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J. bras. pneumol ; 48(1): e20210280, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365051


ABSTRACT Objective: To evaluate the effect of the association of the breath stacking (BS) technique associated with routine physiotherapy on pulmonary function, lung volumes, maximum respiratory pressures, vital signs, peripheral oxygenation, thoracoabdominal mobility, and pain in the surgical incision in patients submitted to upper abdominal surgery during the postoperative period, as well as to analyze BS safety. Methods: This was a randomized clinical trial involving 34 patients divided into a control group (CG; n = 16), who underwent conventional physiotherapy only, and the BS group (BSG; n = 18), who underwent conventional physiotherapy and BS. Both groups performed two daily sessions from postoperative day 2 until hospital discharge. The primary outcomes were FVC and Vt. The safety of BS was assessed by the incidence of gastrointestinal, hemodynamic, and respiratory repercussions. Results: Although FVC significantly increased at hospital discharge in both groups, the effect was greater on the BSG. Significant increases in FEV1, FEV1/FVC ratio, PEF, and FEF25-75% occurred only in the BSG. There were also significant increases in Ve and Vt in the BSG, but not when compared with the CG values at discharge. MIP and MEP significantly increased in both groups, with a greater effect on the BSG. There was a significant decrease in RR, as well as a significant increase in SpO2 only in the BSG. SpO2 acutely increased after BS; however, no changes were observed in the degree of dyspnea, vital signs, or signs of respiratory distress, and no gastrointestinal and hemodynamic repercussions were observed. Conclusions: BS has proven to be safe and effective for recovering pulmonary function; improving lung volumes, maximum respiratory pressures, and peripheral oxygenation; and reducing respiratory work during the postoperative period after upper abdominal surgery.

RESUMO Objetivo: Avaliar o efeito da técnica de breath stacking (BS) associada à fisioterapia de rotina na função pulmonar, volumes pulmonares, pressões respiratórias máximas, sinais vitais, oxigenação periférica, mobilidade toracoabdominal e dor na incisão cirúrgica em pacientes no pós-operatório de cirurgia abdominal alta, bem como analisar a segurança do BS. Métodos: Trata-se de um ensaio clínico randomizado com 34 pacientes divididos em grupo controle (n = 16), que realizou apenas a fisioterapia convencional, e grupo BS (n = 18), que realizou a fisioterapia convencional e BS. Ambos os grupos realizaram duas sessões diárias desde o 2º dia do pós-operatório até a alta hospitalar. Os desfechos primários foram CVF e Vt. A segurança do BS foi avaliada pela incidência de repercussões gastrointestinais, hemodinâmicas e respiratórias. Resultados: Embora a CVF tenha aumentado significativamente no momento da alta hospitalar em ambos os grupos, o efeito foi maior no grupo BS. Aumentos significativos do VEF1, VEF1/CVF, PFE e FEF25-75% ocorreram apenas no grupo BS. Também houve aumentos significativos do Ve e do Vt no grupo BS, mas não em comparação com os valores do grupo controle no momento da alta. A PImáx e a PEmáx aumentaram significativamente em ambos os grupos, com efeito maior no grupo BS. Houve uma diminuição significativa da FR e um aumento significativo da SpO2 apenas no grupo BS. A SpO2 aumentou agudamente após o BS; entretanto, não foram observadas alterações no grau de dispneia, sinais vitais e sinais de desconforto respiratório, e não foram observadas repercussões gastrointestinais e hemodinâmicas. Conclusões: O BS mostrou-se seguro e eficaz na recuperação da função pulmonar; melhoria dos volumes pulmonares, pressões respiratórias máximas e oxigenação periférica; e redução do trabalho respiratório no pós-operatório de cirurgia abdominal alta.

Humans , Dyspnea , Lung , Postoperative Complications , Postoperative Period , Lung Volume Measurements
Neumol. pediátr. (En línea) ; 17(1): 9-11, 2022. ilus
Article in Spanish | LILACS | ID: biblio-1379403


La principal función del aparato respiratorio es permitir el intercambio gaseoso, el cual se produce en las unidades alveolares. Para definir y conocer la ventilación alveolar, es necesario estar familiarizado con los volúmenes y capacidades pulmonares, además de conocer los principios fisiológicos que nos permiten medirlos y/o estimarlos. El objetivo de este artículo es revisar estos conceptos, para aumentar el entendimiento de la fisiología del aparato respiratorio.

The main function of the respiratory system is to allow gas exchange, which occurs in the alveolar units. To define and know alveolar ventilation, it is necessary to be familiarized with lung volumes and capacities, in addition to understand the physiological principles that allow us measure and / or estimate them. The objective of this article is to review these concepts, to increase the understanding of the physiology of the respiratory system.

Humans , Respiration, Artificial , Respiratory Physiological Phenomena
Article in Chinese | WPRIM | ID: wpr-876494


Objective To investigate the correlation between vital capacity, pulmonary ventilation and morphological parameters among children living in different altitude areas, so as to provide a reference basis for the development of prevention and control strategies for high altitude illness. Methods From January 2019 to June 2020, primary and secondary school students aged 7 to 15 years old were randomly selected from three different altitude areas, which were Xining (2 260m, low altitude group), Haixi (2 900m, medium altitude group), and Yushu (4 493m, high altitude group), respectively. The vital capacity, pulmonary ventilation and morphological parameters of the selected children were recorded. Results The vital capacity, pulmonary ventilation and morphological parameters showed statistically significant difference among three groups (P<0.05). The vital capacity and pulmonary ventilation were positively correlated with lung volume, but negatively correlated with lung density and lung artery diameter (P<0.05). Logistic regression analysis showed that there were three factors affecting children's vital capacity and lung ventilation: mean lung density, total lung transverse diameter, and total lung volume (P<0.05). Conclusion The monitoring of lung morphological indexes, mean lung density, total lung transverse diameter, and total lung volume can effectively judge children's lung function, and have certain value in the prevention and treatment of related high-altitude illness.

