内窥镜肺容积缩小术后横膈膜形状和强度的改善。

IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Thorax Pub Date : 2024-07-16 DOI:10.1136/thorax-2024-221375
Olivier Taton, Pierre Alain Gevenois, Alain Van Muylem, Benjamin Bondue, Sébastien Van Laethem, Dimitri Leduc
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引用次数: 0

摘要

理由:内窥镜肺容积缩小术可改善严重肺气肿患者的肺功能、生活质量和运动能力。然而,其对膈肌功能的影响尚不十分清楚。我们假设内窥镜肺容积缩小术通过改变膈肌的形状来增加其强度:研究插入支气管内瓣膜后膈肌形状和强度的变化:在单侧瓣膜植入前和植入 3 个月后,通过应用 3D Slicer 软件对 CT 扫描获得的功能残余能力和通过双侧膈神经磁刺激测量的横膈膜压力分别对 19 例患者的横膈膜形状和强度进行了研究:肺容量缩小后(中位数(IQR),434 mL(-597 至 -156],p2O(2.3 至 4.2),p2(3 至 100),p结论:内窥镜肺容积缩小术通过增加膈肌的长度和贴合区以及减少治疗侧的曲率半径来改变膈肌的形状,从而增加膈肌的强度:NCT05799352.
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Improvements of the shape and strength of the diaphragm after endoscopic lung volume reduction.

Rationale: Endoscopic lung volume reduction improves lung function, quality of life and exercise capacity in severe emphysema patients. However, its effect on the diaphragm function is not well understood. We hypothesised that endoscopic lung volume reduction increases its strength by modifying its shape.

Objectives: To investigate changes in both diaphragm shape and strength induced by the insertion of endobronchial valves.

Methods: In 19 patients, both the diaphragm shape and strength were investigated respectively by 3D Slicer software applied on CT scans acquired at functional residual capacity and by transdiaphragmatic pressure measurements by bilateral magnetic stimulation of the phrenic nerves before and 3 months after unilateral valves insertion.

Measurements and main results: After lung volume reduction (median (IQR), 434 mL (-597 to -156], p<0.0001), diaphragm strength increased (transdiaphragmatic pressure: 3 cmH2O (2.3 to 4.2), p<0.0001). On the treated side, this increase was associated with an increase in the coronal (16 mm (13 to 24), p<0.0001) and sagittal (26 mm (21 to 30), p<0.0001) lengths as well as in the area of the zone of apposition (62 cm2 (3 to 100), p<0.0001) with a decrease in the coronal (8 mm (-12 to -4), p<0.0001) and sagittal (9 mm (-18 to -2), p=0.0029) radii of curvature.

Conclusions: Endoscopic lung volume reduction modifies the diaphragm shape by increasing its length and its zone of apposition and by decreasing its radius of curvature on the treated side, resulting in an increase in its strength.

Trial registration number: NCT05799352.

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来源期刊
Thorax
Thorax 医学-呼吸系统
CiteScore
16.10
自引率
2.00%
发文量
197
审稿时长
1 months
期刊介绍: Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.
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