Physiotherapy Division, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil.
Chron Respir Dis. 2011;8(4):237-44. doi: 10.1177/1479972311424296.
This study investigated the effects of diaphragmatic breathing (DB) on ventilation and breathing pattern, seeking to identify predictors of its efficacy in patients with chronic obstructive pulmonary disease (COPD). Twenty-nine patients with moderate and severe COPD were monitored using respiratory inductance plethysmography and metabolic gas analysis. After 4 minutes of natural breathing, subjects completed 2 minutes of DB followed by 4 minutes of natural breathing. Dyspnea was measured using a visual analogue scale. Diaphragmatic mobility was assessed using chest radiography. DB was associated with a significant increase in tidal volume and reduction in breathing frequency, leading to higher ventilation and oxygen saturation, with a reduction in dead space ventilation and ventilatory equivalent for carbon dioxide. A total of 10 subjects with moderate (5) and severe (5) COPD performed DB with asynchronous thoracoabdominal motion, worsening the dyspnea, and decreasing the gain of tidal volume. Diaphragmatic mobility, inspiratory muscular strength, lower scores for dyspnea and hypoxemia as well as coordinated thoracoabdominal motion are associated with effective DB. In patients with COPD, DB can improve breathing pattern and ventilatory efficiency without causing dyspnea in patients whose respiratory muscular system is preserved.
这项研究旨在探讨膈式呼吸（DB）对通气和呼吸模式的影响，以期确定其在慢性阻塞性肺疾病（COPD）患者中的疗效预测因素。29 名中重度 COPD 患者使用呼吸感应体积描记法和代谢气体分析进行监测。在自然呼吸 4 分钟后，患者完成 2 分钟的 DB，然后再进行 4 分钟的自然呼吸。呼吸困难通过视觉模拟量表进行测量。使用胸部 X 线片评估膈肌活动度。DB 与潮气量显著增加和呼吸频率降低有关，导致通气量和氧饱和度增加，同时死腔通气量和二氧化碳通气当量减少。共有 10 名中重度（5 名）和重度（5 名）COPD 患者进行了膈式呼吸，出现了胸腹腔运动不同步的情况，导致呼吸困难恶化，潮气量增益降低。膈肌活动度、吸气肌力量、呼吸困难和低氧血症评分较低以及胸腹腔运动协调与有效的 DB 相关。在 COPD 患者中，DB 可以改善呼吸模式和通气效率，而不会导致呼吸肌系统正常的患者出现呼吸困难。
