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For?a muscular respirat?ria, qualidade de vida e modula??o auton?mica da frequ?ncia card?aca na distrofia miot?nicaAra?jo, Thaise Lucena 22 July 2009 (has links)
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Previous issue date: 2009-07-22 / Background: The myotonic dystrophy (MD) is a multisystem neuromuscular disease that can affect the respiratory muscles and heart function, and cause impairment in quality of life. Objectives: Investigate the changes in respiratory muscle strength, health-related quality of life (HRQoL) and autonomic modulation heart rate (HR) in patients with MD. Methods: Twenty-three patients performed assessment of pulmonary function, sniff nasal inspiratory pressure (SNIP), the maximal inspiratory (MIP) and expiratory (MEP) pressure, and of HRQoL (SF-36 questionnaire). Of these patients, 17 underwent assessment of heart rate variability (HRV) at rest, in the supine and seated positions. Results: The values of respiratory muscle strength were 64, 70 and 80% of predicted for MEP, MIP, and SNIP, respectively. Significant differences were found in the SF-36 domains of physical functioning (58.7 ? 31,4 vs. 84.5 ? 23, p<0.01) and physical problems (43.4 ? 35.2 vs. 81.2 ? 34, p<0.001) when patients were compared with the reference values. Single linear regression analysis demonstrated that MIP explains 29% of the variance in physical functioning, 18% of physical problems and 20% of vitality. The HRV showed that from supine position to seated, HF decreased (0.43 x 0.30), and LF (0.57 x 0.70) and the LF/HF ratio (1.28 x 2.22) increased (p< 0.05). Compared to healthy persons, LF was lower in both male patients (2.68 x 2.99) and women (2.31 x 2.79) (p< 0.05). LF / HF ratio and LF were higher in men (5.52 x 1.5 and 0.8 x 0.6, p <0.05) and AF in women (0.43 x 0.21) (p< 0.05). There was positive correlation between the time of diagnosis and LF / HF ratio (r = 0.7, p <0.01). Conclusions: The expiratory muscle strength was reduced. The HRQoL was more impaired on the physical aspects and partly influenced by changes in inspiratory muscle strength. The HRV showed that may be sympathetic dysfunction in autonomic modulation of HR, although with normal adjustment of autonomic modulation during the change of posture. The parasympathetic modulation is higher in female patients and sympathetic tends to increase in patients with longer diagnosis / Introdu??o: A distrofia miot?nica (DM) ? uma doen?a neuromuscular multissist?mica que pode afetar a musculatura respirat?ria e a fun??o card?aca, e ocasionar preju?zos na qualidade de vida. Objetivos: Investigar as altera??es na for?a muscular respirat?ria, qualidade de vida relacionada ? sa?de (QVRS), e modula??o auton?mica da freq??ncia card?aca (FC) em pacientes com DM. M?todos: Foram avaliados 23 pacientes quanto ? fun??o pulmonar, press?o inspirat?ria nasal sniff (SNIP), press?es respirat?rias m?ximas (PIm?x e PEm?x), e QVRS (question?rio SF-36). Destes, 17 realizaram avalia??o da variabilidade da frequ?ncia card?aca (VFC) em repouso, nas posturas supina e sentada. Resultados: Os valores da for?a muscular respirat?ria foram de 64, 70 e 80%predito para PEm?x, PIm?x, e SNIP, respectivamente. Foi encontrada diminui??o significativa nos dom?nios do SF-36 capacidade funcional (58.7 ? 31,4 vs. 84.5 ? 23, p<0.01) e disfun??o f?sica (43.4 ? 35.2 vs. 81.2 ? 