Ramos Ercy M C, Ramos Dionei, Moreira Graciane L, Macchione Mariangela, Guimarães Eliane T, Rodrigues Fernanda Maria M, de Souza Altay Alves Lino, Saldiva Paulo H N, Jardim José R
Physical Therapy Department, Presidente Prudente School of Science and Technology, Universidade Estadual Paulist, São Paulo
Physical Therapy Department, Presidente Prudente School of Science and Technology, Universidade Estadual Paulist, São Paulo.
Respir Care. 2015 May;60(5):724-30. doi: 10.4187/respcare.02429. Epub 2015 Feb 3.
Previous studies have evaluated the effectiveness of postural drainage (PD), percussion (PERC), the coughing technique (CT), and other types of coughing in subjects with bronchiectasis. However, the application times of these techniques and the quality of the expectorated mucus require further study. The aim of our study was to evaluate the effectiveness of PD, percussion, CT, and huffing in subjects with bronchiectasis and assess the quantity and quality of bronchial mucus produced (measurement of wet and dry weight and determination of viscoelastic properties).
Twenty-two subjects with stable bronchiectasis (6 men; mean age: 51.5 y) underwent 4 d of experimental study (CT, PD+CT, PD+PERC+CT, and PD+huffing). The techniques were performed in 3 20-min periods separated by 10 min of rest. Before performing any technique (baseline) and after each period (30, 60, and 90 min), expectorated mucus was collected for analysis of viscoelasticity.
A significant increase in the dry weight/wet weight ratio was found after 60 min of PD+PERC+CT (P = .01) and 90 min of PD+huffing (P = .03) and PD+PERC+CT (P = .007) in comparison with CT. PD+PERC+CT and PD+huffing led to the greatest removal of viscoelastic mucus at 60 min (P = .02 and P = .002, respectively) and continued to do so at 90 min (P = .02 and P = .01, respectively) in comparison with CT. An interaction effect was found, as all techniques led to a greater removal of elastic mucus in comparison with CT at 60 min (PD+CT, P = .001; PD+PERC+CT, P < .001; PD+huffing, P < .001), but only PD+PERC+CT and PD+huffing led to a greater removal of elastic mucus than CT at 90 min (P < .001 and P = .005, respectively).
PD+PERC+CT and PD+huffing performed similarly regarding the removal of viscoelastic mucus in 2 and 3 20-min periods separated by 10 min of rest. PD+PERC+CT led to the greatest removal of mucus in the shortest period (2 20-min periods separated by 10 min of rest).
既往研究评估了体位引流（PD）、叩击（PERC）、咳嗽技术（CT）以及其他类型咳嗽对支气管扩张症患者的有效性。然而，这些技术的应用次数以及咳出痰液的质量仍需进一步研究。我们研究的目的是评估PD、叩击、CT和哈夫式呼吸法对支气管扩张症患者的有效性，并评估所产生支气管黏液的数量和质量（测量湿重和干重以及测定黏弹性特性）。
22例稳定期支气管扩张症患者（6例男性；平均年龄：51.5岁）接受了为期4天的实验研究（CT、PD + CT、PD + PERC + CT和PD + 哈夫式呼吸法）。这些技术在3个20分钟的时间段内进行，中间间隔10分钟休息。在进行任何技术之前（基线）以及每个时间段之后（30、60和90分钟），收集咳出的黏液用于黏弹性分析。
与CT相比，PD + PERC + CT进行60分钟后（P = 0.01）、PD + 哈夫式呼吸法进行90分钟后（P = 0.03）以及PD + PERC + CT进行90分钟后（P = 0.007），干重/湿重比显著增加。与CT相比，PD + PERC + CT和PD + 哈夫式呼吸法在60分钟时导致黏弹性黏液清除最多（分别为P = 0.02和P = 0.002），并在90分钟时继续保持（分别为P = 0.02和P = 0.01）。发现存在交互作用，因为与CT相比，所有技术在60分钟时导致弹性黏液清除更多（PD + CT，P = 0.001；PD + PERC + CT，P < 0.001；PD + 哈夫式呼吸法，P < 0.001），但只有PD + PERC + CT和PD + 哈夫式呼吸法在90分钟时导致弹性黏液清除比CT更多（分别为P < 0.001和P = 0.005）。
在间隔10分钟休息的2个和3个20分钟时间段内，PD + PERC + CT和PD + 哈夫式呼吸法在清除黏弹性黏液方面表现相似。PD + PERC + CT在最短时间内（间隔10分钟休息的2个20分钟时间段）导致黏液清除最多。
