Forced Inspiratory Flow Volume Curve in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Objective: Obstructive sleep apnea-hypopnea syndrome (OSA) is a disease of obstructive apnea or hypopnea caused by a repeated partial or complete collapse of the upper airway during sleep. The inspiratory part of the flow-volume curve (F-V curve) can be used as an auxiliary means to evaluate upper airway obstruction in adults. This study is to evaluate the ability of the F-V curve to predict the OSA and explore inspiratory indicators related to airway obstruction during sleep. Methods: There were 332 patients included in this cross-sectional study, who were accompanied by snoring, daytime sleepiness and other symptoms, with suspicion of OSA. According to the nocturnal polysomnography, the subjects were distributed into mild to moderate OSA group, severe OSA group and non-OSA group. A pulmonary function test was used to collect the subjects’ spirometry and F-V curves. Results: There was no significant difference in a variety of indices derived from the F-V curve between OSA and normal subjects, including 25% inspiratory flow rate, middle inspiratory flow rate, 75% inspiratory flow rate, peak flow rate, and forced inspiratory flow rate in the first second. The pulmonary function parameters were significantly correlated with the weight, age and sex of the subjects. Conclusion: These findings suggest that the inspiratory curve of pulmonary function cannot evaluate the upper airway abnormalities in patients with obstructive apnea-hypopnea syndrome.

Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery:A systematic review and meta-analysis

BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,but it can prolong mechanical ventilation time,intensive care unit(ICU)stay,and postoperative hospitalization for patients.Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time,length of ICU stay,and duration of postoperative hospitalization after cardiac surgery.METHODS A literature search of PubMed,Web of Science,Cochrane Library,EMBASE,China National Knowledge Infrastructure,WanFang,and the China Science and Technology journal VIP database was performed on April 13,2022.The data was independently extracted by two authors.The inclusion criteria were:(1)Randomized controlled trial;(2)Accessible as a full paper;(3)Patients who received cardiac surgery;(4)Preoperative inspiratory muscle training was implemented in these patients;(5)The study reported at least one of the following:Mechanical ventilation time,length of ICU stay,and/or duration of postoperative hospitalization;and(6)In English language.RESULTS We analyzed six randomized controlled trials with a total of 925 participants.The pooled mean difference of mechanical ventilation time was-0.45 h[95%confidence interval(CI):-1.59-0.69],which was not statistically significant between the intervention group and the control group.The pooled mean difference of length of ICU stay was 0.44 h(95%CI:-0.58-1.45).The pooled mean difference of postoperative hospitalization was-1.77 d in the intervention group vs the control group[95%CI:-2.41-(-1.12)].CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery.More high-quality studies are needed to confirm our conclusion.

Determinants of inspiratory muscle function in healthy children

Background: Children are affected by disorders that have an impact on the respiratory muscles. Inspiratory muscle function can be assessed by means of the noninvasive tension–time index of the inspiratory muscles(TTImus). Our objectives were to identify the determinants of TTImus in healthy children and to report normal values of TTImus in this population.Methods: We measured weight, height, upper arm muscle area(UAMA), and TTImusin 96 children aged 6–18 years. The level and frequency of aerobic activity was assessed by questionnaire.Results: TTImuswas significantly lower in male subjects(0.095 ± 0.038, mean ± SD) compared with female subjects(0.126 ± 0.056)(p = 0.002).TTImus was significantly lower in regularly exercising(0.093 ± 0.040) compared with nonexercising subjects(0.130 ± 0.053)(p < 0.001). TTImus was significantly negatively related to age(r =-0.239, p = 0.019), weight(r =-0.214, p = 0.037), height(r =-0.355, p < 0.001), and UAMA(r =-0.222, p = 0.030). Multivariate logistic regression analysis revealed that height and aerobic exercise were significantly related to TTImus independently of age, weight, and UAMA. The predictive regression equation for TTImus in male subjects was TTImus = 0.228-0.001 × height(cm), and in female subjects it was TTImus = 0.320-0.001 × height(cm).Conclusion: Gender, age, anthropometry, skeletal muscularity, and aerobic exercise are significantly associated with indices of inspiratory muscle function in children. Normal values of TTImus in healthy children are reported.

