Ishikawa Yuka, Bach John R, Komaroff Eugene, Miura Toshihiko, Jackson-Parekh Roseanna
Department of Pediatrics, Yakumo Byoin National Sanatorium, Hokkaido, Japan.
Am J Phys Med Rehabil. 2008 Sep;87(9):726-30. doi: 10.1097/PHM.0b013e31817f99a8.
The purpose of this work was to compare the relative importance of deep lung insufflation with the abdominal thrust and their combination in augmenting cough peak flows (CPF).
Unassisted CPF and CPF assisted by air stacking to deep lung volumes (CPFair), assisted by abdominal thrusts (CPFthrust), and assisted by both air stacking and abdominal thrusts (aCPF) were measured for 61 patients with Duchenne muscular dystrophy (DMD).
Overall, mean unassisted CPF were 138 +/- 70 liters/min, CPFthrust were 204 +/- 75 liters/min, CPFair were 236 +/- 68 liters/min, and aCPF were 302 +/- 78 liters/min. The differences between each were statistically significant (P < 0.0001).
Thus, air stacking was significantly more effective than abdominal thrust in increasing CPF, but the combination was the most effective. The CPF of the quartile of patients with the lowest unassisted CPF were also significantly (P < or = 0.04) more augmented by air stacking and thrusting than for the milder quartiles of patients. Thus, the greatest improvements in CPF were for patients with the weakest coughs.
本研究旨在比较深肺充气与腹部冲击及其联合应用在增加咳嗽峰值流速（CPF）方面的相对重要性。
对61例杜氏肌营养不良症（DMD）患者测量了无辅助CPF、通过肺容量叠加至深肺容量辅助的CPF（CPFair）、通过腹部冲击辅助的CPF（CPFthrust）以及通过肺容量叠加和腹部冲击两者辅助的CPF（aCPF）。
总体而言，无辅助CPF的平均值为138±70升/分钟，CPFthrust为204±75升/分钟，CPFair为236±68升/分钟，aCPF为302±78升/分钟。各值之间的差异具有统计学意义（P<0.0001）。
因此，肺容量叠加在增加CPF方面比腹部冲击显著更有效，但联合应用最为有效。无辅助CPF最低的四分之一患者的CPF，通过肺容量叠加和冲击的增加也比病情较轻的四分之一患者显著（P≤0.04）。因此，CPF改善最大的是咳嗽最弱的患者。