Article in Chinese | WPRIM | ID: wpr-912042


Objective:To observe the recovery of exercise tolerance among stroke survivors using the cardiopulmonary exercise test (CPET) and analyze the factors influencing it.Methods:A total of 81 stroke survivors hospitalized in the Department of Rehabilitation Medicine of our hospital in year 2018 and 2019 were selected. The general clinical data of all patients were collected retrospectively and combined with the data from CPET to establish a data set. Version 25.0 of the SPSS software was used for multiple linear regressions analysis, with the peak oxygen uptake as the dependent variable, and the age, Brunnstrom stage, peak power, peak heart rate, peak respiratory exchange ratio, peak breathing reserve, peak ventilation per minute, the slope of the VE-VCO 2 curve (ΔVE/ΔVCO 2) and peak end tidal partial pressure of carbon dioxide as independent variables. Results:Stroke survivors at Brunnstrom stage III Ⅲ, Ⅳ and Ⅴ or higher decreased sequentially with their age, but their peak oxygen uptake increased gradually. The multiple linear regression model constructed by " stepwise method" showed that the fitted multiple linear regression equation was statistically significant ( F=100.228, P<0.001). Moreover, the average peak power, peak heart rate, peak ventilation per minute and the slope of the VE-VCO 2 curve were all found to be significant independent predictors of peak oxygen uptake in these stroke survivors. Conclusions:Skeletal muscle power, cardiac function, pulmonary ventilation and ventilation efficiency are useful independent predictors of the exercise tolerance of stroke survivors.

Chinese Journal of Geriatrics ; (12): 1304-1308, 2021.
Article in Chinese | WPRIM | ID: wpr-911008


Objective:To evaluate the effect of preoperative respiratory muscle exercise combined with intraoperative lung protective ventilation strategy on atelectasis in elderly patients undergoing robot-assisted radical prostatectomy.Methods:In the prospective study, a total of 45 patients aged 65-80 years undergoing scheduled robot-assisted radical prostatectomy in First Hospital of Shanxi Medical University from August 2020 to November 2020 were divided into three groups( N=15, each): respiratory muscle exercise combined with lung protective ventilation strategy group(combined group), lung protective ventilation strategy group(pulmonary protective group)and conventional ventilation strategy(control group). Heart rate, systolic blood pressure, diastolic pressure, and pulse oxygen saturation as well as blood gas analysis of arterial blood and the calculated oxygenation index were measured and recorded immediately after establishing invasive artery monitoring in operating room, 10 min after endotracheal intubation, 1 h after the flexitic position, 30 min after tracheal extubation, 24 h after operation in all three groups of patients.The lung compliance values, peak airway pressure, and end-tidal carbon dioxide were recorded at 10 minutes after tracheal intubation, 30 minutes after tracheal extubation, 1 hour after succession position.A single-slice chest CT scan was performed at 1 h after surgery while satisfying the anesthesia recovery steward score ≥ 5.And the percentage of atelectasis area was calculated. Results:The American Society of Anesthesiologisits(ASA)classification of patients was 11/4, 12/3, and 11/4 in the combination group, lung protection group and control group respectively, and the difference was not statistically significant( χ2=0.127, P>0.05). Oxygenation index(mmHg)(1 mmHg=0.133 kPa)at 24 h after surgery was significantly higher in the combined group(351.1±11.2)than in lung protection group(337.0±13.4)( t=3.287, P<0.05). Atelectasis area(Median, Interquartile range)assessed by CT imaging at 30 min after tracheal extubation was 1.92(0.77)% in the combination group, 2.09(1.13)% in lung protection group, and 3.01(1.01)% in control group, with statistically significant difference( χ2 values, 26.036, 12.313, both P<0.05). Atelectasis area at 30 minutes after tracheal extubation was statistically significant smaller in the combination group than in lung protection group( χ2=6.240, P<0.05). Conclusions:Preoperative respiratory muscle exercise combined with intraoperative lung protective ventilation strategy can achieve the better effect of lung protection, reduce the degree of perioperative atelectasis in elderly patients, and improve oxygenation function.

Chinese Journal of Geriatrics ; (12): 707-711, 2021.
Article in Chinese | WPRIM | ID: wpr-910902


