Chiou Michael, Bach John R, Jethani Lavina, Gallagher Michael F
Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, 07103 Newark, USA.
J Rehabil Med. 2017 Jan 19;49(1):49-53. doi: 10.2340/16501977-2144.
To consider the effect of active lung volume recruitment ("air stacking") on rate of decline in vital capacity.
Retrospective cross-sectional design.
People with Duchenne muscular dystrophy.
Vital capacity was measured at every patient visit and then graphed. Air stacking using volume-preset ventilation or manual resuscitator bag was introduced to all patients after their vital capacity plateaued (reached a lifetime maximum).
For 151 consecutive patients with multi-year data, the 1-year rate of greatest decline in post-plateau vital capacity was 104 ml (8.8%)/year and occurred from age 20 to 21 years. For 53 patients with multi-visit data for whom air stacking was begun at the immediate post-plateau visit, the 1-year rate of greatest decline in vital capacity was 118 ml (8.5%) and occurred from age 20 to 21 years. Between annual visits, vital capacity and maximum insufflation capacity increased 26.4% and 43.3% of the time, respectively. The peak of maximal vital capacity decline occurred more than 5 years later than previously reported without air stacking.
For patients with Duchenne muscular dystrophy, active lung volume recruitment may help to preserve vital capacity. Effects on post-plateau vital capacity may be a useful outcome measure for therapeutic trials.
探讨主动肺容积募集（“空气堆叠”）对肺活量下降速率的影响。
回顾性横断面设计。
杜氏肌营养不良症患者。
在每次患者就诊时测量肺活量，然后绘制图表。在所有患者的肺活量达到平台期（达到终生最大值）后，采用容积预设通气或手动复苏袋进行空气堆叠。
对于151例有多年数据的连续患者，平台期后肺活量最大下降的1年速率为每年104毫升（8.8%），发生在20至21岁之间。对于53例在平台期后立即开始进行空气堆叠且有多次就诊数据的患者，肺活量最大下降的1年速率为118毫升（8.5%），发生在20至21岁之间。在年度就诊之间，肺活量和最大吸气量分别有26.4%和43.3%的时间增加。最大肺活量下降的峰值比之前报道的无空气堆叠情况晚了5年多出现。
对于杜氏肌营养不良症患者，主动肺容积募集可能有助于维持肺活量。对平台期后肺活量的影响可能是治疗试验的一个有用的结局指标。
