呼吸训练联合肌电生物反馈对脑梗死恢复期患者吞咽功能的影响

目的:观察呼吸训练联合肌电生物反馈对脑梗死恢复期患者吞咽功能的影响。方法:选取脑梗死恢复期伴吞咽障碍的患者96例,按随机数字表法将其分为对照组、生物反馈组、综合治疗组,每组32例。对照组接受常规吞咽障碍康复治疗,生物反馈组在对照组基础上接受肌电生物反馈训练,综合治疗组在生物反馈组基础上辅以呼吸训练。治疗前、治疗6周后(...     

Effect of continuous positive airway pressure associated to exercise on the breathing pattern and heart rate variability of patients undergoing coronary artery bypass grafting surgery: a randomized controlled trial

Continuous positive airway pressure (CPAP) has been used to improve gas exchange and diaphragmatic function, among others benefits. Moreover, it can be used to increase exercise tolerance and positively influence ventilatory function and breathing pattern (BP) during exercise. However, there is no information about the long-term effects of CPAP, as an adjunct to an inpatient cardiac rehabilitation (CR) program, on BP and heart rate variability (HRV) of patients after coronary artery bypass grafting surgery (CABG). Twenty patients were allocated to receive, after randomization, standard inpatient CR without CPAP (control group - CG) or CR with CPAP between 10 to 12 cmH₂O (CPAP group - CPG) associated with the exercises. Participants were assessed preoperatively and on the discharge day, in the sitting rest position. Outcome measurements included BP variables, collected by respiratory inductive plethysmography, and HRV, collected by polar precision performance. The CPG presented lower values of percent rib cage inspiratory and expiratory contributions to tidal volume (%RCi and %RCe) at discharge time, compared to CG. No statistical differences between groups were observed for HRV variables and both groups presented lower values of these indices, compared to preoperative ones. In this context, the patients who received CPAP throughout the whole rehabilitation program were discharged with a better BP, which could indicate more synchronized breathing. CPAP did not influence cardiac autonomic modulation in the long term.     

吗啡治疗晚期癌症呼吸困难的临床观察及对策

[目的]观察吗啡治疗晚期癌症呼吸困难的效果及安全性。[方法]对68例晚期癌症呼吸困难患者皮下注射吗啡治疗,有效后部分改为口服治疗,观察其呼吸困难缓解及副作用出现情况并给予处理。[结果]吗啡皮下注射治疗患者呼吸困难均有明显缓解,副作用得到及时处理。[结论]吗啡可以有效治疗晚期癌症呼吸困难,经过加强基础护理,培训医护人员及病人和家属对姑息治疗的认识,尤其是用药前后的观察护理,病人未出现严重不良反应,安全,可以推广使用。     

电针配合健腰操治疗腰椎间盘突出症疗效观察

目的:验证电针配合健腰操治疗腰椎间盘突出症的疗效.方法:50例患者均予电针治疗,穴取十七椎、腰阳关、环跳、阳陵泉为主,并配合健腰操锻炼.分别于治疗前、治疗第4个月后、治疗第7个月后评定总体症状总分值,进行疗效比较.结果:治疗4个月后总体症状总分值为15.30±5.66,治疗7个月后为19.08±4.57,均明显高于治疗前的7.42±2.20(均P<0.01),治疗7个月后优于治疗4个月后(P<0.01).不同证型患者治疗后分值差异具有统计学意义(P<0.05),以血瘀型效果最好,肝肾亏虚型其次.结论:电针配合健腰操对腰椎间盘突出症的治疗有显著疗效,并随着治疗时间的延长,效果也越明显.     

A novel respiratory motion compensation strategy combining gated beam delivery and mean target position concept - A compromise between small safety margins and long duty cycles

Purpose

To evaluate a novel respiratory motion compensation strategy combining gated beam delivery with the mean target position (MTP) concept for pulmonary stereotactic body radiotherapy (SBRT).

Materials and methods

Four motion compensation strategies were compared for 10 targets with motion amplitudes between 6 mm and 31 mm: the internal target volume concept (plan_ITV); the MTP concept where safety margins were adapted based on 4D dose accumulation (plan_MTP); gated beam delivery without margins for motion compensation (plan_gated); a novel approach combining gating and the MTP concept (plan_gated&MTP).

Results

For 5/10 targets with an average motion amplitude of 9 mm, the differences in the mean lung dose (MLD) between plan_gated and plan_MTP were <10%. For the other 5/10 targets with an average motion amplitude of 19 mm, gating with duty cycles between 87.5% and 75% reduced the residual target motion to 12 mm on average and 2 mm safety margins were sufficient for dosimetric compensation of this residual motion in plan_gated&MTP. Despite significantly shorter duty cycles, plan_gated reduced the MLD by <10% compared to plan_gated&MTP. The MLD was increased by 18% in plan_MTP compared to that of plan_gated&MTP.

Conclusions

For pulmonary targets with motion amplitudes >10-15 mm, the combination of gating and the MTP concept allowed small safety margins with simultaneous long duty cycles.     

Facial and dental alterations according to the breathing pattern

There is controversy in the literature about possible interaction of the respiratory mode with the facial and dental structures.

Objectives

The aim of this study was to perform a longitudinal assessment of the changes in facial and dental structures in Angle’s Class II, division 1 malocclusion individuals, divided according to the respiratory pattern (predominantly nasal or mouth), at two distinct moments of craniofacial development.

Material and Methods

Pogonium and nose measurements were made on the lateral cephalometric tracings (LS’-Pog’, LS’-B’, B’-Pog’, Pog’-PogTeg’, Line NB, Pog-NB, N''-Prn, Prn-NPog, N-Prn-Sn, Prn-Sn-LS). Dental measurements were made on the plaster models (distances between the tips of the canine cusps and the tips of mesial cusps of the first molars) of 40 individuals aged 10 to 14 years (moment 1) and 13 to 16 years (moment 2), 23 being nose breathers (NB) and 17 being predominantly mouth breathers (MB).

Results

The Student’s-t test and two-way ANOVA with repeated measures were applied to indicate differences between the mean values of these variables according to the moments and/or respiratory mode.

Conclusions

There were alterations in the facial measurements, without interference of the breathing pattern. However, the breathing pattern influenced dental alterations.     

Respiratory variability in preterm and term infants: Effect of sleep state, position and age

The influence of sleep state and position on respiratory variability (RV) was studied in 13 preterm infants (PTIs) and 19 term infants (TIs). Temporally matched epochs of nasal pressure and oxygen saturation (Sp_O2)$(\text{S}{\text{p}}_{{\text{O}}_2})$ data were extracted from nap polysomnography. Inspiratory onset times (I) were determined, and variability measures of the I–I   interval compared in quiet sleep and active sleep, prone and supine and with age. Sleep state influenced respiratory variability (RV) in PTI and TI but Sp_O2$\text{S}{\text{p}}_{{\text{O}}_2}$ only varied with sleep state in PTI (p = 0.03). Position had no effect on RV in TI but influenced the standard deviation of ventilatory frequency (SDf) in PTI (p = 0.04). Age did not influence RV in PTI but SDf and the coefficient of variation of ventilatory frequency (CVf) decreased in TI from birth to 3 months. These data confirm sleep state as the predominant influence on RV in healthy term and convalescent preterm infants, with horizontal prone positioning having little effect when sleep state is controlled for.