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Vol. 26. Issue 8.
Pages 336-340 (November - December 1990)
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Vol. 26. Issue 8.
Pages 336-340 (November - December 1990)
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Función de los músculos inspiratorios en el umbral de la disnea en pacientes con enfermedad pulmonar obstructiva crónica
Function of the inspiratory muscles in the threshold of dyspnea in patients with chronic obstructive pulmonary disease
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F. Capote Gil, A. Pereira Vega, J. Castillo Gómez, S. Cano Gómez, F. Rodriguez Panadero, R. Otero Candelera
Servicio de Neumología. Hospital Universitario Virgen del Rocío. Sevilla
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Hemos intentado evaluar cuáles son los músculos o grupos musculares inspiratorios cuya actividad se relaciona más estrechamente con la producción de la sensación de disnea. Para ello, hemos estudiado en un grupo de 21 pacientes con enfermedad pulmonar obstructiva crónica (EPOC), las presiones musculares inspiratorias medidas en la boca (PI) respirando a volumen corriente y transdiafragmáticas (Pdi), así como sus relaciones con las respectivas presiones máximas (PI/PI max y Pdi/Pdi max) y los índices tensión-tiempo inspiratorio (ITT) y diafragmático (ITTdi), en situación basal y en el umbral de la disnea, determinado este último al respirar contra cargas resistivas externas de intensidad creciente.

En el umbral de la sensación, las presiones transdiafragmáticas y el ITTdi de los pacientes se incrementaban significativamente (p<0,003) en relación con los valores basales. Por otro lado, el aumento del ITTdi en el umbral se producía por entero a expensas de su componente Pdi/Pdi max, sin que se modificara la relación entre el tiempo inspiratorio y el tiempo respiratorio total (Ti/Ttot). Por último, el cambio experimentado por las presiones inspiratorias medidas en la boca y los parámetros relacionados con ella (PI/PI max, ITT), al pasar desde el estado basal al umbral de la disnea, era más constante y mucho más intenso (p<0,0001, p<0,0001 y p<0,0002, respectivamente) que el producido en los índices de presión transdiafragmática. Este hallazgo va a favor de la idea de que es la actividad global de la musculatura inspiratoria, más que la actividad específica del diafragma, el principal factor subyacente a la sensación de esfuerzo o disnea en su umbral de detección.

We have investigated which are the inspiratory muscles or muscular groups whose activity is most closely associated with the development of the dyspnea sensation. To this end we evaluated, in a group of 21 pateints with chronic obstructive pulmonary disease, the inspiratory muscular pressures measured within the mouth (IP) breathing tidal volume and transdiaphragmatic pressures (Pdi). We also evaluated their relation with the respective maximum pressures (PI/PImax and Pdi/Pdimax), and the inspiratory (ITT) and diaphragmatic tension-time (diTTI) indexes, in the baseline situation and in the threshold of dyspnea. The last index was calculated when respiration was carried out against external resistive loads of increasing magnitude.

In the threshold of dyspnea, transdiaphragmatic pressures and diTTI of the patients were significantly higher than the baseline values (p < 0,003). On the other hand, the increased di TTI in the threshold occurred wholly at the expense of its Pdi/Pdimax, without changes in the relation between inspiratory time and total respiratory time (IT/totT). Finally, the changes of inspiratory pressures measured within the mouth and the related parameters (IP/IPmax, ITT) from the baseline to the dyspnea threshold were more consistent and much more marked (p < 0,001, p < 0,0001, and p < 0,0002, respectively) than those in the transdiaphragmatic pressure indexes. This finding supports the notion that the major factor underlying the sensation of dyspnea in the overa» inspiratory muscle activity rather than the specific activity of the diaphragm.

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Copyright © 1990. Sociedad Española de Neumología y Cirugía Torácica
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