COPD 患者不同呼吸困难缓解体位和呼吸练习时的神经呼吸驱动。
Neural Respiratory Drive During Different Dyspnea Relief Positions and Breathing Exercises in Individuals With COPD.
机构信息
Department of Cardiorespiratory Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant İzzet Baysal University, Bolu, Türkiye.
出版信息
Respir Care. 2024 Aug 24;69(9):1129-1137. doi: 10.4187/respcare.11790.
BACKGROUND
When the work load of the respiratory muscles increases and/or their capacity decreases in individuals with COPD, respiratory muscle activation increases to maintain gas exchange and respiratory mechanics, and perception of dyspnea occurs. The present study aimed to compare diaphragm and accessory respiratory muscle activation during normal breathing, pursed-lip breathing, and breathing control in different dyspnea relief positions, supine and side lying.
METHODS
A cross-sectional study design was used. Sixteen individuals with COPD age between 40-75 y were included. Pulmonary function was evaluated by spirometry, muscle activation by surface electromyography, and dyspnea by the modified Borg scale. Muscle activation was measured in the diaphragm, scalene, sternocleidomastoid, and parasternal muscles. The evaluation was made in the dyspnea relief positions (sitting leaning forward, sitting leaning forward at a table, leaning forward with back against a wall, standing leaning forward, and high lying), seated erect, supine, and side lying.
RESULTS
There were significant differences between the 8 positions ( < .001). There was no significant difference in muscle activation between sitting leaning forward and sitting leaning forward at a table position with analyzing post hoc test results ( > .99 for each muscle). However, muscle activation was lower in these 2 positions than in the other positions ( < .001 for each muscle). Muscle activation was greater in the supine position than in the other positions ( < .001 for each muscle). No difference was observed in muscle activation between the seated erect, leaning forward with back against a wall, standing leaning forward, high-lying, or side-lying positions ( > .05 for each muscle with a minimum value of .09).
CONCLUSIONS
The use of sitting leaning forward and sitting leaning forward at a table positions together with breathing control may help people with COPD to achieve more effective dyspnea relief and greater energy efficiency.
背景
当 COPD 患者的呼吸肌工作量增加和/或其容量下降时，呼吸肌会增加激活以维持气体交换和呼吸力学，并引起呼吸困难感知。本研究旨在比较正常呼吸、缩唇呼吸和不同呼吸困难缓解体位（仰卧位和侧卧位）下辅助呼吸肌在膈肌和辅助呼吸肌的激活。
方法
采用横断面研究设计。纳入 16 名 40-75 岁的 COPD 患者。通过肺活量测定法评估肺功能，通过表面肌电图评估肌肉激活，通过改良 Borg 量表评估呼吸困难。测量了膈肌、斜角肌、胸锁乳突肌和胸骨旁肌的肌肉激活。评估在呼吸困难缓解体位（前倾坐、前倾坐于桌旁、靠墙前倾、站立前倾和高卧位）、坐直、仰卧和侧卧位进行。
结果
8 种体位之间存在显著差异（<0.001）。分析事后检验结果后，发现前倾坐和前倾坐于桌旁位置的肌肉激活没有差异（每个肌肉>0.99）。然而，这两个位置的肌肉激活低于其他位置（每个肌肉<0.001）。仰卧位的肌肉激活高于其他位置（每个肌肉<0.001）。坐直、靠墙前倾、站立前倾、高卧位和侧卧位之间的肌肉激活没有差异（每个肌肉>0.05，最小差异值为 0.09）。
结论
同时使用前倾坐和前倾坐于桌旁体位以及呼吸控制可能有助于 COPD 患者更有效地缓解呼吸困难并提高能量效率。
Zotero 插件