Lima Illia Ndf, Fregonezi Guilherme Af, Melo Rodrigo, Cabral Elis Ea, Aliverti Andrea, Campos Tânia F, Ferreira Gardênia Mh
Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, Brazil.
Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano Polytechnic University of Milan, Milan, Italy.
Respir Care. 2014 Jul;59(7):1101-7. doi: 10.4187/respcare.02651. Epub 2013 Nov 12.
The aim of the present study was to assess how volume-oriented incentive spirometry applied to patients after a stroke modifies the total and compartmental chest wall volume variations, including both the right and left hemithoraces, compared with controls.
Twenty poststroke patients and 20 age-matched healthy subjects were studied by optoelectronic plethysmography during spontaneous quiet breathing (QB), during incentive spirometry, and during the recovery period after incentive spirometry.
Incentive spirometry was associated with an increased chest wall volume measured at the pulmonary rib cage, abdominal rib cage and abdominal compartment (P = .001) and under 3 conditions (P < .001). Compared with healthy control subjects, the tidal volume (VT) of the subjects with stroke was 24.7, 18.0, and 14.7% lower during QB, incentive spirometry, and postincentive spirometry, respectively. Under all 3 conditions, the contribution of the abdominal compartment to VT was greater in the stroke subjects (54.1, 43.2, and 48.9%) than in the control subjects (43.7, 40.8, and 46.1%, P = .039). In the vast majority of subjects (13/20 and 18/20 during QB and incentive spirometry, respectively), abdominal expansion precedes rib cage expansion during inspiration. Greater asymmetry between the right and left hemithoracic expansions occurred in stroke subjects compared with control subjects, but it decreased during QB (62.5%, P = .002), during incentive spirometry (19.7%), and postincentive spirometry (67.6%, P = .14).
Incentive spirometry promotes increased expansion in all compartments of the chest wall and reduces asymmetric expansion between the right and left parts of the pulmonary rib cage; therefore, it should be considered as a tool for rehabilitation.
本研究的目的是评估与对照组相比，面向容积的激励肺活量测定法应用于中风患者后如何改变包括左右半侧胸廓在内的胸壁总体积和分区体积变化。
通过光电体积描记法对20名中风后患者和20名年龄匹配的健康受试者在静息呼吸（QB）、激励肺活量测定期间以及激励肺活量测定后的恢复期进行研究。
激励肺活量测定与在肺胸廓、腹胸廓和腹部区域测量的胸壁体积增加相关（P = .001），且在三种情况下均如此（P < .001）。与健康对照受试者相比，中风受试者在QB、激励肺活量测定和激励肺活量测定后，潮气量（VT）分别低24.7%、18.0%和14.7%。在所有三种情况下，中风受试者腹部区域对VT的贡献（54.1%、43.2%和48.9%）大于对照受试者（43.7%、40.8%和46.1%，P = .039）。在绝大多数受试者中（分别在QB和激励肺活量测定期间为13/20和18/20），吸气时腹部扩张先于胸廓扩张。与对照受试者相比，中风受试者左右半侧胸廓扩张之间的不对称性更大，但在QB期间（62.5%，P = .002）、激励肺活量测定期间（19.7%）和激励肺活量测定后（67.6%，P = .14）有所降低。
激励肺活量测定可促进胸壁所有区域的扩张增加，并减少肺胸廓左右部分之间的不对称扩张；因此，应将其视为一种康复工具。
