Breathing retraining in chronic obstructive pulmonary disease.
Breathing retraining in chronic obstructive pulmonary disease.
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DOI：
10.1097/00008483-199501000-00004
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发表时间：
1995-01-01
期刊：
影响因子：
--
通讯作者：
Breslin, E H
中科院分区：
文献类型：
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作者：
Breslin, E H
慢性阻塞性肺疾病（COPD）患者中普遍存在呼吸困难等症状。为了减轻慢性阻塞性肺病患者的呼吸困难和提高功能能力，多种康复策略已经被开发出来。在这些策略中，呼吸再训练是常用的。最常见的呼吸保持技术是横膈膜呼吸（DB）和抿嘴呼吸（PLB）。慢性阻塞性肺病以气道阻力增加和弹性后坐力丧失为特征，与呼吸功增加、通气量和储备减少以及呼吸模式改变有关**活动或运动可导致通气量需求进一步增加。在严重COPD患者中，运动导致分钟通气(V)增加，呼吸速率（RR）增加，而潮气量（VT）可能保持不变。尽管COPD患者运动期间通气-灌注不平等和氧气扩散可能不会改变，但气体交换减少与混合静脉PaO2减少和呼吸肌肉泵对代谢需求增加的反应不足有关。慢性阻塞性肺病患者的运动导致呼吸肌改变，增加胸腔和副肌补充所需的呼吸肌工作，“腹肌收缩”，通气时呼吸肌容量减少，呼吸不同步“，RR和吸气时间-总呼吸周期时间比或占空比（T/Tror）增加。”通过改变胸腔几何形状和呼吸肌长度-张力关系，运动中的空气捕获会导致功能性残余容量的增加，从而降低发力能力。在严重慢性阻塞性肺病患者运动时，吸气时腹部向内运动的矛盾呼吸模式也被观察到。**与通常通过初级呼吸肌收缩维持通气的健康受试者不同，重度COPD患者可能使用上胸、肩带和颈部肌肉进行呼吸，休息时膈肌收缩有限或不存在。**肺功能和肺体积的改变可调节肺的内在特征和功能
LL kkkkkk symptoms, such as dyspnea, are pervasive in the large, growing population of patients with chronic obstructive pulmonary disease (COPD). To reduce dyspnea and increase functional capacity in patients with COPD, multiple rehabilitation strategies have been developed. Among these strategies, breathing retraining is frequently employed. The most common techniques of breathing retaining are diaphragmatic breathing (DB) and pursed lip breathing (PLB). Chronic obstructive pulmonary disease, which is characterized by an increase in airway resistance and loss of elastic recoil," is associated with an increase in work of breathing, a reduction in ventilatory capacity and reserve, and an alteration in the pattern of breathing** Activity or exercise leads to a further increase in ventilatory demand. In patients with severe COPD, ex-ercise results in an increase in minute ventilation (V), with an increase in respiratory rate (RR), while tidal volume (VT) may remain unchangedº Although ventila-tion-perfusion inequality and oxygen diffusion may not be altered during exercise in COPD, º gas exchange is re-duced in association with a decrease in mixed venous PaO2 and inadequate respiratory muscle pump response to the increase in metabolic demand.” Exercise in patients with COPD leads to respira-tory muscle changes, an increase in the work required of the respiratory muscles with rib cage and accessory muscle recruitment," abdominal muscle contraction,” a reduction in respiratory muscle capacity in ventila-tion, breathing dyssynchrony"" and an increase in RR and inspiratory time-total respiratory cycle time ratio or duty cycle (T/Tror)." Air trapping with exercise leads to a rise in functional residual capacity" with alterations in thorax geometry and respiratory muscle length-tension relationships, which reduces force generation capacity. Paradoxical breathing patterns with inward movement of the abdomen during inspiration also are observed in patients with severe COPD during exercise.** Unlike healthy subjects who generally maintain ventilation with contraction of primary respiratory muscles, patients with severe COPD may breathe with muscles of the upper thorax, shoulder girdle, and neck muscles, and with limited or absent diaphragm contraction at rest.** Alterations in pulmonary function and lung vol-umes moderate the intrinsic characteristics and func-