腹部抗阻训练联合与不联合咳嗽训练对机械通气延长患者肺功能的影响：一项随机试验。

Effect of abdominal weight training with and without cough machine assistance on lung function in the patients with prolonged mechanical ventilation: a randomized trial.

机构信息

Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, #123, Ta-Pei Road, Niaosong District, Kaohsiung, 833, Taiwan.

Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

出版信息

Crit Care. 2022 May 25;26(1):153. doi: 10.1186/s13054-022-04012-1.

DOI:10.1186/s13054-022-04012-1

PMID:35614518

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9131694/

Abstract

PURPOSE

The patients with prolonged mechanical ventilation (PMV) have the risk of ineffective coughing and infection due to diaphragm weakness. This study aimed to explore the effect of abdominal weight training (AWT) intervention with/without cough machine (CM) assistance on lung function, respiratory muscle strength and cough ability in these patients.

METHODS

Forty patients with PMV were randomly assigned to three groups: AWT group (n = 12), AWT + CM group (n = 14) and control group (n = 14). Change of maximum inspiratory pressure (MIP), Maximum expiratory pressure (MEP) and peak cough flow (PCF) between 1 day before and 2 weeks after the intervention were compared among these three groups.

RESULTS

MIP before and after intervention in AWT group (30.50 ± 11.73 vs. 36.00 ± 10.79; p < 0.05) and AWT + CM group (29.8 ± 12.14 vs. 36.14 ± 10.42; p < 0.05) compared with control group (28.43 ± 9.74 vs 26.71 ± 10.77; p > 0.05) was significantly improved. MEP before and after intervention in AWT group (30.58 ± 15.19 vs. 41.50 ± 18.33; p < 0.05) and AWT + CM group (27.29 ± 12.76 vs 42.43 ± 16.96; p < 0.05) compared with control group (28.86 ± 10.25 vs. 29.57 ± 14.21; p > 0.05) was significantly improved. PCF before and after intervention in AWT group in AWT group (105.83 ± 16.21 vs. 114.17 ± 15.20; p < 0.05) and AWT + CM group (108.57 ± 18.85 vs. 131.79 ± 38.96; p < 0.05) compared to control group (108.57 ± 19.96 vs. 109.86 ± 17.44; p > 0.05) showed significant improvements. AWT + CM group had significantly greater improvements than control group in MIP and peak cough flow than control group (13.71 ± 11.28 vs 19.64 ± 29.90, p < 0.05).

CONCLUSION

AWT can significantly improve lung function, respiratory muscle strength, and cough ability in the PMV patients. AWT + CM can further improve their expiratory muscle strength and cough ability. Trial registration ClinicalTrials.gov registry (registration number: NCT0529538 retrospectively registered on March 3, 2022).

摘要

目的

长时间机械通气（PMV）的患者由于膈肌无力，存在无效咳嗽和感染的风险。本研究旨在探讨腹部重量训练（AWT）联合/不联合咳嗽机（CM）辅助对这些患者肺功能、呼吸肌力量和咳嗽能力的影响。

方法

将 40 名 PMV 患者随机分为三组：AWT 组（n=12）、AWT+CM 组（n=14）和对照组（n=14）。比较三组患者干预前 1 天和干预后 2 周最大吸气压力（MIP）、最大呼气压力（MEP）和峰值咳嗽流量（PCF）的变化。

结果

AWT 组（30.50±11.73 比 36.00±10.79；p<0.05）和 AWT+CM 组（29.8±12.14 比 36.14±10.42；p<0.05）与对照组（28.43±9.74 比 26.71±10.77；p>0.05）相比，干预前后 MIP 均明显改善。AWT 组（30.58±15.19 比 41.50±18.33；p<0.05）和 AWT+CM 组（27.29±12.76 比 42.43±16.96；p<0.05）与对照组（28.86±10.25 比 29.57±14.21；p>0.05）相比，干预前后 MEP 均明显改善。AWT 组干预前后 PCF （105.83±16.21 比 114.17±15.20；p<0.05）和 AWT+CM 组（108.57±18.85 比 131.79±38.96；p<0.05）与对照组（108.57±19.96 比 109.86±17.44；p>0.05）相比，均明显改善。AWT+CM 组与对照组相比，MIP 和峰值咳嗽流量改善更显著（13.71±11.28 比 19.64±29.90；p<0.05）。