心智觉知干预对咳嗽反射敏感性的影响
2009/10/15
背景：慢性咳嗽很常见，且药物治疗可能无效。心智觉知干预是一种以培养即时非判断性意识、情感及感知为目的的心理干预措施。
方法：对2项序贯性研究中的30例健康受试者和30例慢性咳嗽患者进行研究。两项研究中均采用在两个时间点上冲动对咳嗽的比值测量对柠檬酸（C5）的咳嗽反射敏感性。两次激发试验之间，将受试者随机分为（1）无干预组；（2）心智觉知干预组；（3）无干预，但调整咳嗽激发（受试对象抑制咳嗽）组。健康志愿者中两次检测之间间隔时间为1小时，心智觉知干预时间为15分钟。慢性咳嗽患者的检测间隔时间为1周，心智觉知干预时间为每天30分钟。
结果：健康志愿者中无干预组、心智觉知干预组和咳嗽抑制组的咳嗽反射敏感性（logC5）改变中位数（IQR）分别为+1.0(0.0 -+1.3)、+2.0(+1.0 - +3.0)和+3.0(+2.8-+3.0)（倍增浓度，dc）(P=0.003)。与无干预组相比，心智觉知干预组(P=0.043)和咳嗽抑制组(P=0.002)的咳嗽敏感性显著下降。在咳嗽患者中，无干预组、心智觉知干预组和咳嗽抑制组的logC5改变中位数（IQR）分别为0.0(-1.0 -+1.0) （无干预组）、+1.0(-0.3 - +1.0)和+1.0(+1.0 - +2.0)dc, (P =0.046) （咳嗽抑制）（dc）(P=0.046)，咳嗽抑制组的咳嗽敏感性显著下降(P =0.02)，但心智觉知干预组无明显变化(P =0.35)。与对照组相比，心智觉知干预对慢性咳嗽患者(P =0.47)和健康志愿者(P =0.33)的冲动对咳嗽的比值无明显影响。
结论：与对照组相比，心智觉知干预能降低健康志愿者的咳嗽敏感性，但不能改变慢性咳嗽患者的咳嗽阈值，对两组人群中由吸入柠檬酸诱发的咳嗽反射都有抑制作用。
（刘国梁 审校）
Young EC, et la. Thorax. 2009 Aug 12.
The Effect of Mindfulness Meditation on Cough Reflex Sensitivity.
Young EC, Brammar C, Owen E, Brown N, Lowe J, Johnson C, Calam R, Jones S, Woodcock A, Smith JA.
BACKGROUND: Chronic cough is common and medical treatment can be ineffective. Mindfulness is a psychological intervention that aims to teach moment-to-moment non-judgemental awareness of thoughts, feelings and sensations.
Method: 30 healthy subjects and 30 chronic cough patients were studied in two sequential trials. For both studies, cough reflex sensitivity to citric acid (C5) was measured on two occasions with urge-to-cough rated following each inhalation; between challenges subjects were randomised to (i) no intervention (ii) mindfulness or (iii) no intervention but modified cough challenge (subjects suppress coughing). For the healthy volunteers, measures were one hour apart and mindfulness was practiced for 15 minutes. For the chronic cough patients measures were 1 week apart and mindfulness practiced daily for 30 minutes.
RESULTS: In healthy volunteers, median change (IQR) in cough reflex sensitivity (logC5) for no intervention, mindfulness and suppression was +1.0(0.0 to +1.3), +2.0(+1.0 to +3.0) and +3.0(+2.8 to +3.0) doubling concentrations (dc) (p=0.003); significant reductions for both mindfulness (p=0.043) and suppression (p=0.002) over no intervention. In cough patients, median change (IQR) in logC5 for no intervention, mindfulness training and voluntary suppression was 0.0(-1.0 to +1.0), +1.0(-0.3 to +1.0) and +1.0(+1.0 to +2.0)dc, (p=0.046); significant reduction for suppression (p=0.02) but not mindfulness (p=0.35). Urge-to-cough did not change after mindfulness compared to control in either healthy (p=0.33) or chronic cough subjects (p=0.47).
CONCLUSION: Compared to control, mindfulness decreased cough reflex sensitivity in healthy volunteers, but did not alter cough threshold in chronic cough patients. Both groups were able to suppress cough responses to citric acid inhalation.
上一篇：
呼出气一氧化氮在评价年轻成人慢性咳嗽患者中的作用
下一篇：
神经生长因子通过TrkA 和 TRPV1受体依赖机制增强咳嗽和气道阻塞
