Balzan Fernanda Machado, da Silva Régis Chiarelli, da Silva Danton Pereira, Sanches Paulo Roberto Stefani, Tavares Angela Maria Vicente, Ribeiro Jorge Pinto, Berton Danilo Cortozi, Clausell Nadine Oliveira
Exercise Pathophysiology Research Laboratory, Programa de Pós-Graduação em Ciências da Saúde, Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
Hospital Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
Physiol Rep. 2014 Dec 11;2(12). doi: 10.14814/phy2.12216. Print 2014 Dec 1.
The main objective was to assess the effects of abdominal breathing (AB) versus subject's own breathing on femoral venous blood flow (Qfv) and their repercussions on central hemodynamics at rest and during exercise contrasting healthy subjects versus heart failure (HF) patients. We measured esophageal and gastric pressure (PGA), Qfv and parameters of central hemodynamics in eight healthy subjects and nine HF patients, under four conditions: subject's own breathing and AB ( ∆: PGA ≥ 6 cmH2O) at rest and during knee extension exercises (15% of 1 repetition maximum) until exhaustion. Qfv and parameters of central hemodynamics [stroke volume (SV), cardiac output (CO)] were measured using Doppler ultrasound and impedance cardiography, respectively. At rest, healthy subjects Qfv, SV, and CO were higher during AB than subject's breathing (0.11 ± 0.02 vs. 0.06 ± 0.00 L·min(-1), 58.7 ± 3.4 vs. 50.1 ± 4.1 mL and 4.4 ± 0.2 vs. 3.8 ± 0.1 L·min(-1), respectively, P ≤ 0.05). ∆SV correlated with ∆PGA during AB (r = 0.89, P ≤ 0.05). This same pattern of findings induced by AB was observed during exercise (SV: 71.1 ± 4.1 vs. 65.5 ± 4.1 mL and CO: 6.3 ± 0.4 vs. 5.2 ± 0.4 L·min(-1); P ≤ 0.05); however, Qfv did not reach statistical significance. The HF group tended to increase their Qfv during AB (0.09 ± 0.01 vs. 0.07 ± 0.03 L·min(-1), P = 0.09). On the other hand, unlike the healthy subjects, AB did not improve SV or CO neither at rest nor during exercise (P > 0.05). In healthy subjects, abdominal pump modulated venous return improved SV and CO at rest and during exercise. In HF patients, with elevated right atrial and vena caval system pressures, these findings were not observed.
主要目的是评估腹式呼吸（AB）与受试者自身呼吸对股静脉血流（Qfv）的影响，以及它们在静息和运动状态下对中心血流动力学的影响，对比健康受试者与心力衰竭（HF）患者。我们测量了8名健康受试者和9名HF患者在四种情况下的食管和胃内压力（PGA）、Qfv以及中心血流动力学参数：静息时和进行膝关节伸展运动（15%的1次最大重复量）直至力竭时的受试者自身呼吸和AB（∆：PGA≥6 cmH₂O）。分别使用多普勒超声和阻抗心动图测量Qfv以及中心血流动力学参数[每搏输出量（SV）、心输出量（CO）]。静息时，健康受试者在AB期间的Qfv、SV和CO高于自身呼吸时（分别为0.11±0.02 vs. 0.06±0.00 L·min⁻¹、58.7±3.4 vs. 50.1±4.1 mL以及4.4±0.2 vs. 3.8±0.1 L·min⁻¹，P≤0.05）。AB期间∆SV与∆PGA相关（r = 0.89，P≤0.05）。运动期间观察到AB诱导的相同结果模式（SV：71.1±4.1 vs. 65.5±4.1 mL以及CO：6.3±0.4 vs. 5.2±0.4 L·min⁻¹；P≤0.05）；然而，Qfv未达到统计学显著性。HF组在AB期间Qfv有增加趋势（0.09±0.01 vs. 0.07±0.03 L·min⁻¹，P = 0.09）。另一方面，与健康受试者不同，AB在静息和运动时均未改善SV或CO（P>0.05）。在健康受试者中，腹式泵调节静脉回流在静息和运动时改善了SV和CO。在HF患者中，由于右心房和腔静脉系统压力升高，未观察到这些结果。
