pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2016-26-4-466-472pulmo-747Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESЭффективность метода высокочастотных колебаний грудной стенки при обострении хронической обструктивной болезни легкихEfficacy of high frequency chest wall oscillation method in acute exacerbation of chronic obstructive pulmonary diseaseАвдеевС. Н.AvdeevS. N.

д. м. н., профессор, руководитель клинического отдела ФГБУ «НИИ пульмонологии» ФМБА России, тел. / факс: (495) 465-52-64;

MD, Professor, Head of Clinical Division, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; tel. / fax: (495) 465-52-64;

serg_avdeev@list.ruГусеваН. А.GusevaN. A.

аспирант ФГБУ «НИИ пульмонологии» ФМБА России; тел. / факс: (495) 465-52-64;

PhD student, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; tel. / fax: (495) 465-52-64;

nadik_86@bk.ruНуралиеваГ. С.NuralievaG. S.

к. м. н., старший научный сотрудник лаборатории интенсивной терапии и дыхательной недостаточности ФГБУ «НИИ пульмонологии» ФМБА России; тел. / факс: (495) 465-74-15;

PhD, Senior Researcher at Laboratory of Intensive Care and Respiratory Failure, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; tel. / fax: (495) 465-74-15;

galia32@yandex.ruФГБУ «НИИ пульмонологии» ФМБА России: 105077, Россия, Москва, ул. 11-я Парковая, 32, корп. 4РоссияFederal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; 32, build. 4, 11th Parkovaya str., Moscow, 105077, RussiaRussian Federation201618102016264466472Copyright © Авдеев С.Н., Гусева Н.А., Нуралиева Г.С., 20162016Авдеев С.Н., Гусева Н.А., Нуралиева Г.С.Avdeev S.N., Guseva N.A., Nuralieva G.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/747

Гиперпродукция мокроты и плохой клиренс бронхиального дерева могут представлять серьезную проблему для многих пациентов с обострением хронической обструктивной болезни легких (ХОБЛ). Улучшить дренаж дыхательных путей возможно при помощи специальных высокочастотных методов, модулирующих воздушный поток. Цель. Изучение клинической эффективности и безопасности метода высокочастотных колебаний грудной стенки (ВЧКГС) у больных с обострением ХОБЛ. Материалы и методы. В проспективное рандомизированное контролируемое сравнительное исследование включены больные, госпитализированные в стационар по поводу обострения ХОБЛ (III и IV стадии по GOLD; средний объем форсированного выдоха за 1-ю секунду – 37 %долж.). Все пациенты в 1–2-е сутки госпитализации были случайным методом разделены на 2 группы: терапии ВЧКГС (система Vest#R Airway Clearance System, 15–25 мин 2 раза в сутки, частота осцилляций – 10–15 Гц, уровень давления – 4–6 cм вод. ст.) и контрольную (только стандартная терапия). Исследование завершили 50 пациентов (25 − в группе ВЧКГС и 25 − в группе стандартной терапии). Результаты. При терапии ВЧКГС повысился объем откашливаемой мокроты на 3-й и 7-й дни исследования (р < 0,001). Использование ВЧКГС способствовало б#ольшему снижению выраженности симптомов по сравнению с терапией в контрольной группе (р = 0,006). Тяжесть симптомов по шале BCSS более значимо достоверно уменьшилась в группе ВЧКГС по сравнению с группой сравнения (в среднем на 3,4 и 1,5 балла соответственно; р = 0,006). У получавших терапию ВЧКГС к концу исследования отмечено более выраженное улучшение показателей оксигенации (р = 0,001) и снижение уровней С-реактивного белка (р = 0,001). Заключение. При обострении ХОБЛ с помощью терапии ВЧКГС улучшается отхождение мокроты, достоверно снижаются выраженность клинических симптомов и уровень С-реактивного белка, быстрее улучшается оксигенация.

This study was aimed at investigation of clinical efficacy and safety of high frequency chest wall oscillation (HFCWO) method in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods. This was a prospective randomized controlled comparative study. Patients hospitalized for AECOPD (GOLD III or IV stage; mean FEV 1, 37% pred.) were included. In first two days of admission, all patients were randomized to HFCWO treatment (VestÒ Airway Clearance System; 15–25 min b.i.d.; oscillation frequency, 10–15 Hz; pressure, 4–6 cm H2O) or standard therapy (the control group). Results. Fifty patients completed the study: 25 patients in HFCWO group and 25 patients in the standard therapy group. Therapy with HFCWO was associated with increasing sputum volume to the 3rd and the 7th days of the study (р < 0.001) and more significant reduction in symptom intensity compared to the controls (р = 0.006). Symptom severity measured with the BCSS score decreased by 3.4 and 1.5, respectively (р = 0,006). Therapy with HFCWO was also associated with more significant improvement in oxygenation parameters and reduction in C-reactive protein (CRP) level (р = 0,001 for both). Conclusion. Therefore, treatment with HFCWO was associated to improved sputum clearance, significant improvement in clinical symptoms, earlier oxygenation improvement and CRP reduction.

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The authors declare that there are no conflicts of interest present.