Objective:To investigate the effects of different mechanical ventilation methods on respiratory function in elderly patients in the steep Trendelenburg position undergoing general anesthesia.Methods:This was a randomized controlled study.Sixty patients scheduled for elective laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia were randomly divided into the lung protective ventilation strategy group(the P group)and the traditional ventilation strategy group(the T group)(n=30, each group). The setting for the P group included FiO 2 at 50%, tidal volume at 6 ml/kg, respiratory rate at 14-16/min, positive end expiratory pressure(PEEP)at 5 cmH 2O, with sustained lung inflation by pressure control every 30 min and the pressure at 30 cmH 2O for 30 s. The setting for the T group included FiO 2 at 50%, tidal volume at 10 ml/kg, and respiratory rate at 10-12/min.Anesthesia was maintained by sevoflurane, remifentanil and cis-atracurium.Driving pressure(DP), mean airway pressure(P mean)and end-tidal carbon dioxide(EtCO 2)were recorded at T1(5 mins after intubation), T2(after pneumoperitoneum), T3(30 mins after pneumoperitoneum), T4(1h after pneumoperitoneum), T5(2h after pneumoperitoneum), T6(3h after pneumoperitoneum)and T7(end of surgery). Arterial blood partial pressure of carbon dioxide(PaCO 2), alveolar-arterial oxygen partial pressure difference[P(A-a)O 2]and oxygenation index(OI)were recorded at T0(entering the operating room), T1, T3, T4, T5, T6, T8(after extubation)and T9(24h after operation). Arterial-end-tidal carbon dioxide partial pressure difference[P(a-et)CO 2]was recorded at T3, T4, T5 and T6. Results:DP in the P group was lower than in the T group at each time point( P<0.01). The P mean in the P group at each time point was higher than in the T group( P<0.01). EtCO 2 was higher in the P group than in the T group at T1( t=0.751, P<0.01)and T2( t=2.830, P<0.01). PaCO 2 was higher in the P group than in the T group at T1( t=1.435, P<0.01), T3( t=2.469, P<0.01)and T4( t=1.359, P<0.05). There were no statistic differences in P(A-a)O 2, OI and P(a-et)CO 2 between the two groups at any time point( P>0.05). Conclusions:Compared with the traditional ventilation strategy, the lung protective ventilation strategy has lower DP and higher P mean during laparoscopic radical prostatectomy, while it has no advantage in lung oxygenation.The lung protection ventilation strategy can be safely used in laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia.

Chinese Journal of Anesthesiology ; (12): 1451-1453, 2021.
Article in Chinese | WPRIM | ID: wpr-933270


Objective:To determine the potency of remimazolam in inhibiting ventilatory function during sedation in the patients undergoing internal jugular vein puncture.Methods:American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index<30 kg/m 2, undergoing elective internal jugular vein puncture under local anesthesia, were enrolled in this study.Remimazolam was intravenously injected, and the dose was determined by up-and-down sequential allocation.The initial dose was 0.07 mg/kg and was increased/decreased in the next patient depending on whether the patients showed inhibition of ventilatory function, and the ratio between the 2 successive doses was 1.2.The criterion for inhibition of ventilatory function was defined as Integrated Pulmonary Index < 5.The median effective dose (ED 50) and 95% confidence interval of remimazolam in inhibiting ventilatory function were calculated by Dixon-Massey method. Results:Thirty-six patients were enrolled in this study.The ED 50 (95% confidence interval) was 0.106 (0.097-0.115) mg/kg. Conclusion:The ED 50 of remimazolam in inhibiting ventilatory function during sedation in internal jugular vein puncture is 0.106 mg/kg.

Article in English | WPRIM | ID: wpr-922399


OBJECTIVES@#To establish a predictive equation for commonly used pulmonary ventilation function parameters in children aged 6-<16 years in northeast China.@*METHODS@#A total of 504 healthy children from Liaoning, Jilin, and Heilongjiang provinces of China were selected for the prospective study, among whom there were 242 boys and 262 girls. The JAEGER MasterScreen Pneumo spirometer was used to measure pulmonary ventilation function. With the measured values of 10 parameters, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV@*RESULTS@#The boys aged 9-<10 years and 15-<16 years had significantly higher body height, FVC, and FEV@*CONCLUSIONS@#A new predictive equation for the main pulmonary ventilation function parameters has been established in this study for children aged 6-<16 years in northeast China, which provides a basis for accurate judgment of pulmonary function abnormalities in clinical practice.

Child , China , Female , Forced Expiratory Volume , Humans , Male , Prospective Studies , Pulmonary Ventilation , Reference Values , Schools , Vital Capacity
Arq. bras. cardiol ; 115(5): 821-827, nov. 2020. tab
Article in Portuguese | LILACS, SES-SP | ID: biblio-1142272


