Department of Physiology, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY.
Department of Neurological Surgery, University of Louisville, Louisville, KY.
Arch Phys Med Rehabil. 2018 Mar;99(3):423-432. doi: 10.1016/j.apmr.2017.06.033. Epub 2017 Aug 9.
To evaluate the effects of pressure threshold respiratory training (RT) on heart rate variability and baroreflex sensitivity in persons with chronic spinal cord injury (SCI).
Before-after intervention case-controlled clinical study.
SCI research center and outpatient rehabilitation unit.
Participants (N=44) consisted of persons with chronic SCI ranging from C2 to T11 who participated in RT (n=24), and untrained control subjects with chronic SCI ranging from C2 to T9 (n=20).
A total of 21±2 RT sessions performed 5 days a week during a 4-week period using a combination of pressure threshold inspiratory and expiratory devices.
Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV), and beat-to-beat arterial blood pressure and heart rate changes during the 5-second-long maximum expiratory pressure maneuver (5s MEP) and the sit-up orthostatic stress test, acquired before and after the RT program.
In contrast to the untrained controls, individuals in the RT group experienced significantly increased FVC and FEV (both P<.01) in association with improved quality of sleep, cough, and speech. Sympathetically (phase II) and parasympathetically (phase IV) mediated baroreflex sensitivity both significantly (P<.05) increased during the 5s MEP. During the orthostatic stress test, improved autonomic control over heart rate was associated with significantly increased sympathetic and parasympathetic modulation (low- and high-frequency change: P<.01 and P<.05, respectively).
Inspiratory-expiratory pressure threshold RT is a promising technique to positively affect both respiratory and cardiovascular dysregulation observed in persons with chronic SCI.
评估压力阈呼吸训练（RT）对慢性脊髓损伤（SCI）患者心率变异性和压力感受性反射敏感性的影响。
干预前后对照的临床研究。
SCI 研究中心和门诊康复单位。
参与者（N=44）包括从 C2 到 T11 的慢性 SCI 患者，他们参加了 RT（n=24），以及从 C2 到 T9 的未经训练的慢性 SCI 对照受试者（n=20）。
在 4 周的时间内，每周 5 天，使用压力阈吸气和呼气设备的组合，共进行 21±2 次 RT 治疗。
用力肺活量（FVC）、1 秒用力呼气量（FEV），以及在 5 秒最大呼气压力（5s MEP）和仰卧起坐直立应激测试期间的动脉血压和心率变化，在 RT 方案前后采集。
与未经训练的对照组相比，RT 组的个体经历了显著的 FVC 和 FEV 增加（均 P<.01），同时睡眠质量、咳嗽和言语也得到改善。在 5s MEP 期间，压力感受性反射的交感神经（相位 II）和副交感神经（相位 IV）介导的敏感性均显著增加（P<.05）。在直立应激测试期间，心率自主控制的改善与交感神经和副交感神经调节的显著增加相关（低频和高频变化：P<.01 和 P<.05，分别）。
吸气-呼气压力阈 RT 是一种有前途的技术，可以积极影响慢性 SCI 患者观察到的呼吸和心血管失调。
