Oscillatory positive expiratory pressure treatment in lower respiratory tract infection
Oscillatory positive expiratory pressure treatment in lower respiratory tract infection
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DOI：
10.3892/etm.2018.6552
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发表时间：
2018-10-01
影响因子：
2.7
通讯作者：
Shi, Guochao
中科院分区：
文献类型：
--
作者：
Ni, Yingmeng;Ding, Lin;Shi, Guochao
振荡呼气正压 (OPEP) 装置已被用作传统胸部物理治疗 (CPT) 的辅助治疗，以促进咳嗽能力受损的个体（尤其是患有慢性疾病的个体）呼吸道分泌物的清除。然而，很少有研究关注 OPEP 对下呼吸道感染的有效性。本研究对2016年2月至2017年7月期间在瑞金医院（中国上海）肺科和重症医学科住院的所有下呼吸道感染患者进行了分析。在物理治疗的前7天记录每日痰量和化脓情况。比较接受OPEP的患者和接受机械敲击（MP）的患者CPT前后的氧合指数、二氧化碳分压、白细胞计数、中性粒细胞百分比、C反应蛋白（CRP）和降钙素原（PCT）水平。在 CPT 之前和之后收集痰液。共有 17 名患者接受了 OPEP，10 名患者接受了 MP。经过 7 天的物理治疗后，与 MP 组相比，OPEP 组的体位引流有所改善。 CPT 7天后，接受OPEP的患者也表现出氧合指数显着改善，而MP组的氧合指数没有改善。二氧化碳分压的改善在各组之间没有显着差异。与 MP 组相比，OPEP 组的白细胞计数、中性粒细胞百分比和 CRP 水平也表现出更大的下降。然而，OPEP 组和 MP 组的 PCT 水平下降相似。痰培养结果显示，两组的阴转率都很低。两组的住院结果没有差异。总之，与 MP 相比，OPEP 在下呼吸道感染患者的排痰、改善氧合和减轻炎症状态方面表现出更好的效果；然而，它并没有促进微生物的消除。
Oscillatory positive expiratory pressure (OPEP) devices have been utilized as an adjunct therapy to conventional chest physiotherapy (CPT) to promote the clearance of respiratory secretions in individuals with impaired ability to cough, particularly in chronic diseases. However, few studies have focused on the effectiveness of OPEP in lower respiratory tract infection. In the present study, all patients with lower respiratory tract infections hospitalized in the Department of Pulmonary and Critical Care Medicine, Ruijin Hospital (Shanghai, China) between February 2016 and July 2017 were analyzed. Daily sputum quantity and purulence were recorded on the first 7 days of physiotherapy. Oxygenation index, partial pressure carbon dioxide, white blood cell count, neutrophil percentage, C reactive protein (CRP) and procalcitonin (PCT) levels before and after CPT were compared between patients who received OPEP and patients who received mechanical percussion (MP). Sputum was collected prior to and following CPT. A total of 17 patients received OPEP, while 10 received MP. The OPEP group exhibited improved postural drainage compared with the MP group after 7 days of physiotherapy. After 7 days of CPT, patients who received OPEP also exhibited a significantly improved oxygenation index, while the oxygenation index in the MP group did not improve. The improvement of partial pressure carbon dioxide was not significantly different between groups. The OPEP group also exhibited a greater decrease in white blood cell count, neutrophil percentage and CRP levels, compared with the MP group. However, the decrease in PCT level was similar in the OPEP and MP groups. Sputum culture results revealed that the rate of negative conversion was very low in both groups. There was no difference between the two groups in terms of hospitalization outcomes. In conclusion, OPEP exhibited a greater effectiveness in draining sputum, improving oxygenation and reducing inflammatory status in patients with lower respiratory tract infections compared with MP; however, it did not promote the elimination of microbes.