Resumo Fundamento O tratamento com sacubitril-valsartana teve seu benefício prognóstico confirmado no ensaio PARADIGM-HF. No entanto, dados sobre alterações no teste de esforço cardiopulmonar (TECP) com o uso de sacubitril-valsartana são escassos. Objetivo O objetivo deste estudo foi comparar os parâmetros do TECP antes e depois do tratamento com sacubitril-valsartana. Métodos Avaliação prospectiva de pacientes com insuficiência cardíaca (IC) crônica e fração de ejeção do ventrículo esquerdo ≤40%, mesmo sob terapia padrão otimizada, que iniciaram tratamento com sacubitril-valsartana, sem expectativa de tratamentos adicionais para a IC. Os dados do TECP foram coletados na semana anterior e 6 meses depois do tratamento com sacubitril-valsartana. Diferenças estatísticas com valor p <0,05 foram consideradas significativas. Resultados De 42 pacientes, 35 (83,3%) completaram o seguimento de 6 meses, uma vez que 2 (4,8%) morreram e 5 (11,9%) interromperam o tratamento devido a eventos adversos. A média de idade foi de 58,6±11,1 anos. A classe NYHA (classificação da New York Heart Association) melhorou em 26 (74,3%) pacientes. O consumo máximo de oxigênio (VO2max) (14,4 vs. 18,3 ml/kg/min, p<0,001), a inclinação VE/VCO2 (36,7 vs. 31,1, p<0,001) e a duração do exercício (487,8 vs. 640,3 s, p<0,001) também melhoraram com o uso de sacubitril-valsartana. O benefício foi mantido mesmo com a dose de 24/26 mg (13,5 vs. 19,2 ml/kg/min, p=0,018) de sacubitril-valsartana, desde que esta tenha sido a maior dose tolerada. Conclusões O tratamento com sacubitril-valsartana está associado a uma melhora acentuada do VO2max, da inclinação VE/VCO2 e da duração do exercício no TECP. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Sacubitril/valsartan had its prognosis benefit confirmed in the PARADIGM-HF trial. However, data on cardiopulmonary exercise testing (CPET) changes with sacubitril-valsartan therapy are scarce. Objective This study aimed to compare CPET parameters before and after sacubitril-valsartan therapy. Methods Prospective evaluation of chronic heart failure (HF) patients with left ventricular ejection fraction ≤40% despite optimized standard of care therapy, who started sacubitril-valsartan therapy, expecting no additional HF treatment. CPET data were gathered in the week before and 6 months after sacubitril-valsartan therapy. Statistical differences with a p-value <0.05 were considered significant. Results Out of 42 patients, 35 (83.3%) completed the 6-month follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment for adverse events. Mean age was 58.6±11.1 years. New York Heart Association class improved in 26 (74.3%) patients. Maximal oxygen uptake (VO2max) (14.4 vs. 18.3 ml/kg/min, p<0.001), VE/VCO2slope (36.7 vs. 31.1, p<0.001), and exercise duration (487.8 vs. 640.3 sec, p<0.001) also improved with sacubitril-valsartan. Benefit was maintained even with the 24/26 mg dose (13.5 vs. 19.2 ml/kg/min, p=0.018) of sacubitril-valsartan, as long as this was the highest tolerated dose. Conclusions Sacubitril-valsartan therapy is associated with marked CPET improvement in VO2max, VE/VCO2slope, and exercise duration. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Humans , Middle Aged , Aged , Ventricular Function, Left , Heart Failure/drug therapy , Oxygen , Stroke Volume , Tetrazoles , Prospective Studies , Treatment Outcome , Drug Combinations , Angiotensin Receptor Antagonists , Aminobutyrates
Fisioter. Pesqui. (Online) ; 27(1): 28-33, jan.-mar. 2020. tab
Article in Portuguese | LILACS | ID: biblio-1090415


RESUMO O objetivo deste artigo é avaliar o índice de função sexual de mulheres submetidas à histerectomia total com ooforectomia bilateral (HT-OB), a prevalência de incontinência urinária por esforço (IUE) e sua associação com a realização desse procedimento cirúrgico em um hospital de referência em Belém (PA). Foram incluídas 162 mulheres, com vida sexual ativa, alocadas em dois grupos: aquelas que realizaram HT-OB em período superior a 12 meses (n=68), e aquelas que não realizaram (n=94). Utilizou-se o questionário female sexual function index (FSFI) para avaliação da função sexual, e um questionário desenvolvido pelos pesquisadores para coletar dados sociais, econômicos e clínicos, incluindo informações quanto à presença de IUE. O valor de significância foi definido como p<0,05. Houve diferença significativa no índice de função sexual entre o grupo HT-OB e o grupo-controle, com escore geral do FSFI de 23,56 e 28,68, respectivamente (p=0,0001). Os domínios desejo, excitação, lubrificação (p<0,0001), orgasmo (p=0,04), satisfação (p=0,0006) e dor (p=0,015) apresentaram escores inferiores em mulheres histerectomizadas. A prevalência de sintomas de IUE no grupo HT-OB foi de 35,3%, sendo observada associação significativa entre a presença desses sintomas e a realização da histerectomia (p=0,02). Mulheres que realizam HT-OB têm maior risco de disfunção sexual, e este procedimento cirúrgico é associado ao desenvolvimento de IUE.

RESUMEN El presente artículo tuvo el objetivo de evaluar el índice de función sexual de mujeres sometidas a histerectomía total con ooforectomía bilateral (HT-OB), la prevalencia de incontinencia urinaria de esfuerzo (IUE) y su asociación con la realización de este procedimiento quirúrgico en un hospital de referencia en Belém (Brasil). Se incluyeron a 162 mujeres con vida sexual activa, que fueron divididas en dos grupos: las que se sometieron a HT-OB durante el período superior a 12 meses (n=68) y las que no lo había hecho (n=94). Se les aplicaron el cuestionario female sexual function index (FSFI), para evaluar la función sexual, y un cuestionario desarrollado por investigadores para recopilar datos sociales, económicos y clínicos, con informaciones en cuanto a la presencia de IUE. El valor de significación fue de p<0,05. Hubo una diferencia significativa en el índice de función sexual entre el grupo HT-OB y el grupo control, con un puntaje general de FSFI de 23,56 y 28,68, respectivamente (p=0,0001). Los dominios deseo, excitación, lubricación (p<0,0001), orgasmo (p=0,04), satisfacción (p=0,0006) y dolor (p=0,015) tuvieron puntajes más bajos en mujeres histerectomizadas. La prevalencia de síntomas de IUE fue del 35,3% en el grupo HT-OB, además se observó una asociación significativa entre la presencia de estos síntomas y la realización de la histerectomía (p=0,02). Las mujeres que se someten a HT-OB tienen un mayor riesgo de disfunción sexual, y este procedimiento quirúrgico está asociado al desarrollo de IUE.

