对完全瘫痪患者采用空气挤压及腹部挤压辅助患者咳嗽
2014/07/15
摘要
试验设计：横断面研究。
目的：评估采用空气挤压（AS）辅助吸气与腹部挤压（AC）辅助呼气的方法辅助患者咳嗽的效果，患者均接受美国脊椎损伤学会损伤量表（AIS）评估。
背景：智利大型三级医院。
方法：检测以下四种不同干预措施下的咳嗽峰速（PCF）:自主用力的最大呼气量（MEE）;通过AC能达到的MEE（MEE-AC）；通过AS（人工呼吸气囊）辅助呼吸后产生的MEE（AS-MEE）；同时使用AS及AC后产生的MEE（AS-MEE-AC）。
结果：本研究共纳入15例完全瘫痪的住院患者（C4-C6），中位年龄33岁（15－56岁）。MEE组、MEE-AC组、AS-MEE组及AS-MEE-AC组患者的PCF分别为183±90 L/min、273±119 L/min、278±106 L/min和368±129 L/min。MEE-AC组及AS-MEE组的PCF与MEE组存在显著差异（P=0.0001）。但是，此差异在AS-MEE-AC组最明显（P=0.00001）。
结论：脊髓损伤（SCI）患者存在咳嗽功能不足，是导致呼吸系统并发症的危险因素之一。联合治疗（AS-MEE-AC）可使患者PCF接近正常。该方法成本低、简便易操作，可应用于所有瘫痪患者。
（刘国梁 审校）
Spinal Cord. 2014 May;52(5):354-7. doi: 10.1038/sc.2014.19. Epub 2014 Mar 11.
Use of air stacking and abdominal compression for cough assistance in people with complete tetraplegia.
Torres-Castro R1, Vilaró J2, Vera-Uribe R3, Monge G4, Avilés P4, Suranyi C4.
ABSTRACT
STUDY DESIGN:Cross-sectional.
OBJECTIVE:To assess cough using air stacking (AS) to assist inspiratory volume with abdominal compression (AC) during expiration in patients with American Spinal Injury Association Impairment Scale (AIS) A.
SETTING:Large tertiary hospital in Chile.
METHODS:Peakcough flow (PCF) was measured during four different interventions: spontaneous maximal expiratory effort (MEE); MEE while receiving AC (MEE-AC); MEE after AS with a manual resuscitation bag (AS-MEE); and MEE with AS and AC (AS-MEE-AC).
RESULTS:Fifteen in-patients with complete tetraplegia (C4-C6) were included. Median age was 33 years (16-56). PCF during the different interventions was PCF for MEE was 183±90 l min(-1); PCF for MEE-AC was 273±119 l min(-1); PCF for AS-MEE was 278±106 l min(-1) and PCF for AS-MEE-AC was 368±129 l min(-1). We observed significant differences in PCF while applying MEE-AC and AS-MEE compared with MEE (P=0.0001). However, the difference in PCF value was greater using the AS-MEE-AC technique (P=0.00001).
CONCLUSION:Patients with spinal cord injury (SCI) presented an ineffective cough that constitutes a risk factor for developing respiratory complications. The application of combined techniques (AS-MEE-AC) can reach near normal PCF values. This is a low-cost, simple and easily applied intervention that could be introduced to all patients with tetraplegia.
Spinal Cord. 2014 May;52(5):354-7. doi: 10.1038/sc.2014.19. Epub 2014 Mar 11.
