哮喘联盟

   摘要
   目的：本研究的目的是比较肌营养不良症患者的无辅助性的咳嗽峰流速（CPF）和通过各种技术增强的CPF，这些技术包括最大深度舌咽式呼吸（GPB）结合后续的自我胸部或腹部的推挤。
   试验设计：对所有电动轮椅依赖的，并且之前掌握GPB的肌肉萎缩症患者在家中进行培训，以增强他们的咳嗽有效性。培训涉及操纵轮椅，对抗特制桌子的边缘，以自主产生一个胸部和/或腹部的推力，定时打开声门来完成一个独立的辅助性咳嗽。对无辅助性的和各种辅助性的CPFs进行比较。
   结果：18例（17例男性/1例女性），年龄21.1 ± 5.4岁的肌肉萎缩患者通过不同辅助措施达到的CPFs显著高于自主CPF(P < 0.001)，辅助性CPFs，而不是非辅助性CPFs，明显超过报道的有效咳嗽阈值160升/分钟(P < 0.001)。此外，通过包括人工呼吸和胸腹推挤（326.4±79.5升/分钟）或通过GPB和胸腹推挤（326.4 ± 87.5升/分钟）吞气法在内的自我辅助而获得的CPFs增加与通过GPB联合独立操纵轮椅产生桌推力而独立获得的CPFs(310.3 ± 74.7升/分钟)没有显著差异(P = 0.07)。
   结论：独立的辅助性（GPB结合桌推力）CPF可以与需要个人辅助完成的吞气法和腹部推挤获得的CPFs相媲美。因此，对于肌营养不良患者，这项物理医学技术和需要自我介入的咳嗽辅助技术都是被强烈推荐的。

 

(林江涛 审校)
Am J Phys Med Rehabil. 2013 Jun 4. [Epub ahead of print]

 

Independent Cough Flow Augmentation by Glossopharyngeal Breathing Plus Table Thrust in Muscular Dystrophy.
 

Bianchi C, Carrara R, Khirani S, Tuccio MC.
 

Abstract
OBJECTIVE: The purpose of the present study was to compare the unassisted cough peak flow (CPF) of patients affected by muscular dystrophy with CPF augmented by various techniques, including maximal depth glossopharyngeal breathing (GPB) combined with a subsequent self-induced thoracic or abdominal thrust.
DESIGN: All of the motorized wheelchair-dependent patients with muscular dystrophy who had previously mastered GPB were trained at home to increase their cough efficacy. This training involved maneuvering their wheelchair against the edge of a specially built table to autonomously produce a thoracic and/or abdominal thrust timed to the opening of the glottis for an independently assisted cough. Both unassisted and variously assisted CPFs were compared.
RESULTS:The 18 patients (17 men/1 woman) with muscular dystrophy, aged 21.1 ± 5.4 yrs, achieved variously assisted CPFs that were significantly higher than the spontaneous CPF (P < 0.001), with assisted CPFs but not unassisted CPFs that significantly exceeded a reported efficacious cough threshold value of 160 liters/min (P < 0.001). Moreover, increases in the CPFs by personal assistance including air stacking by manual resuscitator and thoracoabdominal thrust (326.4 ± 79.5 liters/min) or by GPB and thoracoabdominal thrust (326.4 ± 87.5 liters/min) were not significantly different (P = 0.07) from the CPFs independently attained by GPB plus independently maneuvering a wheelchair for a table thrust (310.3 ± 74.7 liters/min).
CONCLUSIONS: The independently assisted (GPB plus table thrust) CPF was comparable to the CPFs that required personal assistance for air stacking and abdominal thrusts. Therefore, for patients with muscular dystrophy, this physical medicine technique and cough-assisted techniques that require personal intervention are strongly recommended.
 

Am J Phys Med Rehabil. 2013 Jun 4. [Epub ahead of print]