ABSTRACT The objective of this article was to evaluate the sexual function index of women submitted to total hysterectomy with bilateral oophorectomy (THBO), the prevalence of urinary incontinence (SUI) and its association with the performance of this surgical procedure in a reference hospital in Belém, Pará. One hundred sixty-two women with active sexual life were included in two groups: those who have undergone THBO for more than 12 months (n=68), and those who have not (n=94). The Female Sexual Function Index (FSFI) questionnaire was used to evaluate sexual function along with a questionnaire developed by the researchers to collect social, economic and clinical data, including information on the presence of SUI. The significance level was defined as p<0.05. There was a significant difference in the sexual function index between THBO group and the control group, with an FSFI overall score of 23.56 and 28.68, respectively (p=0.0001). Desire, arousal, lubrication (p<0.0001), orgasm (p=0.04), satisfaction (p=0.0006) and pain (p=0.015) domains had lower scores in hysterectomized women. The prevalence of SUI symptoms in THBO group was 35.3%, and a significant association was observed between the presence of SUI and hysterectomy (p=0.02). Women who undergo THBO have a higher risk of sexual dysfunction, and this surgical procedure is associated with the development of SUI.

Humans , Female , Adult , Middle Aged , Sexual Dysfunction, Physiological/etiology , Urinary Incontinence/etiology , Hysterectomy/adverse effects , Hysterectomy/methods , Postoperative Complications , Quality of Life , Urinary Incontinence/epidemiology , Prevalence , Surveys and Questionnaires , Sexuality , Evaluation Study
China Occupational Medicine ; (6): 81-85, 2020.
Article in Chinese | WPRIM | ID: wpr-881870


OBJECTIVE: To explore the detection of small airway dysfunction in occupational populations and its influencing factors. METHODS: A convenient sampling method was adopted, and 15 490 occupational health workers who were tested for pulmonary ventilation function in 2018 were selected as study subjects. The results of pulmonary ventilation function examination and chest direct digital radiography(DR) were collected and analyzed. RESULTS: Among the study subjects, 2 083 were detected to have abnormal pulmonary ventilation function, the abnormal detection rate was 13.4%; 3 089 subjects were detected to have small airway dysfunction, and the abnormal detection rate was 19.9%. The two-class logistic regression analysis results suggested that female, exposure to organic dusts during work, exposure to asthmogenic during work, chest DR abnormalities and abnormal pulmonary ventilation function were risk factors for abnormal small airway function(P<0.05). CONCLUSION: The abnormal small airway function in occupational populations is related to various factors such as gender and occupational exposure to allergens. The screening of small airway function in this group may help advance the prevention and treatment of respiratory diseases.

Geriatr., Gerontol. Aging (Impr.) ; 13(4): 183-189, out-.dez.2019. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1097118


INTRODUÇÃO: As alterações musculares que acompanham o envelhecimento, traduzidas numa diminuição quer na massa quer na capacidade de trabalho da musculatura, condicionam diminuições na força e resistência ao esforço no idoso. OBJETIVO: Correlacionar a perda de capacidade de trabalho muscular com as possíveis alterações ventilatórias derivadas dessa perda em idosos. MÉTODOS: Estudo transversal com 18 adultos voluntários com idade superior a 65 anos (13 do sexo feminino e cinco do sexo masculino), incluídos no Projeto AGA@4life. Todos os participantes realizaram provas funcionais respiratórias com espirômetro Flowhandy ZAN 100, e foi-lhes avaliada a força de preensão com um dinamômetro apropriado. Avaliaram-se ainda a composição corporal por bioimpedância e o perfil nutricional. RESULTADOS: Observou-se associação significativa entre a percentagem de massa magra e diversos parâmetros espirométricos, nomeadamente o volume expiratório máximo no primeiro segundo (VEMS), a capacidade vital forçada (CVF), o débito expiratório máximo a 25% da CVF (DEM25), o débito expiratório máximo a 50% da CVF (DEM50), o débito expiratório máximo entre 25 e 75% da capacidade vital forçada (DEM25/75) e o débito expiratório máximo (PEF). Também, a autoeficácia no exercício se associou significativamente com VEMS, CVF, DEM25, DEM50, DEM75 e DEM25/75 e PEF. Constatou-se ainda correlação significativa e positiva da percentagem de massa magra com a força de preensão. CONCLUSÕES: Os resultados demonstram associação entre a função ventilatória e parâmetros funcionais e clínicos característicos da sarcopenia, sugerindo a partilha de mecanismos fisiopatológicos na limitação observada com o agravamento desses parâmetros.

INTRODUCTION: Age-related muscle changes, translated into a decrease both in muscle imass and functionality, are determinants of a decrease in strength and resistance to exercise in older adults. OBJECTIVE: To correlate the loss of muscle mass and functionality with the respiratory function in older adults. METHODS: Cross-sectional study including 18 volunteers with age above 65 years (13 women and 5 men) included in the AGA@4life Project. All participants performed functional respiratory tests with an Flowhandy ZAN 100 spirometer, and handgrip strength was assessed with an appropriate dynamometer. Nutritional profile was assessed and body composition was evaluated via bioimpedance. RESULTS: There was a significant association between the percentage of lean mass and several spirometric parameters, namely the FEV1, FVC, PEF25, PEF50, PEF25/75 and PEF. Significant associations were also found with the self-efficacy for exercise and the same respiratory parameters. A significant and positive correlation was observed between the percentage of lean mass and handgrip strength. CONCLUSIONS: The results show an association between respiratory function and functional and clinical parameters characteristic of sarcopenia, suggesting common pathophysiological mechanisms in the limitation observed with the worsening of these parameters.

