IPPB-assisted coughing in neuromuscular disorders
IPPB-assisted coughing in neuromuscular disorders
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DOI：
10.1002/ppul.20406
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发表时间：
2006-06-01
影响因子：
3.1
通讯作者：
Mellies, Uwe
中科院分区：
文献类型：
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作者：
Dohna-Schwake, Christian;Ragette, Regine;Mellies, Uwe
在神经肌肉疾病中，咳嗽峰值流量 (PCF) 减少被认为会增加肺炎或慢性肺不张等呼吸道并发症的风险。描述了改善 PCF 的不同方法。然而，这些研究主要在成人中进行，关于这些方法在呼吸肌无力儿童中的使用和疗效的信息有限。本研究的目的是调查间歇性正压呼吸 (IPPB) 装置的过度吹气是否能有效缓解儿科患者的咳嗽症状。对 29 名患有各种神经肌肉疾病的学童进行了肺活量测定（用力吸气肺活量；FIVC；1 秒用力呼气量，FEV1）、呼吸肌压力（吸气峰值压力，PIP；呼气峰值压力，PEP）和 PCF。单独教授 IPPB 辅助的过度吹气以将肺容量（最大吹气能力，MIC）增加到 FIVC 以上。记录了过度吹气对咳嗽流量峰值的影响。在 28/29 名患者中，IPPB 辅助的过度吹气将 FIVC 从 0.68 +/- 0.40 I 增强至 MIC 1.05 +/- 0.47 I (P < 0.001)。无辅助 PCF 为 119.0 +/- 57.7 I/min，27/29 名患者增加至 194.5 +/- 74.9 I/min (P < 0.001)。这种效果在年轻患者（6-10 岁）和老年患者（年龄 > 10 岁）中相似。肺容量从 FIVC 到 MIC 的增加与 PCF 的增加相关（R = 0.42，P < 0.05）。 IPPB 辅助的过度吹气可改善儿科神经肌肉疾病的 PCF。结果表明，该技术可用于改善气道分泌物的清除，从而降低 NMD 儿童的呼吸道疾病发病率。
In neuromuscular disorders, reduced peak cough flows (PCFs) are considered to increase the risk of respiratory complications such as pneumonia or chronic atelectasis. Different methods were described to improve PCF. However, these studies were primarily carried out in adults, and there is limited information regarding the use and efficacy of these methods in children with respiratory muscle weakness. The aim of this study was to investigate whether hyperinsufflation with an intermittent positive-pressure breathing (IPPB) device is effective in cough augmentation in pediatric patients. Spirometry (forced inspiratory vital capacity; FIVC; forced expiratory volume in 1 sec, FEV1), respiratory muscle pressures (peak inspiratory pressure, PIP; peak expiratory pressure, PEP), and PCF were measured in 29 schoolchildren with various neuromuscular disorders. IPPB-assisted hyperinsufflation was taught individually to increase lung volumes (maximum insufflation capacity, MIC) above FIVC. The impact of hyperinsufflation on peak cough flow was documented. In 28/29 patients, IPPB-assisted hyperinsufflation enhanced FIVC from 0.68 +/- 0.40 I to an MIC of 1.05 +/- 0.47 I (P < 0.001). Unassisted PCF was 119.0 +/- 57.7 I/min, and increased to 194.5 +/- 74.9 I/min (P < 0.001) in 27/29 patients. This effect was similar in young patients (ages 6-10 years) and older patients (aged > 10 years). Augmentation of lung volumes from FIVC to MIC correlated with an increase of PCF(R = 0.42, P < 0.05). IPPB-assisted hyperinsufflation improves PCF in pediatric neuromuscular disorders. The results suggest that this technique can be used to improve clearance of airway secretions and therefore reduce respiratory morbidity in children with NMD.