Loveridge B, Badour M, Dubo H
Spinal Cord Injury Unit, University of Manitoba, Winnipeg, Canada.
Paraplegia. 1989 Oct;27(5):329-39. doi: 10.1038/sc.1989.50.
We examined the effects of ventilatory muscle endurance training on resting breathing pattern in 12 C6-C7 traumatic quadriplegics at least 1 year post-injury. All subjects had complete motor loss below the lesion level. Subjects were randomly assigned to a training (N = 6), or a control group (N = 6). Baseline tests included measurement of resting ventilation and breathing pattern using mercury in rubber strain gauges for 20 minutes in a seated position; maximum inspiratory mouth pressure (MIP) at FRC, and sustainable inspiratory mouth pressure for 10 minutes (SIP); lung volumes, and arterial blood gases (ABG's). The training protocol consisted of breathing through an inspiratory resistor equivalent to 85% SIP for 15 minutes twice daily, 5 days a week for 8 weeks. Both trainers and controls attended the lab every 2 weeks for reassessment of MIP and SIP and the inspiratory resistance was increased in the training group as SIP increased. At the end of 8 weeks, baseline tests were repeated. All subjects had normal ABG's. There was a significant increase in mean MIP and SIP in both the control group (30% +/- 19% and 31% +/- 18% respectively), and in the training group (42% +/- 24% and 78% +/- 49% respectively). Although the absolute values for both MIP and SIP were greater in the training group than in the control group, the differences were not significant. The alterations in resting breathing pattern were also the same in both groups. Mean frequency decreased significantly in the control group (20.2/minute to 16.9/minute) and, while insignificant, the change in frequency in the training group was the same, 19.4/minute to 16.4/minute. Mean tidal volume (Vt) increased 18.2% of baseline Vt in the control group and 17.0% baseline in the trainers, resulting in no change in minute ventilation. As MIP and SIP increased similarly in both groups, the data from the control and trainers was pooled and timing changes re-evaluated pre- and post-study. A significant decrease in mean Ti/Ttot was observed, while no change in Vt/Ti was found. We concluded that the testing procedure itself provided the stimulus resulting in a significant increase in MIP and SIP. The addition of training did not increase MIP and SIP further. The increased MIP and SIP resulted in a slower and deeper breathing pattern and a significantly shorter Ti/Ttot in both trainers and control subjects.
我们研究了通气肌耐力训练对12名C6 - C7创伤性四肢瘫患者静息呼吸模式的影响，这些患者受伤时间至少已有1年。所有受试者在损伤平面以下均存在完全性运动功能丧失。受试者被随机分为训练组（N = 6）和对照组（N = 6）。基线测试包括：让受试者坐姿下使用橡胶应变仪中的汞测量静息通气和呼吸模式20分钟；在功能残气量（FRC）时测量最大吸气口腔压力（MIP）以及可持续10分钟的吸气口腔压力（SIP）；测量肺容积和动脉血气（ABG）。训练方案为：通过相当于85% SIP的吸气阻力器呼吸，每天两次，每次15分钟，每周5天，共8周。训练组和对照组每2周到实验室重新评估MIP和SIP，训练组随着SIP增加而增加吸气阻力。8周结束时，重复进行基线测试。所有受试者的动脉血气均正常。对照组的平均MIP和SIP均显著增加（分别为30%±19%和31%±18%），训练组的平均MIP和SIP也显著增加（分别为42%±24%和78%±49%）。虽然训练组的MIP和SIP绝对值均高于对照组，但差异不显著。两组静息呼吸模式的改变也相同。对照组的平均呼吸频率显著降低（从20.2次/分钟降至16.9次/分钟），训练组的呼吸频率变化虽不显著，但趋势相同，从19.4次/分钟降至16.4次/分钟。对照组的平均潮气量（Vt）增加了基线Vt的18.2%，训练组增加了基线的17.0%，分钟通气量无变化。由于两组的MIP和SIP增加情况相似，因此将对照组和训练组的数据合并，并在研究前后重新评估时间变化。观察到平均吸气时间/总呼吸时间（Ti/Ttot）显著降低，而潮气量/吸气时间（Vt/Ti）无变化。我们得出结论，测试过程本身提供了刺激，导致MIP和SIP显著增加。额外的训练并未进一步增加MIP和SIP。MIP和SIP的增加导致训练组和对照组的呼吸模式都变得更慢、更深，且Ti/Ttot显著缩短。