Humans , Male , Female , Aged , Aged, 80 and over , Body Composition/physiology , Body Weights and Measures , Pulmonary Ventilation/physiology , Sarcopenia , Respiratory Function Tests , Geriatric Assessment , Hand Strength/physiology , Muscle Strength/physiology
Article in English | WPRIM | ID: wpr-762253


BACKGROUND: Aeration of the lungs must be monitored during general anesthesia because of the possibility of postsurgical pulmonary complications. The aim of this study was to compare PaO₂/FiO₂ and the number of regions with B-line on transthoracic lung ultrasonography (TLU) between the postinduction and postsurgical periods. METHODS: Twenty-six adult patients undergoing major abdominal surgery were enrolled. Arterial blood gas analysis and TLU were performed 30 min after the induction of anesthesia (postinduction) and after skin closure (postsurgical period) while patients were under mechanical ventilation. TLU was performed in 12 regions (anterior, lateral, and posterior in the upper and lower regions of both lungs). The number of regions with B-line was counted. RESULTS: Compared with postinduction values, the number of regions with B-line on TLU was increased in the postsurgical period (0.3 ± 0.5 to 1.3 ± 1.2, P < 0.001); however, PaO₂/FiO₂ did not significantly differ (421.3 ± 95.8 to 425.2 ± 86.0, P = 0.765). The change in PaO₂/FiO₂ (postinduction-postsurgical period) was significantly higher in Group B than in Group A (P = 0.028). CONCLUSIONS: Although the number of regions with B-line on TLU was increased in the postsurgical period, lung oxygenation did not differ, based on the main assessment in this study. In contrast, patients with an increased number of regions with B-line tended to show a reduction in PaO₂/FiO₂ during the postsurgical period. Further study seems necessary to establish the number of regions with B-line on TLU as a tool for evaluation of perioperative oxygenation.

Adult , Anesthesia , Anesthesia, General , Anesthesiology , Blood Gas Analysis , Humans , Lung , Observational Study , Oxygen , Prospective Studies , Pulmonary Atelectasis , Pulmonary Ventilation , Respiration, Artificial , Skin , Ultrasonography
Article in Chinese | WPRIM | ID: wpr-805589


Objective@#To explore the impact of welding operations on the health status of workers with low working age, and provide a basis for occupational health risk assessment for workers of low working age.@*Methods@#Used the method of cluster sampling to randomly selected workers from an automobile manufacturing plant in Guangzhou as research subjects: 982 workers with welding posts of 1 year ≤working age ≤5 years were welding groups, 707 workers with simple exposure noise of 1 year ≤working age ≤5 years were assembly groups, and 717 workers in pre-job medical examinations were pre-job groups from June 2017 to September 2018. Then conducted occupational health checks on all subjects, investigated and detected the occupational hazards in welding posts and assembly posts.@*Results@#There was no statistical difference between the noise over-standard rate of welding posts' (59.3%, 16/27) and the assembly posts' (47.4%, 9/19) (P>0.05) . The over-standard rate of welding fume, manganese and its inorganic compounds in welding posts was 11.11% (3/27) . The results of occupational health examination showed that the detection rate of disease or abnormal of the welding group was 78.4% (770/982) higher than 70.2% (496/707) in the assembly group and 53.0% (380/717) in the pre-job group (the value of 2 were 14.92 and 122.37, respectively, P<0.05) . The rate of hearing loss of the assembly group and the welding group were 14.7% (104/707) and 19.3% (190/982) , respectively, which was higher than that of the pre-job group (10.5%, 75/717) , and the hearing loss rate gradually increased with the increase of working age (the value of linear-by-linear association were 12.04 and 44.67, respectively, P<0.01) . Compared with the hearing loss rate of each working age of the assembly group, the hearing loss rate of each working age of the welding group was higher, and when the working age was 3 years, the risk of hearing loss in the welding group was 2.70 times that of the assembly group (P<0.01) . The rate of pulmonary dysfunction in the welding group was 19.2% (189/982) higher than that in the pre-job group (12.6%, 90/717) , and it increased with the increase of working age (the value of linear-by-linear association was 15.97, P<0.01) .@*Conclusion@#Welding work seriously damages the health of workers with low working age, increases the hearing loss of workers and the occurrence of pulmonary dysfunction; manganese and its compounds increases noise-induced damage to the hearing system.

