Aslan Sevda C, Randall David C, Krassioukov Andrei V, Phillips Aaron, Ovechkin Alexander V
Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.
Department of Physiology, University of Kentucky, Lexington, Kentucky.
Arch Phys Med Rehabil. 2016 Jun;97(6):964-73. doi: 10.1016/j.apmr.2015.11.018. Epub 2015 Dec 21.
To investigate the effects of respiratory motor training (RMT) on pulmonary function and orthostatic stress-mediated cardiovascular and autonomic responses in individuals with chronic spinal cord injury (SCI).
Before-after intervention case-controlled clinical study.
SCI research center and outpatient rehabilitation unit.
A sample of (N=21) individuals with chronic SCI ranging from C3 to T2 diagnosed with orthostatic hypotension (OH) (n=11) and healthy, noninjured controls (n=10).
A total of 21±2 sessions of pressure threshold inspiratory-expiratory RMT performed 5d/wk during a 1-month period.
Standard pulmonary function test: forced vital capacity, forced expiratory volume in one second, maximal inspiratory pressure, maximal expiratory pressure, beat-to-beat arterial blood pressure, heart rate, and respiratory rate were acquired during the orthostatic sit-up stress test before and after the RMT program.
Completion of RMT intervention abolished OH in 7 of 11 individuals. Forced vital capacity, low-frequency component of power spectral density of blood pressure and heart rate oscillations, baroreflex effectiveness, and cross-correlations between blood pressure, heart rate, and respiratory rate during the orthostatic challenge were significantly improved, approaching levels observed in noninjured individuals. These findings indicate increased sympathetic activation and baroreflex effectiveness in association with improved respiratory-cardiovascular interactions in response to the sudden decrease in blood pressure.
Respiratory training increases respiratory capacity and improves orthostatic stress-mediated respiratory, cardiovascular, and autonomic responses, suggesting that this intervention can be an efficacious therapy for managing OH after SCI.
探讨呼吸运动训练（RMT）对慢性脊髓损伤（SCI）患者肺功能以及直立位应激介导的心血管和自主神经反应的影响。
干预前后对照的临床研究。
SCI研究中心和门诊康复科。
选取21例慢性SCI患者作为样本，损伤平面在C3至T2，其中诊断为直立性低血压（OH）的患者11例，健康未受伤对照者10例。
在1个月内，每周5天，共进行21±2节压力阈值吸气-呼气RMT训练。
标准肺功能测试：在RMT训练项目前后的直立位仰卧起坐应激测试中，获取用力肺活量、一秒用力呼气量、最大吸气压力、最大呼气压力、逐搏动脉血压、心率和呼吸频率。
RMT干预完成后，11例患者中有7例的OH消失。用力肺活量、血压和心率振荡功率谱密度的低频成分、压力反射有效性以及直立位挑战期间血压、心率和呼吸频率之间的互相关性均显著改善，接近未受伤个体的水平。这些发现表明，在血压突然下降时，交感神经激活增加，压力反射有效性提高，同时呼吸-心血管相互作用得到改善。
呼吸训练可增加呼吸能力，改善直立位应激介导的呼吸、心血管和自主神经反应，提示该干预措施可能是治疗SCI后OH的有效疗法。
