Dionísio Gustavo Henrique, Dos Santos Daniele Oliveira, Perossi Larissa, de Paula Mayara Holtz, de Souza Hugo Celso Dutra, Gastaldi Ada Clarice
Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Department of Physiotherapy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Respir Care. 2018 May;63(5):565-572. doi: 10.4187/respcare.05471. Epub 2018 Feb 27.
Impulse oscillometry is a method of airway assessment and diagnosis that provides data on lung mechanics. In the literature, studies have used different types of mouthpieces or did not describe the model used for the tests. We sought to compare the 3 most commonly described mouthpieces in terms of test results, comfort, and subject preference.
Thirty-nine healthy volunteers were evaluated with spirometry and impulse oscillometry, assessing the resistance at 5 Hz and 20 Hz (R5 and R20, respectively), reactance at 5 Hz (X5), reactance area, and resonant frequency. A filter heat exchanger with a circular mouthpiece (B1), a filter heat exchanger with an oval mouthpiece (B2), and a filter heat exchanger with a circular mouthpiece coupled with a free-flow piece (B3) were compared using an acceptability and tolerance scale, and subjects noted their preference.
Statistical analysis showed differences between all the mouthpieces and the predicted values for R5, R20, and X5. The mouthpiece comparison showed differences in R5 between a filter heat exchanger with an oval mouthpiece (B2) and a circular mouthpiece coupled with a free-flow piece (B3) ( = .007); resonant frequency between a filter heat exchanger with a circular mouthpiece (B1) and a filter heat exchanger with an oval mouthpiece (B2) ( = .004) and between a filter heat exchanger with a circular mouthpiece (B1) and a circular mouthpiece coupled with a free-flow piece (B3) ( = .003); and reactance area between a filter heat exchanger with a circular mouthpiece (B1) and a circular mouthpiece coupled with a free-flow piece (B3) ( = .01). In the subjective evaluation, acceptability and tolerance differences were found in the ease of carrying out the evaluation, and no difference was found with regard to the degree of discomfort. Ten subjects preferred a filter heat exchanger with a circular mouthpiece (B1), 15 preferred a filter heat exchanger with an oval mouthpiece (B2), and 14 preferred a circular mouthpiece coupled with a free-flow piece (B3).
A circular mouthpiece coupled with a free-flow piece (B3) appeared to be the most suitable mouthpiece for the impulse oscillometry tests. It assured smaller impedance values for the respiratory system, and subjects expressed the most confidence in using this mouthpiece.
脉冲振荡法是一种气道评估和诊断方法，可提供肺力学数据。在文献中，研究使用了不同类型的咬嘴，或者未描述测试所用的型号。我们试图比较3种最常描述的咬嘴在测试结果、舒适度和受试者偏好方面的差异。
对39名健康志愿者进行肺活量测定和脉冲振荡法评估，测量5Hz和20Hz时的阻力（分别为R5和R20）、5Hz时的电抗（X5）、电抗面积和共振频率。使用可接受性和耐受性量表比较了带圆形咬嘴的过滤式热交换器（B1）、带椭圆形咬嘴的过滤式热交换器（B2）和带圆形咬嘴并配有自由流通部件的过滤式热交换器（B3），受试者记录了他们的偏好。
统计分析显示，所有咬嘴与R5、R20和X5的预测值之间存在差异。咬嘴比较显示，带椭圆形咬嘴的过滤式热交换器（B2）与带圆形咬嘴并配有自由流通部件的过滤式热交换器（B3）在R5上存在差异（P = 0.007）；带圆形咬嘴的过滤式热交换器（B1）与带椭圆形咬嘴的过滤式热交换器（B2）在共振频率上存在差异（P = 0.004），带圆形咬嘴的过滤式热交换器（B1）与带圆形咬嘴并配有自由流通部件的过滤式热交换器（B3）在共振频率上也存在差异（P = 0.003）；带圆形咬嘴的过滤式热交换器（B1）与带圆形咬嘴并配有自由流通部件的过滤式热交换器（B3）在电抗面积上存在差异（P = 0.01）。在主观评估中，发现评估的难易程度存在可接受性和耐受性差异，而在不适程度方面未发现差异。10名受试者更喜欢带圆形咬嘴的过滤式热交换器（B1），15名更喜欢带椭圆形咬嘴的过滤式热交换器（B2），14名更喜欢带圆形咬嘴并配有自由流通部件的过滤式热交换器（B3）。
带圆形咬嘴并配有自由流通部件的过滤式热交换器（B3）似乎是脉冲振荡法测试最合适的咬嘴。它确保呼吸系统的阻抗值更小，并且受试者对使用该咬嘴最有信心。
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