Schaper-Magalhães Flavia, Pinho José Felippe, Capuruço Carolina Andrade Bragança, Rodrigues-Machado Maria Glória
Medical Sciences Faculty of Minas Gerais, Post-Graduation Program in Health Sciences, Belo Horizonte, Brazil.
Department of Cardiology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Int J Chron Obstruct Pulmon Dis. 2017 Oct 6;12:2943-2954. doi: 10.2147/COPD.S138737. eCollection 2017.
Inspiratory muscle training (IMT) using a Threshold device is commonly used to improve the strength and endurance of inspiratory muscles. However, the effect of IMT, alone or with positive end-expiratory pressure (PEEP), on hemodynamic parameters in patients with chronic obstructive pulmonary disease (COPD) remains unknown.
To assess the effects of an overload of inspiratory muscles using IMT fixed at 30% of the maximal inspiratory pressure (MIP), and IMT associated with 5 cmHO of PEEP (IMT + PEEP), on the echocardiographic parameters in healthy subjects and patients with COPD.
Twenty patients with COPD (forced expiratory volume in 1 second 53.19±24.71 pred%) and 15 age-matched healthy volunteers were evaluated using spirometry, MIP, the COPD assessment test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. The E- (fast-filling phase) and A- (atrial contraction phase) waves were evaluated at the tricuspid and mitral valves during inspiration and expiration in the following sequence: at basal conditions, using IMT, and using IMT + PEEP.
Patients with COPD had reduced MIPs versus the control group. Ten patients had CAT scores <10 and 12 patients had mMRC scores <2. E-wave values at the mitral valve were significantly decreased with IMT during the inspiratory phase in both groups. These effects were normalized with IMT + PEEP. During the expiratory phase, use of IMT + PEEP normalized the reduction in E-wave values in the COPD group. During inspiration at the tricuspid valve, reduction in E-wave values during IMT was normalized by IMT + PEEP in COPD group. During the expiratory phase, the value of the E-waves was significantly reduced with overload of the inspiratory muscles in both groups, and these effects were normalized with IMT + PEEP. A-waves did not change under any conditions.
Acute hemodynamic effects induced by overloading of the inspiratory muscles were attenuated and/or reversed by the addition of PEEP in COPD patients.
使用阈值装置进行吸气肌训练（IMT）常用于提高吸气肌的力量和耐力。然而，IMT单独使用或联合呼气末正压（PEEP）对慢性阻塞性肺疾病（COPD）患者血流动力学参数的影响仍不清楚。
评估采用固定为最大吸气压（MIP）30%的IMT以及联合5 cmH₂O PEEP的IMT（IMT + PEEP）对健康受试者和COPD患者超声心动图参数的影响。
对20例COPD患者（第1秒用力呼气容积为预计值的53.19±24.71%）和15名年龄匹配的健康志愿者进行肺活量测定、MIP、COPD评估测试（CAT）以及改良医学研究委员会（mMRC）呼吸困难量表评估。在吸气和呼气过程中，按以下顺序评估三尖瓣和二尖瓣处的E波（快速充盈期）和A波（心房收缩期）：基础状态、使用IMT时、使用IMT + PEEP时。
与对照组相比，COPD患者的MIP降低。10例患者的CAT评分<10，12例患者的mMRC评分<2。两组在吸气期使用IMT时，二尖瓣处的E波值均显著降低。这些影响在IMT + PEEP时恢复正常。在呼气期，使用IMT + PEEP使COPD组E波值的降低恢复正常。在COPD组，三尖瓣处吸气时，IMT期间E波值的降低通过IMT + PEEP恢复正常。在呼气期，两组吸气肌负荷增加时E波值均显著降低，这些影响在IMT + PEEP时恢复正常。在任何情况下A波均无变化。
在COPD患者中，增加PEEP可减轻和/或逆转吸气肌负荷过重引起的急性血流动力学效应。
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