Nikethamide affects inspiratory neuron discharge in the nucleus retrofacialis medial region in brain slices from neonatal rats

BACKGROUND： Nikethamide, a respiratory center stimulant, is widely used in China. However, its effects on the central nervous system and medullary respiratory center remain poorly understood. OBJECTIVE： To investigate the influence of nikethamide on inspiratory neuron discharge in the medial region of the nucleus retrofacialis in neonatal rats, based on the observations addressing rhythmic respiratory discharge generated by the basic medullary respiratory center and various respiration neuron discharges in brain slices. DESIGN, TIME AND SETTING： A controlled, observational study utilizing in vitro neuroelectrophysiology was performed at the Department of Physiology in Southern Medical University between September and December in 2007. MATERIALS： Nikethamide was purchased from Sigma, USA; BL-420E biological signal collection and manaclement system was provided by Chengdu TME Technology, China.METHODS： Isolated medulla-spinal cord preparations were collected from neonatal Sprague Dawley rats, aged 1-3 days. Tissues were divided to include the medial region of the nucleus retrofacialis, ventral respiratory, and dorsal respiratory groups. Subsequently, modified Kreb＇s solution and 5 μg/mL nikethamide-containing modified Kreb＇s solution were consecutively perfused into the medial region of the nucleus retrofacialis in neonatal rat brain slices. MAIN OUTCOME MEASURES： Hypoglossal nerve root respiratory-related rhythmic discharge activities and inspiratory neuron discharges were recorded with an adsorption electrode and microelectrode. RESULTS Nikethamide resulted in prolonged inspiratory neuron discharge time, shortened respiratory cycle and expiratory time. Nikethamide intervention resulted in enhanced integral amplitude of some inspiratory neurons with no changes in discharge frequency or increased discharge frequency in remaining inspiratory neurons with no changes in integral amplitude. CONCLUSION： Nikethamide excites inspiratory neurons in the basic rhythmic respiration and medullary respiratory center, in addition to increased inspiratory neuron and neural network excitability.

Predicting maximum voluntary ventilation in normal healthy individuals using indirect inspiratory muscle strength measurements: a correlation study

Maximum Voluntary Ventilation (MVV), one of the components of Pulmonary Function Testing (PFT), has multiple uses. Various factors including the inspiratory muscle strength (IMS) influence its magnitude. Our aim was to quantify the IMS indirectly using an economical and non invasive bedside assessment tool, determine its association with MVV and then develop a predictive equation for MVV. 41 healthy non-athletic physical therapy students participated in the study. IMS measurement was performed with a sphygmomanometer. Average of the three net deflections in sphygmomanometer following deepest possible breaths was taken as indirect measurement of IMS in mm of Hg. MVV was measured according to ATS guidelines using a spirometer. Results from the data analysis revealed a significant correlation between IMS and MVV(r = 0.83, p < 0.001) and the coefficient of determination = 0.68. So, we developed a regression equation: Y = 1.9669(X) + 49.838 with SEE: 13.02L/min and ANOVA for the equation was (F=68.9, p < 0.001). Hence, it can be concluded that a strong correlation between the indirect IMS and MVV was established and a predictive equation to estimate MVV was developed. This equation proved to have a high predictive value with a small error of estimation. This indicates that the value of the indirect IMS measurement obtained using the sphygmomanometer can be used to estimate MVV in normal healthy individuals without the use of a conventional spirometer.

Reduction in pulmonary complications in high risk patients undergoing surgery for total hip replacement under general anesthesia by preoperative intensive inspiratory muscle training:A randomized controlled clinical trial

Objective： To evaluate the effects of preoperative inspiratory muscle training （IMT） on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hip replacement surgery under general anesthesia. Methods： Thirty two high-risk patients undergoing elective total hip replacement surgery under general anesthesia were chosen from Nanjing Medical University, Affiliated Nanjing First Hospital. In this single-blind randomized controlled clinical triM, patients were randomly assigned to receive preoperative inspiratory muscle training or conventional treatment （CT）. The major effectiveness outcome variables were atelectasis and duration of postoperative hospitalization. Results： Both groups were comparable prior to surgery. Seven patients in the CT group and 3 in the IMT group developed atelectasis （P = 0.25）. Median duration of postoperative hospitalization was 13 days （range, 10～17 days） in the IMT group versus 16 days （range, 11～23 days） in the CT group （Mann- Whitney U statistics, Z = -2.22, P = 0.03）. Mean postoperative inspiratory pressure was 5% higher in the IMT group. Conclusion： Preoperative intensive inspiratory muscle training appears to reduce the incidence of atelectasis and duration of postoperative hospitalization in patients at high risk of developing postoperative pulmonary complications who were scheduled for elective total hip replacement surgery under general anesthesia.