Article in Chinese | WPRIM | ID: wpr-803338


Objective@#To evaluate the protective effects of ulinastatin combined with lung-protective ventilation on lungs in patients undergoing laparoscopic colorectal carcinoma surgery.@*Methods@#A total of 120 patients undergoing laparoscopic radical resection of colorectal cancer in Yuncheng Central Hospital were selected in this study.According to thedigital table, they were randomly divided into conventional mechanical ventilation group(G0 group), lung protection mechanical ventilation group(G1 group), conventional mechanical ventilation combined with ulinastatin group(G2 group)and lung protection mechanical ventilation combined with ulinastatin group(G3 group), with 30 cases in each group.Ulinastatin 2 500IU was intravenously infused 10min before induction of anesthesia in G2 group and G3 group.Ventilator parameters were set as tidal volume(VT)10mL/kg, respiratory frequency 12 times/min, inspiration-expiration ratio(I∶E)1∶2 in G0 group and G2 group.VT 6mL/kg in G1 group and G3 group , positive end-expiratory pressure ventilation(PEEP)5-10cmH2O, respiratory frequency 12-18 times/min, once every 30min.Before anesthesia induction(T0), before pneumoperitoneum(T1), 2h after pneumoperitoneum(T2), before extubation(T3), 24h after operation(T4), arterial blood was collected to detect partial pressure of oxygen(PaO2), oxygenation index(OI). And mean airway pressure(Pmean), peak airway pressure(Ppeak)at T1-3 were recorded.Venous blood was collected at T0, T3 and T4 to detect serum concentrations of interleukin-6(IL-6), interleukin-8(IL-8)and tumor necrosis factor-alpha(TNF-α).@*Results@#At T3, the PaO2 of G1 group, G2 group and G3 group were (457±60)mmHg, (460±49)mmHg and (510±45)mmHg, respectively.At T4, the PaO2 of the three groups were (90±6)mmHg, (92±7)mmHg and (96±7)mmHg, respectively.The PaO2 in G1 group and G2 group were lower thanthose in G3 group at T3-4(t=3.872, 3.850, 4.186, 2.513, all P<0.05). At T2, the OI of the three groups were (460±44), (462±37) and (481±31), respectively.At T3, the OI of the three groups were (460±51), (475±62) and (504±38), respectively.The OI in G1 group and G2 group were lower than those in group G3 at T2-3(t=2.142, 3.753, 2.209, 2.170, all P<0.05). At T2, the Pmean of G1 group, G2 group and G3 group were (10.5±1.5)cmH2O, (11.2±1.9)cmH2O and (9.5±0.9)cmH2O, respectively, the Ppeak of the three groups were (22.3±3.0)cmH2O, (24.0±3.3)cmH2O and (22.3±2.9)cmH2O, respectively.At T3, the Pmean of the three groups were (10.9±1.1)cmH2O, (11.1±1.8)cmH2O and (9.8±0.9)cmH2O, respectively, the Ppeak of the three groups were (22.8±2.7)cmH2O, (24.1±2.1)cmH2O and (21.6±2.0)cmH2O, respectively.The Pmean in G1 group and G2 group at T2-3 were lower than those in G3 group(t=3.061, 4.580, 5.759, 4.305, 3.746, all P<0.05), the Ppeak in G2 group at T2-3 were lower than those in G3 group(t=2.952, 4.630, all P<0.05). At T4, the serum concentrations of IL-6 of G1 group, G2 group and G3 group were (151±28)ng/L, (152±20)ng/L and (136±18)ng/L, respectively, the IL-8 levels of the three groups were (468±28)ng/L, (359±65)ng/L and (327±51)ng/L, respectively, the TNF-α levels of the three groups were (1.09±0.20)ng/L, (1.08±0.20)ng/L and (0.94±0.20)ng/L, respectively.The concentrations of IL-6, IL-8 and TNF-α at T4 in G1 group and G2 group were higher than those in G3 group(t=2.428, 4.094, 2.536, 4.251, 2.807, 3.128, 4.119, 2.592, 3.446, 2.555, all P<0.05).@*Conclusion@#The combination of ulinastatin and lung-protective ventilation provides protective effects on lungs and exerts better efficacy than either alone.

Article in English | WPRIM | ID: wpr-825216


@#Asthma is a common respiratory condition seen in primary care. It is characterised by common respiratory symptoms and variable expiratory airflow limitation due to underlying chronic airway inflammation. Diagnosis should be established promptly to prevent misdiagnosis and inappropriate management. Objective lung function assessment is therefore recommended to guide the primary care physician. This article describes the use of spirometry, its role in the diagnosis of asthma and assessment of asthma control. Barriers to the use of spirometry in primary care are also discussed with suggested interventions.

Article in Chinese | WPRIM | ID: wpr-824935


Objective:To observe the effect of warm-unblocking acupuncture plus fluticasone propionate nasal spray on the pulmonary ventilation, level of interferon-γ (IFN-γ) and sleep quality in patients with allergic rhinitis (AR). Methods: A total of 112 AR patients were enrolled between January 2013 and August 2018 and were divided into an observation group and a control group by the random number table method, with 56 cases in each group. Patients in the observation group received warm-unblocking acupuncture plus fluticasone propionate nasal spray, and patients in the control group only received fluticasone propionate nasal spray. The nasal symptom score, pulmonary function indexes, the levels of IFN-γ and interleukin (IL)-4 in serum, and sleep quality in the two groups were compared. Results: After treatment, the total effective rate in the observation group was higher than that in the control group (P<0.05). The nasal symptom score dropped in both groups after treatment (both P<0.05), and the score in the observation group was lower than that in the control group (P<0.05). The pulmonary ventilation indexes all increased significantly after treatment in the observation group (all P<0.05); the forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio (FEV1/FVC) and the forced expiratory flow at 50%, 75% and 25%-75% of the vital capacity (FEF50%, FEF75%, FEF25%-75%) increased after treatment in the control group (all P<0.05); the pulmonary ventilation indexes were higher in the observation group than those in the control group (all P<0.05). The level of IFN-γ increased significantly after treatment in the two groups (both P<0.05) and the level of IL-4 dropped significantly (both P<0.05); the observation group had a higher IFN-γ level (P<0.05) and a lower IL-4 level (P<0.05) compared with the control group. Regarding the Pittsburgh sleep quality index (PSQI), the scores of subjective sleep quality, habitual sleep efficiency and sleep disturbances and the general PSQI score decreased significantly after treatment in both groups (all P<0.05), and the scores in the observation group were significantly lower than those in the control group (all P<0.05). Conclusion: Warm-unblocking acupuncture plus fluticasone propionate nasal spray can effectively control the clinical symptoms and improve pulmonary function in the treatment of AR; this approach can regulate the levels of IFN-γ and IL-4 towards the normal range in AR patients; it can also improve patient’s sleep quality. This method can produce more significant efficacy than fluticasone propionate nasal spray used alone.

