Laboratório de Pesquisa em Fisioterapia Pulmonar, Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina, Paraná, Brazil.
Respir Care. 2013 Dec;58(12):2142-9. doi: 10.4187/respcare.02393. Epub 2013 May 28.
A more profound investigation of respiratory muscle strength during COPD exacerbation was needed, so we investigated respiratory muscle strength and related factors in patients with COPD during and after hospitalization for COPD exacerbation.
In 19 subjects hospitalized for COPD exacerbation (12 males, mean age 67 ± 11 y, median percent-of-predicted FEV(1) 26% [IQR 19-32%]) we measured lung function and respiratory and quadriceps muscle strength at admission (day 1), at discharge, and 1 month after discharge.
At admission, 68% of the subjects had inspiratory muscle dysfunction (maximum inspiratory pressure < 70% of predicted). Inspiratory muscle strength increased between day 1 (56 cm H(2)O [IQR 45-64 cm H(2)O]) and 1 month after discharge (65 cm H(2)O [IQR 51-74 cm H(2)O], P = .007). Expiratory muscle strength increased between day 1 (99 cm H(2)O [65-117 cm H(2)O]) and discharge (109 cm H(2)O [77-136 cm H(2)O], P = .005), and between day 1 and 1 month after discharge (114 cm H(2)O [90-139 cm H(2)O], P = .001). Inspiratory capacity increased between discharge (1.59 ± 0.44 L) and 1 month after discharge (1.99 ± 0.54 L, P = .02). There was no significant change in other lung function variables or quadriceps strength. At admission the inspiratory muscle dysfunction and reduction in inspiratory capacity (< 80% of predicted) correlated linearly (phi coefficient 0.62, P = .03), whereas the expiratory muscle strength correlated inversely with FEV(1) (Spearman rho -0.61, P = .005) and inspiratory capacity (Spearman rho -0.54, P = .02).
There was a high prevalence of inspiratory muscle dysfunction in patients hospitalized for COPD exacerbation. Inspiratory and expiratory muscle strength increased markedly during and after hospitalization. The degree of air-flow obstruction and hyperinflation were related to inspiratory and expiratory muscle strength.
需要更深入地研究 COPD 加重期间的呼吸肌力量，因此我们研究了 COPD 加重住院患者的呼吸肌力量及其相关因素。
在 19 名因 COPD 加重而住院的患者（12 名男性，平均年龄 67 ± 11 岁，中位预计 FEV1%为 26%[IQR 19-32%]）中，我们在入院时（第 1 天）、出院时和出院后 1 个月测量了肺功能和呼吸及股四头肌力量。
入院时，68%的患者存在吸气肌功能障碍（最大吸气压力 < 70%预计值）。吸气肌力量在第 1 天（56cmH2O[IQR 45-64cmH2O]）和出院后 1 个月（65cmH2O[IQR 51-74cmH2O]）之间增加，差异有统计学意义（P =.007）。呼气肌力量在第 1 天（99cmH2O[65-117cmH2O]）和出院时（109cmH2O[77-136cmH2O]）之间增加，差异有统计学意义（P =.005），第 1 天和出院后 1 个月之间也增加（114cmH2O[90-139cmH2O]，P =.001）。出院时（1.59 ± 0.44L）和出院后 1 个月（1.99 ± 0.54L）时的吸气量增加，差异有统计学意义（P =.02）。其他肺功能指标或股四头肌力量无明显变化。入院时，吸气肌功能障碍和吸气量减少（<80%预计值）呈线性相关（phi 系数 0.62，P =.03），而呼气肌力量与 FEV1（Spearman rho -0.61，P =.005）和吸气量（Spearman rho -0.54，P =.02）呈负相关。
因 COPD 加重而住院的患者中，吸气肌功能障碍的发生率较高。吸气和呼气肌力量在住院期间和出院后明显增加。气流阻塞和过度充气的程度与吸气和呼气肌力量有关。