The impact of inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure patients:a meta-analysis

Objective:To systematically evaluate the therapeutic effects of inspiratory muscle training(IMT)on cardiopulmonary functions in patients with heart failure.Methods:PubMed,EMbase,the Cochrane Library,Web of Science,CBM,WanFang Data,VIP,and CNKI databases were searched to collect randomized controlled trials about the effects of IMT on cardiopulmonary function in patients with heart failure.Meta-analysis was performed using RevMan 5.3 software after two researchers independently screened the literatures,extracted the data,and evaluated the risk of bias.Results:A total of 20 articles with 1,415 patients were included.Meta-analysis showed that IMT was able to increase the 6-minute walking distance(mean difference(MD)=59.41,95%confidence interval(CI)(51.02–67.80),P<0.001)and maximum inspiratory pressure(MD=15.59,95%CI(12.96–18.21),P<0.001)in patients with heart failure compared with the control group.But there was no statistical difference in peak oxygen uptake(MD=1.37,95%CI(?0.57–3.30),P=0.17),first second forced expiratory volume(MD=?5.79,95%CI(?12.23–0.65),P=0.08)and forced vital capacity(MD=?0.45,95%CI(?6.39–5.49),P=0.88)between the control and the experimental group.Conclusion:Available evidence suggested that IMT seemed to be a useful strategy for improving exercise capacity and inspiratory muscle strength in heart failure patients.Limited by the quantity and quality of the included studies,the above conclusions need to be verified by more high-quality studies.

Prolonged Intermittent Running Induces Inspiratory-Muscle Fatigue in Female Runners

Inspiratory-muscle fatigue （IMF） may occur after long-duration or continuous short-duration exercise and may limit exercise performance. Daily athletics training is often intermittent, but it is unclear if intermittent running induces IMF. We investigated IMF after a maximal anaerobic running test （MART） and maximal intermittent graded exercise test. Nine female middle-distance （400 or 800 m） runners performed MART and maximal intermittent graded exercise tests. Maximal inspiratory pressure （MIP） was measured before and after each test using a portable autospirometer. There was no significant difference in mean MIPs before （105 ± 24 cm H2O） and after （104 ± 28 cm H2O） the MART （P = 0.95, effect size [ES] as partial η2 = 0.01）. Mean M IP after the maximal intermittent graded exercise test （97 ± 26 cm H2O） was lower than before exercise （105 ± 27 cm H2O） （P = 0.01, 1]2 = 0.83） Mean IMF was higher for the maximal intermittent graded exercise test （8.5 ± 4.2 cm H2O） than for the MART （0.8 ± 4.1 cm H2O） （P = 0.01, ES as Cohen＇s d = 1.88）. IMF occurs after relatively long-duration intermittent running exercise. Coaches may consider recommending inspiratory-muscle training or warm-up to reduce IMF resulting from relatively long-duration intermittent running exercise.

