Brückner U
Klinik Donaustauf, Zentrum für Pneumologie, Psychosomatische Medizin und Psychotherapie, Donaustauf.
Pneumologie. 2008 Mar;62 Suppl 1:S31-4. doi: 10.1055/s-2007-1016425.
Assisted coughing and mechanical cough aids compensate for the weak cough flow in patients with neuromuscular diseases (NMD). In cases with preserved respiratory muscles also breathing techniques and special devices, e. g., flutter or acapella can be used for secretion mobilisation during infections of the airways. These means are summarised as oscillating physiotherapy. Their mechanisms are believed to depend on separation of the mucus from the bronchial wall by vibration, thus facilitating mucus transport from the peripheral to the central airways. In mucoviscidosis and chronic obstructive pulmonary disease their application is established, but there is a paucity of data regarding the commitment in patients with neuromuscular diseases. The effective adoption of simple oscillation physiotherapeutic interventions demands usually a sufficient force of the respiratory muscles--exceptions are the application of the percussionaire (intrapulmonary percussive ventilator, IPV) or high frequency chest wall oscillation (HFCWO). In daily practice there is evidence that patients with weak respiratory muscles are overstrained with the use of these physiotherapeutic means, or get exhausted. A general recommendation for the adoption of simple oscillating physiotherapeutic interventions cannot be made in patients with NMDs. Perhaps in the future devices such as IPV or HFCWO will prove to be more effective in NMD patients.
辅助咳嗽和机械咳嗽辅助装置可弥补神经肌肉疾病（NMD）患者咳嗽气流微弱的问题。对于呼吸肌功能尚存的患者，在气道感染期间，还可采用呼吸技术和特殊装置，如颤振器或阿帕拉装置来促进分泌物排出。这些方法统称为振荡物理治疗。其作用机制被认为是通过振动使黏液与支气管壁分离，从而促进黏液从外周气道向中央气道的运输。在黏液黏稠病和慢性阻塞性肺疾病中，其应用已得到确立，但关于神经肌肉疾病患者使用这些方法的数据却很匮乏。通常，有效采用简单的振荡物理治疗干预措施需要呼吸肌具备足够的力量——除了使用叩击式肺通气机（IPV）或高频胸壁振荡（HFCWO）。在日常实践中，有证据表明呼吸肌无力的患者在使用这些物理治疗方法时会过度劳累或疲惫不堪。对于神经肌肉疾病患者，无法给出采用简单振荡物理治疗干预措施的一般性建议。或许在未来，诸如IPV或HFCWO等装置在神经肌肉疾病患者中会被证明更有效。
