不同自主呼吸训练方法对区域性肺通气影响的对比研究

关键词：生物电阻抗成像技术  区域性肺通气  腹式呼吸  缩唇呼吸  慢性阻塞性肺疾病

Keywords:electrical impedance tomography  regional pulmonary ventilation  diaphragmatic breathing  pursed lip breathing  chronic obstructive pulmonary disease

摘要：

      摘要 目的：利用生物电阻抗成像（EIT）技术探究不同自主呼吸训练方法对区域性肺通气的影响， 以期为慢性阻塞性肺疾病（COPD）患者在训练标准及方法选取上提供行之有效的康复指导方案。 方法：共纳入28名健康志愿者，取舒适站立位并进行：①平静呼吸；②腹式呼吸；③缩唇呼吸；④腹式缩唇呼吸，每位被试的四种呼吸方式随机决定，整个过程中连续记录胸部EIT；分别对比四种呼吸方式期间的潮气量（TV）、呼气末肺阻抗（EELI）、通气中心（center of ventilation， CoV）、不均一指数（GI）、区域通气延迟（RVD）。 结果：较平静呼吸，腹式呼吸、缩唇呼吸及腹式缩唇呼吸三种呼吸训练方法期间的TV明显增大（P＜0.05）； EELI明显降低（P＜0.05）；CoV明显减小（P＜0.05，腹侧通气增多）；腹式呼吸和腹式缩唇呼吸的GI明显减小（P＜0.05，通气更均匀）；缩唇呼吸和腹式缩唇呼吸RVD明显增加（P＜0.05）。 结论：腹式呼吸、缩唇呼吸、腹式缩唇呼三种呼吸训练方法均能有效增加肺通气量，减少肺功能残气量，但三种呼吸训练方法对肺通气的影响各不相同：缩唇呼吸通气向腹侧移动更显著（COV更小），区域通气延迟更显著（RVD更大），而腹式呼吸可改善通气均匀性（GI更小）。因此，从区域性肺通气的角度，建议COPD患者在进行呼吸训练时应腹式呼吸与缩唇呼吸独立交替进行，以达到更好的呼吸训练效果。

Abstract:

      Abstract Objective： To explore the impact of different autonomous breathing exercises on regional pulmonary ventilation using electrical impedance tomography （EIT）， in order to provide effective rehabilitation guidance for patients with chronic obstructive pulmonary disease (COPD) in selecting exercise standards and methods. Method： A total of 28 healthy volunteers were recruited in the study， who performed the following breathing exercises in a comfortable standing position： ①quiet breathing； ②diaphragmatic breathing； ③pursed-lip breathing； ④pursed-lip combining diaphragmatic breathing. The four breathing modes were randomly determined for each subject. Chest EIT was continuously performed during the whole process. The tidal volume （TV）， end-expiratory lung impedance （EELI）， center of ventilation （CoV）， global inhomogeneity index （GI） and regional ventilation delay （RVD） were compared during the four breathing modes. Result： Compared with quiet breathing， diaphragmatic breathing, pursed-lip breathing, and diaphragmatic pursed-lip breathing significantly increased TV（P<0.05）, reduced EELI（P<0.05） and decreased CoV （P<0.05， with increased ventral ventilation）. GI of diaphragmatic breathing and pursed lip combining diaphragmatic breathing was significantly reduced （P<0.05， more uniform ventilation）， while RVD of pursed lip breathing and pursed lip combining diaphragmatic breathing was significantly increased （P<0.05）. Conclusion： Diaphragmatic breathing， pursed-lip breathing， and pursed-lip combining diaphragmatic breathing can effectively increase pulmonary ventilation and reduce pulmonary functional residual volume. However, the three breathing exercises have different impacts on pulmonary ventilation: pursed-lip breathing shifts ventilation more significantly towards the ventral side （smaller COV）， and has a more significant regional ventilation delayed（larger RVD）， while diaphragmatic breathing improves ventilation homogeneity （smaller GI）. Therefore, from the perspective of regional pulmonary ventilation， it is recommended that COPD patients should alternate between diaphragmatic breathing and pursed-lip breathing independently during breathing exercises to achieve better breathing exercise effects.