机械性吸呼仪参数设置对模拟肺呼气峰流速、呼气容量的影响研究

目的:探讨使用机械性吸呼仪(mechanical in-exsufflation,MIE)治疗中的吸气压力设置参数(set inspiratory pressure,SIP)、呼气压力设置参数(set expiratory pressure,SEP)及SIP/SEP对模拟肺呼气峰流速(peak expiratory flow,PEF)和呼气容量(expiratory volume,EV)的影响,以为临床治疗中增强气道廓清的效果提供参考。方法:将MIE与模拟肺连接,在模拟肺无自主呼吸状态下分别针对健康成人、肺部感染成人、慢性阻塞性肺疾病成人、急性呼吸窘迫综合征成人设置气道阻力及肺顺应性。MIE压差(SIP与SEP的差值)分别设置为60、40、30 cmH_(2)O(1 cmH_(2)O=98.06 Pa),在固定压差下,SIP/SEP设置为1∶1、1∶2、2∶3。在每种参数设置状态下,MIE均工作5个周期,记录PEF、EV的平均值。分析MIE治疗中PEF的出现时间,对比不同参数设置下PEF、EV的平均值,并分析SIP及SEP分别与PEF、EV的相关性。采用SPSS 20.0统计学软件进行数据分析。结果:模拟肺在不同生理条件下,MIE治疗中的PEF均出现在呼气初始,当压力释放的瞬间产生最大的PEF。MIE设置的压差越大,产生的PEF、EV越大;在压差相同情况下,SIP/SEP为1∶1时产生的PEF、EV最大。SIP与PEF、EV的斯皮尔曼相关系数为0.919、0.990,SEP与PEF、EV的斯皮尔曼相关系数为-0.737、-0.674,SIP与PEF、EV的相关性高于SEP与PEF、EV的相关性。结论:MIE治疗中设置压差越大,产生的气道廓清效果越好;在压差相同情况下,将SIP/SEP设置为1∶1,能够产生咳嗽效应的最大化,从而增强气道廓清的效果。

吸气肌训练对支气管哮喘患者肺功能影响的Meta分析

目的:系统评价吸气肌训练对支气管哮喘(哮喘)患者肺功能的影响。方法:计算机检索PubMed、Cochrane Library、EMBASE、中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、维普网(VIP)等数据库,查找自建库至2023年7月关于吸气肌训练对哮喘患者肺功能影响的随机对照试验。两名研究人员独立筛选文献、提取资料,按照Cochrane手册评价纳入文献的偏倚风险,然后采用RevMan 5.3软件进行Meta分析。结果:共纳入7篇文献,包括229例受试者。Meta分析结果显示:与对照组相比,吸气肌训练能有效地改善用力肺活量占预计值百分比[MD=10.86,95%CI(4.34,17.38),P=0.001]、呼气峰流速[MD=98.47,95%CI(71.76,125.19),P<0.00001]、和最大呼气压[MD=21.67,95%CI(5.50,37.85),P=0.0009],但对第一秒用力呼气容积占预计值百分比[MD=4.51,95%CI(-3.55,12.56),P=0.27]、一秒率[MD=-2.70,95%CI(-18.71,13.30),P=0.74]的改善情况与对照组相比,差异无统计学意义。干预时长大于8周的吸气肌训练组最大吸气压显著高于对照组[MD=16.25,95%CI(5.62,26.88),P=0.003];干预时长小于8周,2组间差异无统计学意义[MD=36.51,95%CI(-0.62,73.64),P=0.05]。结论:吸气肌训练能有效改善哮喘患者的呼吸肌肌力,且对肺通气功能部分指标有明显提高。

慢性心力衰竭患者肺康复训练的证据总结

目的:检索并获取慢性心力衰竭患者肺康复训练的相关证据,并对证据进行总结,为临床实践提供依据。方法:遵循“6S”模型,检索国内外数据库中有关慢性心力衰竭患者肺康复训练的相关证据,根据相关文献评价标准进行文献质量评价并提取证据。结果:共纳入文献17篇,包括指南3篇、专家共识4篇、系统评价10篇,最终总结了19条慢性心力衰竭患者肺康复训练的证据。结论:本研究归纳了关于慢性心力衰竭患者肺康复训练的证据,可以为临床开展肺康复训练提供循证依据,在实施过程中,应综合评估患者的身心状况,结合临床情景及患者意愿,遵循个体化原则,将证据审慎应用于临床实践。

