PULMONER ARTERYEL HİPERTANSİYONDA İNSPİRATUAR KAS KUVVETİNİ BELİRLEYEN FAKTÖRLER: DİSPNE VE FONKSİYONEL KAPASİTE
Abstract
Amaç: Dispne ve yorgunluk, pulmoner arteryel hipertansiyon (PAH) hastalarında sık görülen semptomlardır. Bu çalışmanın amacı, PAH hastalarında inspiratuar kas kuvvetinin dispne ve fonksiyonel kapasite üzerine etkisinin araştırılmasıydı. Yöntemler: Çalışmaya New York Heart Association (NYHA) sınıf II ve III‘te olan 31 PAH hastası (6 erkek, 25 kadın; yaş ortalaması= 49.74±12.40 yıl) dahil edildi. Solunum kas kuvveti taşınabilir ağız basıncı ölçüm cihazı ile değerlendirildi. Dispne algılamasının değerlendirilmesinde, Modifiye Medical Research Council (MMRC) skalası kullanıldı. Fonksiyonel kapasite, altı dakika yürüme testi (6DYT) kullanılarak ölçüldü. 6DYT’den önce ve sonra oksijen satürasyonu, kalp hızı, yorgunluk ve dispne algılaması kaydedildi. Sonuçlar: Hastaların 16’sının (% 51.6) inspiratuar kas zayıflığı olduğu bulundu. İnspiratuar kas kuvveti, MMRC skoru (r=-0.61, p<0.0001), NYHA sınıfı (r=-0.38, p=0.03), 6DYT mesafesi (r=0.58, p=0.001), egzersiz sırasındaki dispne algılaması (r =-0.40, p=0.03) ve egzersiz oksijen satürasyonu (r =0.37, p=0.04) ile anlamlı ilişki gösterdi. MMRC skoru ve 6DYT mesafesi, inspiratuar kas kuvvetini bağımsız olarak tahmin eden faktörlerdi (R=0.68, R2=0.46, F(127)=4.625, p=0.041). MMRC dispne skoru, inspiratuar kas kuvvetindeki değişimin % 36.7’sini bağımsız olarak açıklamaktaydı. 6DYT mesafesinin ise, inspiratuar kas kuvvetinin % 9.3’sini bağımsız olarak açıkladığı belirlendi (p<0.05). Tartışma: PAH hastalarında inspiratuar kas zayıflığı görülme sıklığı yüksektir. PAH’ta günlük yaşam aktiviteleri ve egzersiz sırasında dispne algılamasında artış ve fonksiyonel kapasitede azalma inspiratuar kas zayıflığını belirleyen faktörlerdir. PAH’ta inspiratuar kas kuvvetini artırmayı hedefleyen pulmoner rehabilitasyon programlarının dispne ve fonksiyonel kapasiteye etkisi araştırılmalıdır.
References
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Year 2014,
Volume: 25 Issue: 3, 0 - 0, 27.05.2016
Abstract
References
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- ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518-624. 13. Kabitz HJ, Windisch W. Respiratory muscle testing: state of the art. Pneumologie. 2007;61(9):582-7. 14. Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969;99(5):696-702. 15. Stenton C. The MRC breathlessness scale. Occup Med (Lond). 2008;58(3):226-7. 16. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7. 17. Demir R, Küçükoğlu MS. Pulmoner arter hipertansiyonda egzersiz kapasitesinin değerlendirilmesi. Türk Kardiyol Dern Arş. 2010;38(8):580-8. 18. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81. 19. Fox EL BR, Foss ML. The Physiological Basis of Physical Education and Athletics. Dubuque: Wm C Brown Publishers; 1989. 20. Carter R, Holiday DB, Nwasuruba C, Stocks J, Grothues C, Tiep B. 6-minute walk work for assessment of functional capacity in patients with COPD. Chest. 2003;123(5):1408-15. 21. Troosters T, Gosselink R, Decramer M. Six-minute walk test: a valuable test, when properly standardized. Phys Ther. 2002;82(8):826-7. 22. Taylor R. Interpretation of the correlation coefficient: a basic review. JDMS 1990;6(1):35-9. 23. Tabachnick BG, Fidell LS. Using Multivariate Statistics. 6th ed. Boston: Pearson; 2013. 24. Green SB SN, Akey TM. Using SPSS for Windows: Analyzing and Understanding Data. 2nd ed. New Jersey: Prentice Hall; 2000. 25. Arena R. Exercise testing and training in chronic lung disease and pulmonary arterial hypertension. Prog Cardiovasc Dis. 2011;53(6):454-63. 26. Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation. 2001;104(4):429-35. 27. Savci S, Inal-Ince D, Arikan H, Guclu-Gunduz A, Cetisli-Korkmaz N, Armutlu K, et al. Six-minute walk distance as a measure of functional exercise capacity in multiple sclerosis. Disabil Rehabil. 2005;27(22):1365-71. 28. Fowler RM, Gain KR, Gabbay E. Exercise intolerance in pulmonary arterial hypertension. Pulm Med. 2012;2012, Article ID 359204:1-10. 29. Kearon MC, Summers E, Jones NL, Campbell EJM, Killian KJ. Breathing during prolonged exercise in humans. J Physiol. 1991;442(1):477–87. 30. Yasunobu Y, Oudiz RJ, Sun XG, Hansen JE, Wasserman K. End-tidal PCO2 abnormality and exercise limitation in patients with primary pulmonary hypertension. Chest. 2005;127(5):1637-46. 31. Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, et al. Peripheral muscle dysfunction in idiopathic pulmonary arterial hypertension. Thorax. 2010;65(2):113-7. 32. Meyer FJ, Borst MM, Zugck C, Kirschke A, Schellberg D, Kübler W, et al. Respiratory muscle dysfunction in congestive heart failure: clinical correlation and prognostic significance. Circulation. 2001;103(17):2153-8.
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| Journal Section | Articles |
|---|---|
| Authors | |
| Publication Date | May 27, 2016 |
| Published in Issue | Year 2014 Volume: 25 Issue: 3 |