Asakawa Takashi, Ogino Mieko, Tominaga Naomi, Ozaki Naoto, Kubo Jin, Kakuda Wataru
Department of Clinical Medical Sciences, Rehabilitation Medicine, International University of Health and Welfare Graduate School of Medicine, Narita, Japan.
Department of Rehabilitation Division of Physiotherapy, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan.
Prog Rehabil Med. 2023 Oct 3;8:20230035. doi: 10.2490/prm.20230035. eCollection 2023.
One of the causes of death in patients with multiple system atrophy (MSA) is aspiration pneumonia caused by cough dysfunction. This study aimed to identify an effective approach to improve coughing and to explore the establishment of criteria for the use of gastrostomy based on cough and respiratory dysfunctions.
Eighteen probable MSA patients participated in the study. They were categorized into air stacking and non-air stacking groups. First, we investigated how the inspiration volume changes by applying maximum insufflation capacity (MIC). Second, peak cough flow (PCF) was measured by different cough augmentation methods: 1) spontaneous coughing (SpC); 2) SpC with MIC (SpC + MIC); 3) SpC with manually assisted cough (MAC) (SpC + MAC); and 4) SpC with MIC and MAC (SpC + MIC + MAC). Among these four conditions, PCF values were compared to determine the most effective approach for cough augmentation. Receiver operating characteristic analysis was performed on percent forced vital capacity (%FVC) to determine an index for discriminating PCF below160 L/min, which indicates a high risk of suffocation, involving SpC and SpC + MIC.
Inspiration volume increased significantly with MIC in both groups (P < 0.05), and PCF increased significantly with MIC in the air stacking group (P < 0.01). PCF could not be maintained at 160 L/min when %FVC fell below 59%, even when MIC was applied.
PCF increases with MIC in patients with MSA. It may be meaningful to consider the timing of gastrostomy introduction based on the severity of cough and respiratory dysfunction.
多系统萎缩（MSA）患者的死亡原因之一是咳嗽功能障碍导致的吸入性肺炎。本研究旨在确定一种改善咳嗽的有效方法，并探索基于咳嗽和呼吸功能障碍建立胃造口术使用标准。
18例可能患有MSA的患者参与了本研究。他们被分为空气堆叠组和非空气堆叠组。首先，我们通过应用最大吸气容量（MIC）来研究吸气量如何变化。其次，通过不同的咳嗽增强方法测量峰值咳嗽流量（PCF）：1）自主咳嗽（SpC）；2）SpC加MIC（SpC + MIC）；3）SpC加手动辅助咳嗽（MAC）（SpC + MAC）；4）SpC加MIC和MAC（SpC + MIC + MAC）。在这四种情况下，比较PCF值以确定增强咳嗽的最有效方法。对用力肺活量百分比（%FVC）进行受试者工作特征分析，以确定区分PCF低于160 L/min（这表明窒息风险高）的指标，其中涉及SpC和SpC + MIC。
两组中吸气量均随MIC显著增加（P < 0.05），空气堆叠组中PCF随MIC显著增加（P < 0.01）。当%FVC低于59%时，即使应用MIC，PCF也无法维持在160 L/min。
MSA患者的PCF随MIC增加。根据咳嗽和呼吸功能障碍的严重程度考虑胃造口术的引入时机可能具有重要意义。
