Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.
Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.
Pediatr Pulmonol. 2021 Jul;56(7):2136-2145. doi: 10.1002/ppul.25412. Epub 2021 Apr 18.
To assess thoracoabdominal asynchrony (TAA) and inspiratory paradoxical motion at different positionings in subjects with Duchenne muscular dystrophy (DMD) versus healthy subjects during quiet spontaneous breathing (QB) and cough.
This is a case control study with a matched-pair design. We assessed 14 DMD subjects and 12 controls using optoelectronic plethysmography (OEP) during QB and spontaneous cough in 3 positions: supine, supine with headrest raised at 45°, and sitting with back support at 80°. The TAA was assessed using phase angle (θ) between upper (RCp) and lower rib cage (RCa) and abdomen (AB), as well as the percentage of inspiratory time the RCp (IP ), RCa (IP ), and AB (IP ) moved in opposite directions.
During cough, DMD group showed higher RCp and RCa θ (p < .05), RCp and AB θ (p < .05) in supine and 45° positions, and higher RCp and Rca θ (p = .006) only in supine position compared with controls. Regarding the intragroup analysis, during cough, DMD group presented higher RCp and AB θ (p = .02) and RCa and AB θ (p = .002) in supine and higher RCa and AB θ (p = .002) in 45° position when compared to 80°. Receiver operating characteristic curve analyzes were able to discriminate TAA between controls and DMD in RCa supine position (area under the curve: 0.81, sensibility: 78.6% and specificity: 91.7%, p = .001).
Subjects with DMD yields TAA with insufficient deflation of chest wall compartments and rib cage distortion during cough, by noninvasive assessment.
在安静自主呼吸（QB）和咳嗽期间，评估杜氏肌营养不良症（DMD）患者与健康受试者在不同体位时的胸腹不同步（TAA）和吸气矛盾运动。
这是一项病例对照研究，采用配对设计。我们使用光电体积描记法（OEP）在 3 种体位（仰卧位、仰卧位头抬高 45°、和背靠 80°坐立位）下评估了 14 例 DMD 患者和 12 例对照者在 QB 和自发性咳嗽期间的 TAA。使用上（RCp）和下（RCa）肋骨笼以及腹部（AB）之间的相位角（θ）来评估 TAA，以及 RCp（IP）、RCa（IP）和 AB（IP）在吸气时反向移动的时间百分比。
在咳嗽期间，DMD 组在仰卧位和 45°位时，RCp 和 RCaθ（p<0.05）、RCp 和 ABθ（p<0.05）更高，且仅在仰卧位时 RCP 和 RCaθ（p=0.006）更高与对照组相比。关于组内分析，在咳嗽时，DMD 组在仰卧位时 RCP 和 ABθ（p=0.02）和 RCa 和 ABθ（p=0.002）更高，在 45°位时 RCa 和 ABθ（p=0.002）更高与 80°相比。受试者工作特征曲线分析能够在 RCa 仰卧位区分对照组和 DMD 的 TAA（曲线下面积：0.81，敏感性：78.6%，特异性：91.7%，p=0.001）。
通过非侵入性评估，DMD 患者在咳嗽时表现出胸壁隔室和肋骨笼变形导致的 TAA 不足。
