在GOLD 3-4级慢性阻塞性肺疾病（COPD）患者中，持续气道正压通气（CPAP）和呼气末气道正压通气（EPAP）以非等效模式引起相似的肺萎陷。

CPAP and EPAP elicit similar lung deflation in a non-equivalent mode in GOLD 3-4 COPD patients.

作者信息

Müller Paulo de Tarso, Christofoletti Gustavo, Koch Rodrigo, Zardetti Nogueira João Henrique, Patusco Luiz Armando Pereira, Chiappa Gaspar Rogério

机构信息

Federal University of Mato Grosso do Sul (UFMS)/Maria Aparecida Pedrossian Hospital (HUMAP), Laboratory of Respiratory Pathophysiology (LAFIR)/Division of Respiratory Medicine, Campo Grande, Mato Grosso do Sul, MS, Brazil.

Department of Physical Therapy, University of Brasilia (UnB), Brasilia, Brazil.

出版信息

Clin Respir J. 2018 Apr;12(4):1598-1606. doi: 10.1111/crj.12716. Epub 2017 Oct 24.

DOI:10.1111/crj.12716

PMID:28960914

Abstract

INTRODUCTION

Lung hyperinflation is associated with inspiratory muscle strength reduction, nocturnal desaturation, dyspnea, altered cardiac function and poor exercise capacity in advanced COPD.

OBJECTIVES

We investigated the responses of inspiratory capacity (IC) and inspiratory muscle strength (PImax), comparing continuous positive airway pressure (CPAP) and expiratory positive airway pressure (EPAP) with the main hypothesis that there would be similar effects on lung deflation.

METHODS

Eligible patients were submitted to 10 cmH O CPAP and EPAP on different days, under careful ECG (HR) and peripheral oxygen saturation (SpO ) monitoring.

RESULTS

Twenty-one eligible COPD patients were studied (13 male/8 female, FEV % predicted of 36.5 ± 9.8). Both CPAP and EPAP demonstrated significant post-pre (Δ) changes for IC and PImax, with mean ΔIC for CPAP and EPAP of 200 ± 100 mL and 170 ± 105 mL (P = .001 for both) in 13 and 12 patients (responders) respectively. There were similar changes in % predicted IC and PImax (∼7%, P = .001 for both) for responders and poor responder/non-responder agreement depending on CPAP/EPAP mode (Kappa = .113, P = .604). There were no differences in CPAP and EPAP regarding intensity of lung deflation (P =.254) and no difference was measured regarding HR (P = .235) or SpO (P = .111) CONCLUSIONS: Both CPAP and EPAP presented a similar effect on lung deflation, without guaranteeing that the response to one modality would be predictive of the response to the other.

摘要

引言

肺过度充气与晚期慢性阻塞性肺疾病（COPD）患者的吸气肌力量降低、夜间低氧血症、呼吸困难、心功能改变及运动能力下降有关。

目的

我们研究了吸气容量（IC）和吸气肌力量（PImax）的反应，比较了持续气道正压通气（CPAP）和呼气末正压通气（EPAP），主要假设是二者对肺萎陷的影响相似。

方法

符合条件的患者在不同日期接受10 cmH₂O的CPAP和EPAP治疗，同时进行仔细的心电监护（HR）和外周血氧饱和度（SpO₂）监测。

结果

共研究了21例符合条件的COPD患者（13例男性/8例女性，预测FEV₁%为36.5±9.8）。CPAP和EPAP治疗后IC和PImax均有显著的前后变化（Δ），13例和12例患者（反应者）中，CPAP和EPAP的平均ΔIC分别为200±100 mL和170±105 mL（两者P均=0.001）。反应者的预测IC和PImax百分比有相似变化（约7%，两者P均=0.001），根据CPAP/EPAP模式，反应者与反应差者/无反应者的一致性较差（Kappa=0.113，P=0.604）。CPAP和EPAP在肺萎陷强度方面无差异（P=0.254），在HR（P=0.235）或SpO₂（P=0.111）方面也无差异。结论：CPAP和EPAP对肺萎陷的影响相似，但不能保证对一种模式的反应可预测对另一种模式的反应。