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腹式呼吸和胸式呼吸对正常受试者及慢性阻塞性肺疾病患者呼吸模式组成部分的影响。

Effects of abdominal and thoracic breathing on breathing pattern components in normal subjects and in patients with chronic obstructive pulmonary disease.

作者信息

Sackner M A, Gonzalez H F, Jenouri G, Rodriguez M

出版信息

Am Rev Respir Dis. 1984 Oct;130(4):584-7. doi: 10.1164/arrd.1984.130.4.584.

Abstract

The purpose of this study was to assess the effect of voluntarily controlled breathing maneuvers on breathing pattern components measured noninvasively with the respiratory inductive plethysmograph. In normal subjects, these maneuvers included predominantly thoracic and abdominal patterns with and without visual reinforcement from video-displayed plots of rib cage versus abdominal loops. In patients with chronic obstructive pulmonary disease (COPD), only predominantly abdominal breathing without and with visual feedback was employed; the latter produced greater abdominal contribution to tidal volume. Voluntarily controlled breathing patterns led to increased minute ventilation (VI) in normal subjects because of variable changes of frequency and tidal volume. This increase in ventilation was achieved despite increased asynchronous and paradoxic motion between rib cage and abdominal excursions that would add to the work of breathing. Patients with COPD had heightened baseline respiratory center drive when compared with that in normal subjects, as evidenced by elevation of VI and mean respiratory flow (VT/TI). In contrast to normal subjects, abdominal breathing produced no change in VI and VT/TI for the group as a whole, but 6 of the 9 patients with COPD had decreases compared with natural breathing. This diminution of respiratory drive in some patients with COPD during voluntary abdominal breathing might relate to limitation of ventilatory response by the increased work of breathing caused by pulmonary hyperinflation, elevated airway resistance, and increased asynchronous and paradoxic motion of the rib cage to the abdominal excursions, and/or the mental activity required to perform the breathing maneuver might be inhibitory to respiratory drive.

摘要

本研究的目的是评估自主控制呼吸动作对通过呼吸感应体积描记器无创测量的呼吸模式组成部分的影响。在正常受试者中,这些动作主要包括胸式和腹式呼吸模式,有或没有来自胸廓与腹部环视频显示图的视觉强化。在慢性阻塞性肺疾病(COPD)患者中,仅采用主要的腹式呼吸,有无视觉反馈;后者使腹部对潮气量的贡献更大。自主控制的呼吸模式导致正常受试者的分钟通气量(VI)增加,这是由于频率和潮气量的变化所致。尽管胸廓与腹部运动之间的异步和矛盾运动增加,这会增加呼吸功,但通气量仍实现了这种增加。与正常受试者相比,COPD患者的基线呼吸中枢驱动增强,表现为VI和平均呼吸流量(VT/TI)升高。与正常受试者不同,腹式呼吸对整个COPD患者组的VI和VT/TI没有影响,但9例COPD患者中有6例与自然呼吸相比有所下降。一些COPD患者在自主腹式呼吸期间呼吸驱动的减弱可能与肺过度充气、气道阻力升高以及胸廓与腹部运动的异步和矛盾运动增加导致的呼吸功增加对通气反应的限制有关,和/或进行呼吸动作所需的精神活动可能对呼吸驱动有抑制作用。

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