Vitacca M, Clini E, Bianchi L, Ambrosino N
Fondazione Salvatore Maugeri IRCCS, Respiratory Department, Centro Medico di Gussago, Italy.
Eur Respir J. 1998 Feb;11(2):408-15. doi: 10.1183/09031936.98.11020408.
This study investigated the impact of deep diaphragmatic breathing (DB) on blood gases, breathing pattern, pulmonary mechanics and dyspnoea in severe hypercapnic chronic obstructive pulmonary disease (COPD) patients recovering from an acute exacerbation. Transcutaneous partial pressure of carbon dioxide (Ptc,CO2) and oxygen (Ptc,O2) and arterial oxygen saturation (Sa,O2), were continuously monitored in 25 COPD patients with chronic hypercapnia, during natural breathing and DB. In eight of these patients, breathing pattern and minute ventilation (V'E) were also assessed by means of a respiratory inductance plethysmography. In five tracheostomized patients, breathing pattern and mechanics were assessed by means of a pneumotachograph/pressure transducer connected to an oesophageal balloon. Subjective rating of dyspnoea was performed by means of a visual analogue scale. In comparison to natural breathing deep DB was associated with a significant increase in Ptc,O2 and a significant decrease in Ptc,CO2, with a significant increase in tidal volume and a significant reduction in respiratory rate resulting in increased V'E. During DB, dyspnoea worsened significantly and inspiratory muscle effort increased, as demonstrated by an increase in oesophageal pressure swings, pressure-time product and work of breathing. We conclude that in severe chronic obstructive pulmonary disease patients with chronic hypercapnia, deep diaphragmatic breathing is associated with improvement of blood gases at the expense of a greater inspiratory muscle loading.
本研究调查了深膈肌呼吸(DB)对严重高碳酸血症慢性阻塞性肺疾病(COPD)急性加重期恢复患者的血气、呼吸模式、肺力学和呼吸困难的影响。在25例慢性高碳酸血症的COPD患者自然呼吸和进行DB时,连续监测经皮二氧化碳分压(Ptc,CO2)、氧分压(Ptc,O2)和动脉血氧饱和度(Sa,O2)。其中8例患者还通过呼吸感应体积描记法评估呼吸模式和分钟通气量(V'E)。5例气管切开患者通过连接食管气囊的呼吸流速仪/压力传感器评估呼吸模式和力学。通过视觉模拟量表对呼吸困难进行主观评分。与自然呼吸相比,深度DB与Ptc,O2显著增加、Ptc,CO2显著降低相关,潮气量显著增加,呼吸频率显著降低,导致V'E增加。在DB期间,呼吸困难显著加重,吸气肌用力增加,食管压力波动、压力-时间乘积和呼吸功增加证明了这一点。我们得出结论,在患有慢性高碳酸血症的严重慢性阻塞性肺疾病患者中,深膈肌呼吸与血气改善相关,但代价是吸气肌负荷增加。