Sleep Medicine and Biology Division of the Psychobiology Department of the Universidade Federal de São Paulo - UNIFESP, Federal University of São Paulo - São Paulo, Brazil.
J Bras Pneumol. 2009 Oct;35(10):973-9. doi: 10.1590/s1806-37132009001000005.
To evaluate cough efficiency using two manually-assisted cough techniques.
We selected 28 patients with Duchenne muscular dystrophy. The patients were receiving noninvasive nocturnal ventilatory support and presented FVC values < 60% of predicted. Peak cough flow (PCF) was measured, with the patient seated, at four time points: at baseline, during a spontaneous maximal expiratory effort (MEE); during an MEE while receiving chest compression; during an MEE after air stacking with a manual resuscitation bag; and during an MEE with air stacking and compression (combined technique). The last three measurements were conducted in random order. The results were compared using Pearson's correlation test and ANOVA with repeated measures, followed by Tukey's post-hoc test (p < 0.05).
The mean age of the patients was 20 + or - 4 years, and the mean FVC was 29 + or - 12%. Mean PCF at baseline, with chest compression, after air stacking and with the use of the combined technique was 171 + or - 67, 231 + or - 81, 225 + or - 80, and 292 + or - 86 L/min, respectively. The results obtained with the use of the combined technique were significantly better than were those obtained with the use of either technique alone (F[3.69] = 67.07; p < 0.001).
Both chest compression and air stacking techniques were efficient in increasing PCF. However, the combination of these two techniques had a significant additional effect (p < 0.0001).
评估两种手动辅助咳嗽技术的咳嗽效率。
我们选择了 28 例患有杜氏肌营养不良症的患者。这些患者正在接受无创夜间通气支持，且 FVC 值<预测值的 60%。在四个时间点测量了最大呼气流量峰值（PCF）：基线时、进行自发性最大呼气努力（MEE）时、进行胸部按压时的 MEE 期间、进行手动复苏袋空气叠加时的 MEE 期间以及进行空气叠加和按压（联合技术）时的 MEE 期间。最后三个测量以随机顺序进行。使用 Pearson 相关检验和重复测量方差分析进行比较，然后进行 Tukey 事后检验（p<0.05）。
患者的平均年龄为 20+/-4 岁，平均 FVC 为 29+/-12%。基线时、进行胸部按压时、进行空气叠加时和使用联合技术时的平均 PCF 分别为 171+/-67、231+/-81、225+/-80 和 292+/-86 L/min。使用联合技术获得的结果明显优于单独使用任何一种技术时的结果（F[3.69]=67.07；p<0.001）。
胸部按压和空气叠加技术都能有效提高 PCF。然而，这两种技术的结合具有显著的额外效果（p<0.0001）。
