COPD 缓解期患者阈压力负荷吸气肌锻炼的疗效观察

Effects of threshold loading device for inspiratory muscles training in patients with COPD

作者自行研制一种阈压力负荷吸气肌锻炼器，该锻炼器通过弹簧控制吸气瓣开瓣压，压力负荷与弹簧压缩程度成直线关系，故调节方便且基本不受吸气流量的影响。３４例ＣＯＰＤ缓解期患者用４０％最大口腔吸气压（ｍａｘｉｕｍｉｎｓｐｉｒａｔｏｒｙｐｒｅｓｕｒｅ，ＭＩＰ）作为压力负荷，每天用该锻炼器锻炼４０ｍｉｎ，５周后ＭＩＰ由６３７±２１７ｋＰａ（４７９±１６３ｍｍＨｇ）增加到７７９±２４２ｋＰａ（５８６±１８２ｍｍＨｇ），Ｐ＜００１，负荷呼吸时间由１７２４±９０３ｓ延长到２６７９±１５７５ｓ（Ｐ＜００１），常规肺功能指标则无明显变化。２５例对照组上述指标均无明显变化。锻炼组中８例继续锻炼１０周，ＭＩＰ和负荷呼吸时间较锻炼５周时进一步提高；用力肺活量、第一秒用力呼气量和最大通气量也较锻炼前增加。另外８例停止锻炼１０周后各项参数均返回到锻炼前水平。

The physical characters and clinical significance of a threshold loading device for inspiratory muscle training in patients with COPD was reported. The loading was adjustable easily and linearly by the spring which controlled the motion of the inspiratory valve. The loading was so stable that it was hardly affected by flow rate. 34 COPD patients (treatment group) were trained 40min per day for 5 weeks with the device loaded with 40% MIP. The beneficials were as following: (1) MIP raised from 6 37±2 17kPa(47 9±16 3mmHg) to 7 79±2 42kPa(58.6±18.2mmHg) ( P <0 01).(2)The time of loading breathing prolonged from 172.4±90.3s to 267.9±157.5s, P <0 01. There was no change in routine pulmonary function. Oppositely, there was no any change in the control group (25 cases). In the treatment group, 8 cases were trained for additional course of 10 weeks, and the further improvement could be found in MIP and the time of loading breathing. Furthermore, FVC, FEV 1 and MVV also increased significantly. All the beneficials disappeared when other 8 cases discontinued the training for 10 weeks. Author′s address Zhongshan Hospital, Shanghai Medical University, Shanghai, 200032