Pessoa Isabela M B Sclauser, Costa Dirceu, Velloso Marcelo, Mancuzo Eliane, Reis Marco A S, Parreira Verônica F
Physical Therapy Department, Universidade Católica de Minas Gerais, Belo Horizonte, MG, Brazil.
Rev Bras Fisioter. 2012 Jan-Feb;16(1):61-7.
Patients with chronic obstructive pulmonary disease (COPD) complain of dyspnea on activities of daily living (ADLs) with the upper limbs. Dynamic hyperinflation (DH) is one of the ventilatory mechanisms that may contribute towards dyspnea. To minimize the DH it is indicated the use of noninvasive ventilation (NIV).
To verify whether there is DH and dyspnea during the performance of ADL with the upper limbs with and without the use of NIV.
32 patients with moderate-to-severe COPD, aged 54 to 87 years (mean 69.4, SD 7.4) were evaluated. The subjects lift up containers weighing between 0.5 and 5.0 kg over a five-minute period, starting from the waist level and putting them onto a shelf located above head height, with and without the use of NIV (BiPAP®; IPAP 10cmH₂O; EPAP 4 cmH₂O). The inspiratory capacity (IC) and dyspnea (Borg scale) were evaluated on all the patients. The IC was measured before and after simulation of the ADL. In order to analyze the data, Student's t test for dependent samples and the Wilcoxon test were used.
There were statistically significant reductions in IC after the ADL with and without NIV (p=0.01). The dyspnea increased after the ADL with and without the NIV, however between both interventional procedures protocols no between-group difference was observed.
The simulation of an ADL with the upper limbs resulted in an increase in DH and dyspnea. The NIV supplied with pre-established pressure was not enough to prevent the DH and dyspnea.
慢性阻塞性肺疾病（COPD）患者在进行上肢日常生活活动（ADL）时会出现呼吸困难。动态肺过度充气（DH）是可能导致呼吸困难的通气机制之一。为了尽量减少DH，建议使用无创通气（NIV）。
验证在上肢进行ADL时，使用和不使用NIV的情况下是否存在DH和呼吸困难。
评估了32例年龄在54至87岁（平均69.4岁，标准差7.4）的中重度COPD患者。受试者在5分钟内将重量在0.5至5.0千克之间的容器从腰部水平举起，放置到头顶上方的架子上，分别在使用和不使用NIV（BiPAP®；吸气压力支持10cmH₂O；呼气末正压4cmH₂O）的情况下进行。对所有患者评估吸气容量（IC）和呼吸困难（Borg量表）。在模拟ADL之前和之后测量IC。为了分析数据，使用了配对样本的Student t检验和Wilcoxon检验。
无论是否使用NIV，ADL后IC均有统计学意义的降低（p = 0.01）。无论是否使用NIV，ADL后呼吸困难均增加，然而在两种干预方案之间未观察到组间差异。
上肢模拟ADL会导致DH和呼吸困难增加。预先设定压力的NIV不足以预防DH和呼吸困难。