34, p<0.001) comparado a valores de refer?ncia. A an?lise de regress?o linear mostrou que a PIm?x explica 29% da vari?ncia na capacidade funcional, 18% na disfun??o f?sica e 20% na vitalidade. A VFC mostrou que, da postura supina para a sentada, o espectro AF diminuiu (0.43 x 0.30) e o espectro BF (0.57 x 0.70) e a raz?o BF/AF (1.28 x 2.22) aumentaram, com p<0.05. Comparado a valores de refer?ncia, BF foi inferior (p<0.05) tanto nos pacientes homens (2.68 x 2.99), como nas mulheres (2.31 x 2.79). A raz?o BF/AF e o espectro BF foram maiores nos homens (5.52 x 1.5 e 0.8 x 0.6), e o espectro AF, nas mulheres (0.43 x 0.21), com p<0.05. Houve correla??o significativa positiva entre tempo de diagn?stico e raz?o BF/AF (r= 0.7, p< 0.01). Conclus?es: Indiv?duos com DM t?m for?a muscular expirat?ria diminu?da. A QVRS mostrou-se mais prejudicada em rela??o a aspectos f?sicos e parcialmente influenciada por varia??es na for?a muscular inspirat?ria. Pode haver disfun??o simp?tica na modula??o auton?mica da FC, com ajuste normal da postura supina para a sentada. A modula??o parassimp?tica ? superior em pacientes mulheres e a modula??o simp?tica tende a aumentar nos pacientes com maior tempo de diagn?stico
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Avalia??o muscular respirat?ria: adapta??o do mano vacu?metro nacional para a avalia??o da press?o inspirat?ria nasal e n?vel de intensidade da ventila??o volunt?ria m?xima em sujeitos saud?veisSeverino, Fernanda Gadelha 18 May 2010 (has links)
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Previous issue date: 2010-05-18 / The clinical importance of evaluating the respiratory muscles with a variety of tests
has been proposed by several studies, once that the combination of several tests
would allow a better diagnosis and therefore, a better clinical follow of disorders of
the respiratory muscles. This study aimed to evaluate the feasibility of adapting a
national electronic manovacuometer to measure the nasal inspiratory pressure (study
1) and analyze the level of load intensity of maximum voluntary ventilation, as well as
the variables that may influence this maneuver in healthy subjects (study 2). We
studied 20 healthy subjects by a random evaluation of two measures of SNIP in
different equipments: a national and an imported. In study 2 it was analyzed the
intensity of the load of MVV test, change in pressure developed during the maneuver,
the possible differences between genders, and the correlations between the flow
developed in the test and the result of MVV. In study 1 it was found the average for
both measures of nasal inspiratory pressures: 125 ? 42.4 cmH2O for the imported
equipment and 131.7 ? 28.7 cmH2O for the national one. Pearson analysis showed a
significant correlation between the average, with a coefficient r = 0.63. The average
values showed no significant differences evaluated by paired t test (p> 0.05). In the
Bland-Altman analysis it was found a BIAS = 7 cmH2O, SD 32.9 and a confidence
interval of - 57.5 cmH2O up to 71.5 cmH2O. In the second study it was found
significant differences between the genders in the air volume moved, being higher in
males 150.9 ? 13.1 l / min vs 118.5 ? 15.7 L / min for (p = 0.0002, 95% CI 44.85 to
20:05). Regarding the inspiratory and expiratory loading, they were significantly
higher in men than in women, peak inspiratory pressure (34.7 ? 5.3 cmH2O vs 19.5 ?
