Wu Weiliang, Zhang Xianming, Lin Lin, Ou Yonger, Li Xiaoying, Guan Lili, Guo Bingpeng, Zhou Luqian, Chen Rongchang
State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou.
Department of Respiratory Medicine, The First Affiliated Hospital of Guizhou Medical University, Guizhou, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2017 Mar 2;12:773-781. doi: 10.2147/COPD.S126354. eCollection 2017.
Inspiratory muscle training (IMT) is a rehabilitation therapy for stable patients with COPD. However, its therapeutic effect remains undefined due to the unclear nature of diaphragmatic mobilization during IMT. Diaphragmatic mobilization, represented by transdiaphragmatic pressure (Pdi), and neural respiratory drive, expressed as the corrected root mean square (RMS) of the diaphragmatic electromyogram (EMGdi), both provide vital information to select the proper IMT device and loads in COPD, therefore contributing to the curative effect of IMT. Pdi and RMS of EMGdi (RMSdi%) were measured and compared during inspiratory resistive training and threshold load training in stable patients with COPD.
Pdi and neural respiratory drive were measured continuously during inspiratory resistive training and threshold load training in 12 stable patients with COPD (forced expiratory volume in 1 s ± SD was 26.1%±10.2% predicted).
Pdi was significantly higher during high-intensity threshold load training (91.46±17.24 cmHO) than during inspiratory resistive training (27.24±6.13 cmHO) in stable patients with COPD, with <0.01 for each. Significant difference was also found in RMSdi% between high-intensity threshold load training and inspiratory resistive training (69.98%±16.78% vs 17.26%±14.65%, <0.01).
We concluded that threshold load training shows greater mobilization of Pdi and neural respiratory drive than inspiratory resistive training in stable patients with COPD.
吸气肌训练（IMT）是慢性阻塞性肺疾病（COPD）稳定期患者的一种康复治疗方法。然而，由于IMT过程中膈肌活动的性质尚不清楚，其治疗效果仍不明确。以跨膈压（Pdi）表示的膈肌活动和以膈肌肌电图（EMGdi）的校正均方根（RMS）表示的神经呼吸驱动，都为选择合适的IMT设备和负荷提供了重要信息，因此有助于IMT的治疗效果。在COPD稳定期患者的吸气阻力训练和阈值负荷训练期间，测量并比较了Pdi和EMGdi的RMS（RMSdi%）。
对12例COPD稳定期患者（第1秒用力呼气量±标准差为预测值的26.1%±10.2%）在吸气阻力训练和阈值负荷训练期间连续测量Pdi和神经呼吸驱动。
在COPD稳定期患者中，高强度阈值负荷训练期间的Pdi（91.46±17.24 cmH₂O）显著高于吸气阻力训练期间（27.24±6.13 cmH₂O），每组均P<0.01。高强度阈值负荷训练与吸气阻力训练之间的RMSdi%也存在显著差异（69.98%±16.78%对17.26%±14.65%，P<0.01）。
我们得出结论，在COPD稳定期患者中，阈值负荷训练比吸气阻力训练能更好地调动Pdi和神经呼吸驱动。