肌肉压力指数与压力支持模式下吸气努力水平的相关性研究:基于ASL5000平台

目的通过主动模拟肺(ASL5000)模拟吸气努力,评价肌肉压力指数(pressure muscle index,PMI)与反映吸气努力水平指标包括吸气肌肉呼吸做功比例(percent of inspiratory muscle work of breathing,WOBmus%)和吸气肌肉压力-时间积分比例(percent of inspiratory muscle pressure time product,PTPmus%)之间的相关性。方法基于ASL5000平台进行实验设计,模拟50个不同肺模型参数以及25个不同的压力支持(pressure support,PS)水平,共模拟1250例具有不同自主呼吸水平的患者。通过软件对采集到的流速、气道压和食道压-时间波形数据进行线下分析。使用Spearman相关性分析对PMI和WOBmus%、PTPmus%进行分析。结果不同PMI分组患者之间的PS水平、WOBmus%和PTPmus%差异均有统计学意义。并且随着PMI数值增加,PS水平以及驱动压力逐步下降,呼吸机做功也随之减小。PMI与WOBmus%的Spearman相关系数为0.874(P<0.001),PMI与PTPmus%的Spearman相关系数为0.875(P<0.001)。结论PMI与WOBmus%、PTPmus%之间具有良好相关性,PMI可能是指导PS水平设置的一种无创、有效的指标。关于PMI在不同临床情境下的适用性,及其指导PS水平设置的有效性,未来需要更多的研究进行调查。

Synchronization of two electrically coupled inspiratory pacemaker neurons

Synchronization is considered to be a crucial mechanism that maintains respiratory rhythm.For understanding the effect of electrical coupling on the transition of the firing patterns and synchronization,we coupled two inspiratory pacemaker neurons together,and studied various synchronous behaviors between them.We firstly compared the bifurcation diagrams between the coupled neurons and single neuron,and found that the coupled neurons had a more complicated bifurcation mode.By increasing the coupling strength,the regular variation of phase differences was illustrated so that asynchronous and some synchronous states could be observed.These synchronous states were also shown in detail by phase portraits and firing series.In addition,we explored the ranges of different synchronous states,which attributed to different ranges of membrane capacitance and coupling strength.

六字诀联合吸气肌训练对颈髓损伤患者功能恢复的影响

目的探讨六字诀联合吸气肌训练对颈髓损伤患者功能恢复的影响。方法选取2022年1月至2023年7月于康复医学科就诊的42例颈髓损伤患者,将其按随机数字表法分为干预组和对照组,每组21例。2组均进行常规康复训练,对照组在常规康复训练基础上,增加吸气肌抗阻训练;干预组在对照组基础上,增加六字诀气功锻炼。2组均接受4周的康复干预,治疗前后对患者吸气肌功能[最大吸气压(MIP)、吸气峰流速(PIF)]、神经功能(脊髓损伤神经学分类国际标准第7版)和日常生活能力(MBI,改良Barthel指数量表)进行评估。结果治疗后,2组MIP、PIF、运动评分均优于治疗前(P<0.05);干预组轻触觉评分、针刺觉评分、MBI评分优于治疗前(P<0.05),而对照组则差异无统计学意义(P>0.05)。治疗后,干预组MIP、PIF、运动评分、MBI评分优于对照组(P<0.05);2组轻触觉评分及针刺觉评分比较差异无统计学意义(P>0.05)。结论在常规康复的基础上,与单独的吸气肌训练相比,六字诀联合吸气肌训练对改善颈髓损伤患者的吸气肌功能、运动功能和日常生活能力更为明显,也更有利于患者的整体康复。

有限资源下创新性吸气肌训练方案对心脏瓣膜疾病患者术后肺部并发症的影响

目的:探究有限资源下匹配中国心脏瓣膜疾病患者术前等待时间的强化吸气肌训练方案对预防术后肺部并发症的有效性和可行性。方法:以择期心脏瓣膜手术患者为研究对象,随机分为对照组和干预组,每组各65例。所有入组患者术前均接受常规物理治疗干预方案,干预组额外增加术前3天的强化吸气肌训练。术后14天内,对所有患者进行术后并发症发生率的记录,在入院和出院当天对所有患者进行呼吸功能和运动能力测试,并统计患者术后住院时长。结果:治疗前两组患者一般人口学特征无显著性差异。经术前3天强化吸气肌训练后,干预组术后肺部并发症(postoperative pulmonary complications,PPCs)发生率低于对照组(P=0.03),出院时6min步行距离高于对照组(P=0.01),而出院时的肺功能与术后住院时间与对照组比较无显著性差异(P>0.05),训练期间无任何不良事件发生。结论:术前3天强化吸气肌训练方案在择期心脏瓣膜患者中是安全可行的,能够减少术后肺部并发症的发生和改善患者出院时的运动功能水平。

