Aldrich T K, Karpel J P, Uhrlass R M, Sparapani M A, Eramo D, Ferranti R
Department of Medicine, Montefiore Medical Center, North Central Bronx Hospital, NY 10467.
Crit Care Med. 1989 Feb;17(2):143-7.
We used inspiratory resistive training (IRT) in an effort to improve the respiratory muscle endurance of 27 patients with respiratory failure who had failed repeated weaning attempts using standard techniques. Seven patients had primary neuromuscular diseases; the other 20 had primary lung diseases. All patients had stable respiratory failure, without gross malnutrition or electrolyte disorders. Their best initial T-piece duration averaged 6.4 +/- 8.4 (SD) h, with pHa 7.33 +/- 0.09 and PCO2 63 +/- 4 torr at the end of the T-piece trial. We provided a mean of five weekly training sessions of spontaneous breathing through an adjustable nonlinear resistor, with gradually increasing duration and resistance. When initial T-piece tolerance was less than 2 h, two to ten breaths of mechanical ventilation were provided during IRT sessions. No training session exceeded 30 min, and mechanical ventilation was provided between IRT sessions. Under this regimen, maximal inspiratory pressure improved from -37 +/- 15 to -46 +/- 15 cm H2O (p less than .001) and vital capacity improved from 561 +/- 325 to 901 +/- 480 ml (p less than .001). Twelve of the 27 patients were successfully weaned after 10 to 46 days; five more were weaned to nocturnal ventilation, for a total of 63%. We conclude that IRT can improve respiratory muscle strength and endurance in patients with respiratory failure, and can allow many of them to be weaned from mechanical ventilation.
我们采用吸气阻力训练（IRT）来提高27例呼吸衰竭患者的呼吸肌耐力，这些患者使用标准技术多次尝试撤机均失败。7例患者患有原发性神经肌肉疾病；另外20例患有原发性肺部疾病。所有患者的呼吸衰竭病情稳定，无明显营养不良或电解质紊乱。他们最初使用T形管的最佳持续时间平均为6.4±8.4（标准差）小时，在T形管试验结束时，动脉血pH值为7.33±0.09，二氧化碳分压为63±4托。我们通过一个可调节的非线性电阻器，平均每周为患者提供五次自主呼吸训练，训练时间和阻力逐渐增加。当初始T形管耐受时间小于2小时时，在IRT训练期间给予2至10次机械通气。每次训练时间不超过30分钟，在IRT训练之间给予机械通气。在这种方案下，最大吸气压力从-37±15厘米水柱提高到-46±15厘米水柱（p<0.001），肺活量从561±325毫升提高到901±480毫升（p<0.001）。27例患者中有12例在10至46天后成功撤机；另外5例改为夜间通气，撤机成功率总计为63%。我们得出结论，IRT可以提高呼吸衰竭患者的呼吸肌力量和耐力，并使他们中的许多人能够从机械通气中撤机。