Article in Chinese | WPRIM | ID: wpr-743745


Objective To compare the cost-effectiveness of non-intubated general anesthesia with conventional general anesthesia for thoracoscopic bulla resection. Methods Sixty patients scheduled for elective thoracoscopic bulla resection, were divided into two groups (30 each) using a random number table: the conventional general anesthesia group (T group) and the non-intubated general anesthesia group (NT group). Patients in group T were induced with conventional general anesthetic, single-lung ventilated after intubation with double-lumen bronchial catheters. Patients in group NT were induced with general anesthesia combined nerve block, and spontaneous breathings were retained. The results of blood gas analysis, anesthesia time, operation time, intraoperative blood loss, time for orientation recovery and modified Aldrete score ≥ 9 minutes were recorded. The intraoperative and postoperative complications, postoperative hospital stay time, VAS and PC A scores 48 h after operation were recorded. Calculate the cost of anesthesia and the total cost of hospitalization. Results Compared with T group, NT group had lower pH value and higher PCO2 at 30 min before and after the thoracic closure, oxygenation index in the NT group increased at 30 min after the thoracic closure (P < 0.05). Compared with T group, anesthesia time, time for orientation recovery and modified Aldrete score ≥ 9 minutes, incidence of postoperative sore throat, postoperative hospital stay time, VAS scores at 6, 12 h and PC A at 48 h after the operation, anesthesia costs, and total hospitalization costs in the NT group were all reduced (P < 0.05). Conclusions Fully considering the safety, compared with the traditional tracheal intubation general anesthesia, non-intubation general anesthesia can not only promote postoperative outcomes but also improve the cost-effectiveness in the patients undergoing thoracoscopic bulla resection.

J. bras. pneumol ; 45(1): e20170347, 2019. tab, graf
Article in English | LILACS | ID: biblio-984615


ABSTRACT Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or "air hunger", DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners.

RESUMO A disfunção respiratória (DR) é um quadro respiratório caracterizado por padrões respiratórios irregulares que ocorrem na ausência de doenças concomitantes ou secundariamente a doenças cardiopulmonares. Embora o principal sintoma seja frequentemente dispneia ou "fome por ar", a DR também está associada a sintomas não respiratórios, como vertigem e palpitações. A DR pode ser identificada em todas as idades. Sua prevalência entre adultos na atenção primária no Reino Unido é de aproximadamente 9,5%. Além disso, entre indivíduos com asma, um diagnóstico positivo de DR é encontrado em um terço das mulheres e um quinto dos homens. Embora a DR tenha sido investigada por décadas, ela permanece pouco compreendida devido a uma escassez de ensaios clínicos de alta qualidade e de variáveis de desfecho validadas especificamente para essa população. Assim, a DR é frequentemente subdiagnosticada ou diagnosticada incorretamente, devido à similaridade de seus sintomas associados (dispneia, taquicardia e vertigem) aos de outras doenças cardiopulmonares comuns, como DPOC e asma. As altas taxas de diagnóstico incorreto de DR sugerem que os profissionais de saúde não entendam completamente esse quadro e possam, portanto, não fornecer aos pacientes um tratamento adequado. Dada à natureza multifatorial e psicofisiológica da DR, uma avaliação holística e multidimensional parece ser a maneira mais apropriada de melhorar a compreensão e a precisão do diagnóstico. A presente revisão foi desenvolvida como um meio de resumir as evidências disponíveis sobre DB, bem como de melhorar a compreensão do quadro por pesquisadores e profissionais.

Humans , Respiration Disorders/physiopathology , Respiration Disorders/cerebrospinal fluid , Respiration Disorders/psychology , Respiratory Muscles/physiopathology , Exercise Tolerance/physiology , Heart/physiopathology , Hyperventilation/physiopathology , Lung/physiopathology
Chinese Journal of Geriatrics ; (12): 76-79, 2019.
Article in Chinese | WPRIM | ID: wpr-734518


Objective To study the effect of noninvasive ventilation on heart failure(HF)in rats after acute myocardial infarction(AMI)and the mechanisms involved.Methods A total of 30 Wistar rats were randomly divided into three groups:the noninvasive ventilation group,the non-treatment group and the sham operation group(n=10 in each group).The model for HF after AMI was established by left anterior descending coronary artery ligation.Serum levels of B-type natriuretic peptide-45 (BNP-45),70 000 heat-shock protein(HSP70),matrix metalloproteinases(MMP-2 and-9),tumor necrosis factor-α(TNF-α)and echocardiography parameters,such as left atrium(LA)diameter,left ventricular(LV)end-diastolic diameter,interventricular septal(IVS)thickness,and left ventricular ejection fraction(LVEF),were measured at 3,5,7 and 14 days after operation in each group.Results Compared with the non-treatment group,LVEDD was reduced and LVEF was increased in the noninvasive ventilation group at 14 days after operation(155.92±14.74)mm/m2 vs.(149.35±11.29)mm/m2,(92.13±3.72)% vs.(76.39±9.24)%,(P<0.05),while LA diameter and IVS thickness showed no significant difference(P>0.05).Compared with the non-treatment group,serum levels of BNP45,MMP-2,MMP-9,and TNF-α were decreased and HSP70 levels were increased in the noninvasive ventilation group at 3,5,7,and 14 days after operation (P < 0.05).In the noninvasive ventilation group,serum levels of BNP45,MMP-2,MMP-9 and TNF-α at 5,7,and 14 days after operation were lower than those at 3 days after operation,and serum HSP70 levels at 7 and 14 days after operation were higher than those at 3 days after operation (P < 0.01).Conclusions Noninvasive ventilation can effectively reduce the inflammatory response in rats with HF after AMI and reduce myocardial ischemia-reperfusion injury.It is an effective treatment for HF after AMI.