自动挤压控制潮气量的简易呼吸器研制与功能测试

目的研制一种能自动挤压控制潮气量的简易呼吸器并探讨其功能。方法标准测试条件下,将该仪器、呼吸机检测仪和模拟肺通过呼吸管路连接,不同干预措施下对其进行功能测试,记录潮气量、呼吸频率和吸呼比。计量资料采用方差分析或Friedman检验,计数资料采用卡方检验或Fisher精确检验进行比较。最后评估其呼吸参数是否满足性能指标要求,从而验证该仪器主要呼吸参数的准确、使用的安全性和稳定性。结果在标准测试条件下,自动挤压并精准控制潮气量的简易呼吸器设定潮气量、呼吸频率、吸呼比输出的最大误差分别在±15%、±10%、±10%以内,部分常用呼吸参数校准点均有较高的准确性,且操作者通气3 h,呼吸参数数据仍然保持准确且稳定。结论自动挤压并精准控制潮气量的简易呼吸器的呼吸参数数据输出是准确、稳定、可靠的,一定程度上提高了简易呼吸器通气效率,节省操作人力及培训成本。

青年人躯干压力生物反馈与膈肌功能参数的相关性

背景:躯干压力生物反馈被认为是评估核心肌肉力量的一个可靠指标,其不仅能反映个体躯干力量状况,而且与呼吸肌功能有着密切关系。目的:探讨青年人躯干压力生物反馈与膈肌功能之间的相关性。方法:选择上饶师范学院80名大学生为研究对象,男34名,女46名,年龄(19.83±1.45)岁,采用床旁肌骨超声系统测量受试者膈肌厚度和移动度,便携式肺功能检测仪检测受试者最大吸气压,压力生物反馈仪测试受试者俯卧与仰卧位的腰部及腹部压力。采用Pearson或Spearman相关系数确定躯干压力生物反馈与膈肌功能之间的相关程度,多元线性回归分析确定膈肌功能的预测模型。结果与结论:①以性别分组,男子组年龄、身高、体质量、躯干压力生物反馈数值、平静吸气末膈肌厚度、平静呼气末膈肌厚度、平静呼吸膈肌增厚率、深吸气末膈肌厚度、深呼气末膈肌厚度、深吸气膈肌移动度、最大吸气压均大于女子组(P均<0.05);②以体力活动水平分组,久坐组躯干压力生物反馈数值及最大吸气压均低于运动组(P均<0.05);③相关性分析显示,躯干压力生物反馈(俯卧)、躯干压力生物反馈(仰卧)与平静吸气末膈肌厚度、平静呼气末膈肌厚度、平静呼吸膈肌增厚率、深吸气末膈肌厚度、深呼气末膈肌厚度、深呼吸膈肌增厚率、深吸气膈肌移动度、最大吸气压均具有显著性相关关系(P均<0.01);④多元线性回归分析显示,躯干压力生物反馈(俯卧)进入平静吸气末膈肌厚度的预测模型(F=27.228,P<0.001),躯干压力生物反馈(俯卧)进入深吸气末膈肌厚度的预测模型(F=38.615,P<0.001),躯干压力生物反馈(仰卧)、年龄进入深吸气膈肌移动度的预测模型(F=15.408,P<0.001),躯干压力生物反馈(俯卧)、体质量、年龄进入最大吸气压的预测模型(F=22.314,P<0.001);⑤结果显示,躯干压力生物反馈与膈肌厚度、膈肌移动度和最大吸气压的相关性较强,快速简便的躯干压力生物反馈测量可以作为筛查健康青年人膈肌功能的一种方法。

