Neuroscience Research Australia, Sydney, New South Wales, Australia
Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia.
Thorax. 2020 Mar;75(3):279-288. doi: 10.1136/thoraxjnl-2019-213917. Epub 2020 Jan 14.
Respiratory complications remain a leading cause of morbidity and mortality in people with acute and chronic tetraplegia. Respiratory muscle weakness following spinal cord injury-induced tetraplegia impairs lung function and the ability to cough. In particular, inspiratory muscle strength has been identified as the best predictor of the likelihood of developing pneumonia in individuals with tetraplegia. We hypothesised that 6 weeks of progressive respiratory muscle training (RMT) increases respiratory muscle strength with improvements in lung function, quality of life and respiratory health.
Sixty-two adults with tetraplegia participated in a double-blind randomised controlled trial. Active or sham RMT was performed twice daily for 6 weeks. Inspiratory muscle strength, measured as maximal inspiratory pressure (PImax) was the primary outcome. Secondary outcomes included lung function, quality of life and respiratory health. Between-group comparisons were obtained with linear models adjusting for baseline values of the outcomes.
After 6 weeks, there was a greater improvement in PImax in the active group than in the sham group (mean difference 11.5 cmHO (95% CI 5.6 to 17.4), p<0.001) and respiratory symptoms were reduced (St George Respiratory Questionnaire mean difference 10.3 points (0.01-20.65), p=0.046). Significant improvements were observed in quality of life (EuroQol-Five Dimensional Visual Analogue Scale 14.9 points (1.9-27.9), p=0.023) and perceived breathlessness (Borg score 0.64 (0.11-1.17), p=0.021). There were no significant improvements in other measures of respiratory function (p=0.126-0.979).
Progressive RMT increases inspiratory muscle strength in people with tetraplegia, by a magnitude which is likely to be clinically significant. Measurement of baseline PImax and provision of RMT to at-risk individuals may reduce respiratory complications after tetraplegia.
Australian New Zealand Clinical Trials Registry (ACTRN 12612000929808).
呼吸并发症仍然是急性和慢性四肢瘫痪患者发病率和死亡率的主要原因。脊髓损伤引起的四肢瘫痪后呼吸肌无力会损害肺功能和咳嗽能力。特别是，吸气肌力量已被确定为预测四肢瘫痪患者发生肺炎可能性的最佳指标。我们假设，6 周的渐进性呼吸肌训练（RMT）可增加呼吸肌力量，改善肺功能、生活质量和呼吸健康。
62 名四肢瘫痪的成年人参加了一项双盲随机对照试验。主动或假 RMT 每天进行两次，持续 6 周。吸气肌力量，以最大吸气压力（PImax）来衡量，是主要结局。次要结局包括肺功能、生活质量和呼吸健康。使用线性模型进行组间比较，调整结局的基线值。
6 周后，主动组的 PImax 改善程度大于假组（平均差异 11.5 cmHO（95%CI 5.6 至 17.4），p<0.001），呼吸症状减轻（圣乔治呼吸问卷平均差异 10.3 分（0.01 至 20.65），p=0.046）。生活质量（EuroQol-Five Dimensional Visual Analogue Scale 14.9 分（1.9 至 27.9），p=0.023）和呼吸困难感知（Borg 评分 0.64（0.11 至 1.17），p=0.021）有显著改善。其他呼吸功能测量值无显著改善（p=0.126-0.979）。
渐进式 RMT 可增加四肢瘫痪患者的吸气肌力量，其程度可能具有临床意义。测量基线 PImax 并为高危个体提供 RMT 可能会减少四肢瘫痪后的呼吸并发症。
澳大利亚和新西兰临床试验注册中心（ACTRN 12612000929808）。