4.2 cmH2O, 95% CI - 18.0 to -12.3, p <0.0001), peak expiratory (33.8 vs. 23.1 ? 5.9
cmH2O ? 5.4 cmH2O, 95% CI -17.1 to - 4.6, p <0.0001), and the delta pressure (59.7
? 10 cmH2O vs 36.8 ? 8.3 cmH2O, 95% CI 14.5 to 31.2, p <0.0002). The Pearson
correlation showed that the flow generated by the maneuver is strongly correlated
with the delta-expiratory pressure / inspiratory (r2= 0.83,R = 0.91, 95%IC 0.72 a 0.97
e p< 0.0001).Through these results we suggest that the national electronic
manovacuometer is feasible and safe to perform the sniff test in healthy subjects. For
the MVV, there are differences between the genders in the intensity of pressure
developed during the maneuver. We found a load intensity considered low during the
MVV, and found a strong correlation between the flow generated in the test and the
delta pressure expiratory / inspiratory / A import?ncia clinica de avaliar os m?sculos respirat?rios com uma variedade de
testes vem sendo proposta por diversos trabalhos, pois a combina??o de v?rios
testes possibilitaria um melhor diagn?stico e consequentemente um melhor
seguimento cl?nico das disfun??es dos m?sculos respirat?rios. Este trabalho teve
como objetivo avaliar a viabilidade da adapta??o do manovacu?metro nacional
eletr?nico para a realiza??o da medida de press?o inspirat?ria nasal (estudo 1) e
analisar o n?vel de intensidade de carga da ventila??o volunt?ria m?xima, assim
como as vari?veis que possam influenciar a manobra em sujeitos saud?veis (estudo
2). Foram estudados 20 sujeitos saud?veis atrav?s da avalia??o aleat?ria de duas
medidas de SNIP em equipamentos diferentes: um nacional e outro importado. No
estudo 2 foi analisado a intensidade da carga do teste da ventila??o volunt?ria
m?xima(VVM), a varia??o de press?o desenvolvida durante manobra, as poss?veis
diferen?as entre g?neros, e as correla??es entre o fluxo desenvolvido no teste e o
resultado da VVM. No estudo 1 as m?dias encontradas durante as duas medidas
das press?es nasais foram de 125 ? 42,4 cmH2O para o aparelho importado e de
131,7 ? 28,7 cmH2O para o nacional. A an?lise de Pearson demonstrou uma
correla??o significativa entre as m?dias com um coeficiente r=0.63. Os valores
m?dios n?o apresentaram diferen?as significativas avaliadas pelo teste t pareado
(p>0,05).Na an?lise de Bland-Altman foi encontrado um BIAS igual a 7 cmH2O,
desvio padr?o 32,9 e um intervalo de confian?a de - 57,5cmH2O at? 71,5 cmH2O.
No estudo 2 foi encontrada diferen?a significativa entre os g?neros para o volume
de ar deslocado maior em homens 150.9 ? 13.1 l/mim vs 118.5 ? 15.7 L/mim para
(p= 0.0002, IC95% 20.05 ? 44.85). Em rela??o carga inspirat?ria e expirat?ria foram
significativamente maiores em homens que nas mulheres: pico inspirat?rio (34.7 ?
5.3 cmH2O vs 19.5 ? 4.2 cmH2O, IC95% - 18.0 a -12.3, p< 0.0001), pico expirat?rio
(33.8 ? 5.9 cmH2O vs 23.1 ? 5.4 cmH2O, IC95% -17.1 a - 4.6, p< 0.0001), assim
como o delta de press?o (59.7 ? 10 cmH2O vs 36.8 ? 8.3 cmH2O, IC95% 14.5 a 31.2
, p< 0.0002). A correla??o de Pearson mostrou que o fluxo gerado pela manobra
est? fortemente correlacionado com o delta de press?o expirat?ria/inspirat?ria (r2=
0.83,R = 0.91, (95%IC 0.72 a 0.97 e p< 0.0001). Atrav?s dos resultados
encontrados podemos sugerir que o manovacu?metro eletr?nico nacional ? vi?vel e
seguro para realiza??o do sniff teste em sujeitos saud?veis. Em rela??o a VVM,
existem diferen?as entre os g?neros na intensidade de press?o desenvolvida
durante a VVM, a uma intensidade de carga durante a VVM foi considerada baixa
assim como foi encontrada uma forte correla??o entre o fluxo gerado no teste e o
delta de press?o expirat?rio/inspirat?rio
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