吸气肌压力指数评价低吸气努力的可行性和有效性

目的探索在压力支持通气(pressure support ventilation,PSV)模式下,通过压力监测设备获得肌肉压力指数(reference measurement of inspiratory muscle pressure index on experimental condition,PMIref)和通过呼吸机屏幕获得PMI(simple measurement of PMI from the ventilator,PMIvent)的一致性,PMIvent与吸气努力的相关性,以及PMI评价低吸气努力的预测价值。方法本研究纳入2022年6月至2023年6月间22例使用PSV模式的成年急性呼吸衰竭患者,将压力支持(support pressure,PS)水平从20 cmH_(2)O到2 cmH_(2)O(1 cmH_(2)O=0.098 kPa)进行滴定,每个PS水平进行吸气末保持和呼气末保持,记录流量、气道压和食道压信号,计算PMIref、PMIvent和食道-压力时间乘积(esophageal pressure-time product,PTPes)。采用Bland-Altman检验分析PMIvent与PMIref的一致性,采用决定系数(R^(2))评估PMI与吸气努力之间的相关性,采用受试者工作特征(receiver operating characteristic,ROC)曲线的方法评估PMI检测低努力的诊断效能,根据约登指数确定最佳临界值。结果PMIvent和PMIref之间的残差(95%一致性区间)为0.18(-0.44~0.80)。PMIref和PTPes/min显著相关(患者间R^(2)=0.61,患者内R^(2)=0.80),PMIvent与PTPes/min显著相关(患者间R^(2)=0.62,患者内R^(2)=0.81)。对于临界值PTPes<50 cmH_(2)O·s·min^(-1)时,PMIvent的ROC曲线下面积(area under the curve,AUC)为0.93(0.89,0.96),最佳临界值为-0.77 cmH_(2)O。结论通过呼吸机获得的PMIvent可以有效替代实验条件下测量的PMIref。PMIvent和PMIref都与吸气努力显著相关,具有预测低吸气努力的潜在价值。

术前吸气肌训练对预防二尖瓣介入术患者术后肺部并发症及心肺功能的影响

目的 探究二尖瓣介入术患者进行术前吸气肌训练对预防术后肺部并发症及心肺功能的影响。方法 将需进行二尖瓣介入术患者74例依据随机数字表法分为参照组(37例)、试验组(37例)。参照组术前进行常规干预方案,试验组术前在参照组基础上进行吸气肌训练,均于术前干预5 d。将两组患者术后并发症,术前5 d与术后5 d心功能、肺功能,术前5 d及术后5、10 d世界卫生组织生存质量量表(WHOQOL)、焦虑抑郁量表(HADS)评分进行比较。结果 参照组、试验组术后并发症发生率占21.62%、5.41%,试验组比参照组更低;两组术后5 d左心室血流传播速度相较于术前5 d加快,试验组比参照组更快;左心房容积相较于术前5 d减小,试验组比参照组更小;第1秒用力呼气容积占预计值百分比相较于术前5 d降低,试验组比参照组升高;两组术后5 d最大代谢量、最大摄氧量、最大每搏摄氧量相较于术前5 d增加,试验组比参照组更高;两组术后5、10 d WHOQOL评分相较于术前5 d升高,试验组比参照组更高;HADS评分相较于术前5 d降低,试验组比参照组更低(P<0.05)。结论 二尖瓣介入术患者进行术前吸气肌训练可降低患者术后并发症发生风险,促进心功能恢复,恢复患者肺摄氧能力,提高生活质量,改善其不良情绪。

高强度吸气肌抗阻训练对支气管扩张患者气道黏液分泌及运动耐力的影响研究

目的:探究高强度吸气肌抗阻训练对支气管扩张患者气道黏液分泌及运动耐力的影响。方法:将2021年3月—2023年3月福建省漳州市医院的100例支气管扩张患者根据随机数字表法分为两组,每组50例。对照组进行常规支气管扩张治疗干预,观察组则在对照组的基础上进行高强度吸气肌抗阻训练。比较两组的总有效率、干预前后的排痰量、气道黏液分泌指标(痰液干/湿重及黏度)、运动耐力[6分钟步行试验(6MWT)及心率(HR)]及生存质量[圣乔治呼吸问卷(SGRQ问卷)]。结果:观察组的支气管扩张治疗总有效率显著高于对照组(P<0.05),干预前两组的排痰量、气道黏液分泌指标、运动耐力指标及SGRQ问卷评分比较,差异均无统计学意义(P>0.05),干预3 d、1周后观察组的排痰量均显著多于对照组,干预2周后的排痰量显著少于对照组,干预1周及2周观察组的气道黏液分泌指标均显著低于对照组,6MWT均显著长于对照组,HR及SGRQ问卷评分均显著低于对照组(P<0.05)。结论:高强度吸气肌抗阻训练在支气管扩张患者中的应用效果较好,且可显著改善患者的气道黏液分泌及运动耐力状态,因此在支气管扩张患者中的应用价值相对更高。