脊髓损伤时发生的矛盾呼吸丨医学英语视听学习

Paradoxical breathing in spinal cord injury

脊髓损伤时的矛盾呼吸

We breathe using three groups of muscles, the diaphragm, the intercostals, and the abdominals. These muscles receive their nerve supply from the brain via the spinal cord. If someone has a spinal cord injury, some or all of these muscles can be paralyzed.

人体参与呼吸的肌肉群有 3 个：膈肌、肋间肌和腹肌。这些肌肉通过脊髓，接收来自大脑的神经支配。如果有人发生脊髓损伤，部分或全部这些肌肉可能会瘫痪。

When the diaphragm contracts, it moves down and we breathe in. Its nerve supply is from C3, 4, and 5 in the spinal cord in the neck.

当膈肌收缩时，它向下移动，我们吸气。膈肌的神经支配来自颈部脊神经 C3、4和5。

The intercostals have two layers that either lift or compress the rib cage when we breathe in or out. Their nerve supply is from T1 to T11 in the spinal cord.

肋间肌有两层，当我们吸气或呼气时，它们牵拉或压缩胸腔。它们的神经支配由脊神经 T1-T11 提供。

The abdominal muscles are mainly needed for breathing only when we want to help force air out such as coughing or during and after strenuous exercise. Their nerve supply is from T6 to T12 in the spinal cord.

腹肌仅辅助迫使空气排出，如咳嗽或剧烈运动期间和之后，从而参与呼吸。它们的神经支配由脊神经 T6-T12 提供。

This person has recently suffered a spinal cord injury at the level of C5 in the neck. This means they can't use their intercostal or abdominal muscles to breathe because they are paralyzed. Their only working breathing muscle is the diaphragm.

该人最近遭受颈部 C5 水平脊髓损伤。这表示肋间肌或腹肌无法参与呼吸，因为它们发生瘫痪。唯一发挥作用的呼吸肌是膈肌。

The diaphragm contracts and moves down creating negative pressure inside the chest and the person breathes in.

膈肌收缩并向下移动，产生胸腔内负压，患者吸气。

However, in the first few days and weeks following a spinal cord injury, there is a phase of spinal shock when the paralyzed muscles have no tone and are flaccid which means they are completely slack or limp.

然而，在脊髓损伤后的数天和数周内，有一段脊髓休克期，即瘫痪的肌肉无张力，疲软（完全松弛无力）。

Now, the negative pressure inside the chest causes an adverse effect. Because the intercostals are flaccid, they are not stabilizing the rib cage, and the chest collapses and is pulled inwards by the diaphragm action on inspiration.

现在，胸腔内的负压会造成不良影响。因为肋间肌疲软，它们不能稳定胸廓，胸部塌陷，吸气时，膈肌将其向内牵拉。

At the same time, the abdomen rises because the organs are being displaced by the downward movement of the diaphragm.

与此同时，腹部上升，因为膈肌向下运动，迫使器官移位。

This condition is known as paradoxical breathing because of the reverse pattern of movement seen in the chest and abdomen. It is also sometimes called see-saw breathing.

这种情况就是矛盾呼吸，因为胸部和腹部出现相反的运动模式。它有时也被称为“跷跷板样”呼吸。

It can lead to respiratory distress or even respiratory failure as the person's work of breathing is greatly increased.

随着患者的呼吸作功大幅增加，它可能导致呼吸窘迫，或者甚至呼吸衰竭。

Over a period of between several days to weeks following injury, spinal shock resolves gradually and the paralyzed muscles develop tone often in the form of spasticity.

在损伤后的数天到数周内，脊髓休克逐渐缓解，瘫痪的肌肉通常以痉挛的形式恢复张力。

The chest mechanics then improve and paradoxical breathing reduces as does work of breathing. Outcomes will be more favorable if weaning from ventilation is delayed until this stage is reached.

然后，胸部机械运动改善，随着呼吸力量减小，矛盾呼吸减少。如果将停止通气的时间推迟到这个阶段，结果会更好。