Stites Steven W, Perry Gayln V, Peddicord Tom, Cox Glen, McMillan Chris, Becker Brian
Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Mail Stop 3007, Kansas City, KS 66160, USA.
Chest. 2006 Mar;129(3):712-7. doi: 10.1378/chest.129.3.712.
High-frequency chest wall oscillation (HFCWO) has been shown to be as effective as standard chest physiotherapy (SCPT) for removal of pulmonary secretions as well as increasing FEV(1) in cystic fibrosis (CF) patients. Patients using HFCWO often administer aerosolized medications simultaneously, reducing time required for daily care. While peripheral pulmonary distribution of tracer in normal subjects has been shown to be unaffected by HFCWO, this has not been studied in CF patients. We evaluated distribution of aerosolized (99m)Tc diethylene triamine penta-acetic acid (DTPA) administered simultaneously with HFCWO and compared this with DTPA aerosolized after SCPT.
Ten CF patients, ages 22 to 38 years, with moderate-to-severe obstructive disease were studied in a crossover design after documentation of stable lung function. (133)Xe was administered to delineate total lung volume. DTPA was aerosolized (Pari LC Plus nebulizer and Pulmo-Aide compressor; Pari Respiratory Equipment Inc.; Richmond, VA) to delineate airway deposition. The central to peripheral deposition ratio (C/P ratio) of each lung was analyzed in each study group. Central regions were represented by the inner one third of the (133)Xe scan as demonstrated in previous research models.
The mean C/P ratio (+/- SD) for both lungs was 1.45 +/- 0.31 with HFCWO and 1.46 +/- 0.28 following SCPT (p = not significant [NS]). Right lung mean C/P ratio was 1.74 +/- 0.43 with HFCWO and 1.85 +/- 0.63 after SCPT (p = NS). Left lung mean C/P ratio was 1.25 +/- 0.29 with HFCWO and 1.21 +/- 0.35 after SCPT (p = NS). There was no correlation between C/P ratio and FEV(1) or FVC.
Use of HFCWO in combination with aerosolized DTPA did not result in increased central deposition as compared with aerosolized DTPA administered after SCPT. Further study is required to determine if combining HFCWO with aerosolized medications can be modified to improve peripheral deposition.
高频胸壁振荡（HFCWO）已被证明在清除囊性纤维化（CF）患者肺部分泌物以及提高第一秒用力呼气容积（FEV₁）方面与标准胸部物理治疗（SCPT）效果相当。使用HFCWO的患者通常会同时雾化吸入药物，从而减少日常护理所需时间。虽然正常受试者中示踪剂的外周肺分布不受HFCWO影响，但尚未在CF患者中进行研究。我们评估了与HFCWO同时给予的雾化（⁹⁹ᵐTc）二乙烯三胺五乙酸（DTPA）的分布情况，并将其与SCPT后雾化的DTPA进行比较。
对10名年龄在22至38岁、患有中度至重度阻塞性疾病的CF患者进行交叉设计研究，研究前记录其稳定的肺功能。给予（¹³³）Xe以描绘肺总量。雾化吸入DTPA（使用Pari LC Plus雾化器和Pulmo - Aide压缩机；Pari呼吸设备公司；弗吉尼亚州里士满）以描绘气道沉积。在每个研究组中分析每个肺的中央与外周沉积比（C/P比）。如先前研究模型所示，中央区域由（¹³³）Xe扫描的内三分之一表示。
HFCWO时双肺的平均C/P比（±标准差）为1.45±0.31，SCPT后为1.46±0.28（p =无显著差异[NS]）。HFCWO时右肺平均C/P比为1.74±0.43，SCPT后为1.85±0.63（p = NS）。HFCWO时左肺平均C/P比为1.25±0.29，SCPT后为1.21±0.35（p = NS）。C/P比与FEV₁或用力肺活量（FVC）之间无相关性。
与SCPT后雾化吸入DTPA相比，HFCWO联合雾化吸入DTPA并未导致中央沉积增加。需要进一步研究以确定将HFCWO与雾化药物联合使用是否可以进行调整以改善外周沉积。
