Toussaint Michel, De Win Harry, Steens Mark, Soudon Philippe
Subacute Respiratory Rehabilitation Unit, Mechanical Ventilation Centre and Neuromuscular Excellency Centre, Vrije University Brussel-Ziekenhuis De Bijtjes, Brussels, Belgium.
Respir Care. 2003 Oct;48(10):940-7.
To determine the effects of intrapulmonary percussive ventilation (IPV) on mucus clearance in tracheostomized Duchenne muscular dystrophy patients.
We studied 8 patients, 5 of whom had mucus hypersecretion (> 30 mL/d). In a randomized, cross-over study we compared assisted mucus clearance techniques with and without IPV. There were 2 treatment sequences and each patient received 5 consecutive days of each treatment sequence, delivered 3 times a day. One sequence consisted of (1) assisted mucus clearance technique (AMCT, which involves forced expiratory technique and manual assisted cough), (2) endotracheal suctioning, (3) nebulizer administration of 5 mL of 0.9% sodium chloride solution for 5 min, (4) a second AMCT session, (5) endotracheal suctioning, (6) 45 min after the end of the nebulizer treatment a third AMCT session, (7) endotracheal suctioning. The other treatment sequence was the same except that it included IPV during the 5-min nebulizer treatment. The collected secretions were weighed. Vital capacity was measured once, before the treatments. Heart rate, respiratory rate, oxyhemoglobin saturation, end-tidal carbon dioxide, airway resistance, and peak expiratory flow were measured before and at 45 min after the treatments. Mean values were compared using analysis of variance with repeated measures.
In patients with hypersecretion the mean +/- SD weight of the collected secretions was significantly higher with IPV (6.53 +/- 4.77 g vs 4.57 +/- 3.50 g, p = 0.01). Heart rate, respiratory rate, oxyhemoglobin saturation, end-tidal carbon dioxide, airway resistance, and peak expiratory flow did not differ statistically between the 2 treatments.
IPV is a safe airway clearance method for tracheostomized Duchenne muscular dystrophy patients, and this preliminary study suggests that IPV increases the effectiveness of assisted mucus clearance techniques.
确定肺内叩击通气（IPV）对气管切开的杜氏肌营养不良患者黏液清除的影响。
我们研究了8例患者，其中5例有黏液分泌过多（>30 mL/天）。在一项随机交叉研究中，我们比较了有和没有IPV的辅助黏液清除技术。有2个治疗序列，每个患者接受每个治疗序列连续5天的治疗，每天进行3次。一个序列包括：（1）辅助黏液清除技术（AMCT，包括用力呼气技术和手动辅助咳嗽），（2）气管内吸痰，（3）雾化吸入5 mL 0.9%氯化钠溶液5分钟，（4）第二次AMCT疗程，（5）气管内吸痰，（6）雾化治疗结束后45分钟进行第三次AMCT疗程，（7）气管内吸痰。另一个治疗序列相同，只是在5分钟的雾化治疗期间包括IPV。对收集的分泌物进行称重。在治疗前测量一次肺活量。在治疗前和治疗后45分钟测量心率、呼吸频率、氧合血红蛋白饱和度、呼气末二氧化碳、气道阻力和呼气峰值流量。使用重复测量的方差分析比较平均值。
在分泌过多的患者中，使用IPV时收集的分泌物的平均±标准差重量显著更高（6.53±4.77 g对4.57±3.50 g，p = 0.01）。两种治疗之间的心率、呼吸频率、氧合血红蛋白饱和度、呼气末二氧化碳、气道阻力和呼气峰值流量在统计学上没有差异。
IPV是气管切开的杜氏肌营养不良患者的一种安全的气道清除方法，这项初步研究表明IPV可提高辅助黏液清除技术的有效性。
