Ni Yingmeng, Ding Lin, Yu Youchao, Dai Ranran, Chen Hong, Shi Guochao
Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China.
Exp Ther Med. 2018 Oct;16(4):3241-3248. doi: 10.3892/etm.2018.6552. Epub 2018 Aug 1.
Oscillatory positive expiratory pressure (OPEP) devices have been utilized as an adjunct therapy to conventional chest physiotherapy (CPT) to promote the clearance of respiratory secretions in individuals with impaired ability to cough, particularly in chronic diseases. However, few studies have focused on the effectiveness of OPEP in lower respiratory tract infection. In the present study, all patients with lower respiratory tract infections hospitalized in the Department of Pulmonary and Critical Care Medicine, Ruijin Hospital (Shanghai, China) between February 2016 and July 2017 were analyzed. Daily sputum quantity and purulence were recorded on the first 7 days of physiotherapy. Oxygenation index, partial pressure carbon dioxide, white blood cell count, neutrophil percentage, C reactive protein (CRP) and procalcitonin (PCT) levels before and after CPT were compared between patients who received OPEP and patients who received mechanical percussion (MP). Sputum was collected prior to and following CPT. A total of 17 patients received OPEP, while 10 received MP. The OPEP group exhibited improved postural drainage compared with the MP group after 7 days of physiotherapy. After 7 days of CPT, patients who received OPEP also exhibited a significantly improved oxygenation index, while the oxygenation index in the MP group did not improve. The improvement of partial pressure carbon dioxide was not significantly different between groups. The OPEP group also exhibited a greater decrease in white blood cell count, neutrophil percentage and CRP levels, compared with the MP group. However, the decrease in PCT level was similar in the OPEP and MP groups. Sputum culture results revealed that the rate of negative conversion was very low in both groups. There was no difference between the two groups in terms of hospitalization outcomes. In conclusion, OPEP exhibited a greater effectiveness in draining sputum, improving oxygenation and reducing inflammatory status in patients with lower respiratory tract infections compared with MP; however, it did not promote the elimination of microbes.
振荡呼气正压（OPEP）装置已被用作传统胸部物理治疗（CPT）的辅助治疗手段，以促进咳嗽能力受损个体（尤其是慢性病患者）呼吸道分泌物的清除。然而，很少有研究关注OPEP在下呼吸道感染中的有效性。在本研究中，分析了2016年2月至2017年7月期间在上海瑞金医院肺科与重症医学科住院的所有下呼吸道感染患者。在物理治疗的前7天记录每日痰液量和脓性程度。比较了接受OPEP的患者和接受机械叩击（MP）的患者在CPT前后的氧合指数、二氧化碳分压、白细胞计数、中性粒细胞百分比、C反应蛋白（CRP）和降钙素原（PCT）水平。在CPT前后收集痰液。共有17例患者接受OPEP，10例接受MP。物理治疗7天后，与MP组相比，OPEP组的体位引流效果有所改善。CPT治疗7天后，接受OPEP的患者氧合指数也显著改善，而MP组的氧合指数没有改善。两组间二氧化碳分压的改善无显著差异。与MP组相比，OPEP组的白细胞计数、中性粒细胞百分比和CRP水平下降幅度更大。然而，OPEP组和MP组的PCT水平下降幅度相似。痰培养结果显示两组的转阴率都很低。两组在住院结局方面没有差异。总之，与MP相比，OPEP在引流痰液、改善氧合和降低下呼吸道感染患者炎症状态方面表现出更大的有效性；然而，它并没有促进微生物清除。
