表型的改变.两样本组间均数比较用t检验,多组间均数差异性比较采用单因素方差分析.结果 与对照组比较,18、24 Hcmv组Pdimax分别为[(8.98±0.55、6.12±0.53、14.92±0.16)cm H2O,1 cm H2O=0.098 kPa],实验组均低于对照组,差异有统计学意义(F=82.35,P<0.01);实验组EMGdi的中心频率和高低频比值均低于对照组;在最大刺激频率(100 Hz)下18、24 h CMV组的膈肌肌张力[(84.11±0.43、52.65±0.64)N]较对照组[(98.13±0.50)N]低,差异有统计学意义(F=15.02,P<0.01);同时MHC2A比例下降;24 h CMV组大鼠膈肌肌纤维的电镜下病理改变为:膈肌出现肌原纤维排列疏松、脂肪滴和空泡增多,个别出现线粒体肿胀、空化,嵴减少.结论 短期CMV即可导致膈肌功能失调和形态改变;机械通气,特别是CMV诱导的膈肌功能障碍可能是引起临床上一些患者脱机困难的重要原因之一.
目的 探討控製性機械通氣(CMV)對大鼠膈肌功能的影響,瞭解不適噹控製性機械通氣與膈肌功能不全和脫機睏難的關繫.方法 將24隻雄性SD大鼠按隨機數字錶法分為3組:正常對照組、18 h CMV組和24 h CMV組.後兩組分彆給予18 h和24 h CMV,併測定膈肌跨膈壓(Pdi)、最大跨膈壓(Pdimax)、膈肌肌電圖(EMGdi)等指標和膈肌肌毬蛋白重鏈(MHC)錶型的改變.兩樣本組間均數比較用t檢驗,多組間均數差異性比較採用單因素方差分析.結果 與對照組比較,18、24 Hcmv組Pdimax分彆為[(8.98±0.55、6.12±0.53、14.92±0.16)cm H2O,1 cm H2O=0.098 kPa],實驗組均低于對照組,差異有統計學意義(F=82.35,P<0.01);實驗組EMGdi的中心頻率和高低頻比值均低于對照組;在最大刺激頻率(100 Hz)下18、24 h CMV組的膈肌肌張力[(84.11±0.43、52.65±0.64)N]較對照組[(98.13±0.50)N]低,差異有統計學意義(F=15.02,P<0.01);同時MHC2A比例下降;24 h CMV組大鼠膈肌肌纖維的電鏡下病理改變為:膈肌齣現肌原纖維排列疏鬆、脂肪滴和空泡增多,箇彆齣現線粒體腫脹、空化,嵴減少.結論 短期CMV即可導緻膈肌功能失調和形態改變;機械通氣,特彆是CMV誘導的膈肌功能障礙可能是引起臨床上一些患者脫機睏難的重要原因之一.
목적 탐토공제성궤계통기(CMV)대대서격기공능적영향,료해불괄당공제성궤계통기여격기공능불전화탈궤곤난적관계.방법 장24지웅성SD대서안수궤수자표법분위3조:정상대조조、18 h CMV조화24 h CMV조.후량조분별급여18 h화24 h CMV,병측정격기과격압(Pdi)、최대과격압(Pdimax)、격기기전도(EMGdi)등지표화격기기구단백중련(MHC)표형적개변.량양본조간균수비교용t검험,다조간균수차이성비교채용단인소방차분석.결과 여대조조비교,18、24 Hcmv조Pdimax분별위[(8.98±0.55、6.12±0.53、14.92±0.16)cm H2O,1 cm H2O=0.098 kPa],실험조균저우대조조,차이유통계학의의(F=82.35,P<0.01);실험조EMGdi적중심빈솔화고저빈비치균저우대조조;재최대자격빈솔(100 Hz)하18、24 h CMV조적격기기장력[(84.11±0.43、52.65±0.64)N]교대조조[(98.13±0.50)N]저,차이유통계학의의(F=15.02,P<0.01);동시MHC2A비례하강;24 h CMV조대서격기기섬유적전경하병리개변위:격기출현기원섬유배렬소송、지방적화공포증다,개별출현선립체종창、공화,척감소.결론 단기CMV즉가도치격기공능실조화형태개변;궤계통기,특별시CMV유도적격기공능장애가능시인기림상상일사환자탈궤곤난적중요원인지일.
Objective To investigate the effect of controlled mechanical ventilation (CMV) on the diaphragm of rats, and therefore to understand the theoretic basis of difficulty weaning due to dysfunction and morphology in diaphragm induced by inappropriate mechanical ventilation. Methods Twenty-four adult male SD rats were randomly assigned into 3 experimental groups: a control group, a 18 h CMV group, and a 24 h CMV group. Trans-diaphragmatic pressure ( Pdi ) , maximal trans-diaphragmatic pressure ( Pdimax ) , diaphragm electromyogram ( EMGdi) , and diaphragm muscle force were measured during CMV at various stimulation frequencies. Morphological changes of the diaphragm myofibril were observed by transmission electron microscopy. Myosin heavy chain ( MHC) isoform expression were analyzed with SDS-glycerol PAGE and Western blotting. Results The Pdimax in the 18 h CMV group and the 24 h CMV group [ (8. 98 ± 0.55, 6. 12 ±0.53) cm H2O, 1 cmH2O=0.098 kPa] was significantly reduced (F = 82. 35,P <0. 01) compared with the control group [ (14. 92 ±0. 16) cm H2O]. The Fc and the H/L decreased significantly. At the stimulation frequency of 100 Hz, the diaphragm muscle force in the 18 h CMV group and 24 h CMV group [ (84. 11 ±0. 43) N, (52. 65 ±0. 64) N, respectively] decreased compare with the control[ (98. 13 ± 0. 50) N, F = 15. 02, P < 0.01 ]. The proportion of MHC2A decreased in the 24 h group compared with control. The ultrastructural changes of the diaphragm was observed in the 24 h CMV group, such as disrupted myofibrils, increased numbers of lipid vacuoles in the sarcoplasm, and abnormally small mitochondria containing focal membrane disruptions. Conclusion Short-term CMV induced diaphragm fatigue and altered the function and morphology of diaphragm in SD rats. Diaphragmatic dysfunction induced by CMV maybe one of the important reasons for difficult weaning.
