Abdel Kafi S, Leduc D, Sergysels R, Ninane V
Service de Pneumologie et de Soins Intensifs, CHU Saint-Pierre, Bruxelles, Belgique.
Rev Mal Respir. 2005 Feb;22(1 Pt 1):93-101. doi: 10.1016/s0761-8425(05)85440-3.
Expiratory flow limitation (EFL) is a characteristic feature of chronic obstructive pulmonary disease (COPD) and leads to dynamic hyperinflation (DH) which is a major source of dyspnoea, particularly during exercise.
A new technique for the detection of EFL, based on manual compression of the abdomen (MCA), was assessed both in normal subjects and patients with COPD. MCA was always associated with a moderate increase in pleural pressure and allowed the detection of EFL in a reproducible manner, in both the seated and supine postures. The technique was well tolerated. It was also a reliable method for the detection of EFL during exercise since EFL detection was effectively associated with the development of DH. Finally, MCA was also compared to NEP in patients with obstructive sleep apnoea syndrome (OSAS) and in these patients, MCA invariably increased expiratory flow whereas the NEP method produced flow limitation in some cases because of upper airway collapse.
EFL detection with MCA may be clinically useful since EFL is a determinant of dyspnoea, affects ventilatory response to exercise as well as maximum exercise capacity.
MCA is a reliable technique for the detection of EFL in different positions, during resting breathing or exercise, requiring neither special equipment nor patient cooperation.
呼气流量受限（EFL）是慢性阻塞性肺疾病（COPD）的一个特征性表现，并导致动态肺过度充气（DH），而动态肺过度充气是呼吸困难的主要来源，尤其是在运动期间。
一种基于手动按压腹部（MCA）检测EFL的新技术，在正常受试者和COPD患者中均进行了评估。MCA总是与胸膜压力适度增加相关，并能以可重复的方式在坐姿和仰卧位检测到EFL。该技术耐受性良好。它也是运动期间检测EFL的可靠方法，因为EFL检测与DH的发生有效相关。最后，在阻塞性睡眠呼吸暂停综合征（OSAS）患者中，还将MCA与食管压力描记法（NEP）进行了比较，在这些患者中，MCA总是能增加呼气流量，而NEP方法在某些情况下由于上气道塌陷会产生流量受限。
由于EFL是呼吸困难的一个决定因素，影响对运动的通气反应以及最大运动能力，因此用MCA检测EFL可能具有临床实用性。
MCA是一种可靠的技术，可在不同体位、静息呼吸或运动期间检测EFL，既不需要特殊设备，也不需要患者配合。
