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2016年6月，英国放射学研究所官方期刊《英国放射学杂志》正式发表伯明翰大学的小型研究报告，发现乳腺癌放疗期间屏住呼吸有助减少健康组织损伤。 如果肿瘤保持不动，那么更多的周围健康组织可能幸免。为了评估患者在放疗时屏住呼吸的可行性，该研究入组15例已经接受放疗的乳腺癌患者，年龄37～74岁，均无呼吸疾病或吸烟史、心血管或神经疾病、糖尿病或肥胖症，所有这些情况都可能使患者较难掌握延长呼吸。该研究开始时，患者屏住呼吸时间平均为42秒。为了延长呼吸，患者练习几天维持放松姿势、减慢呼吸。该研究通过指导，使患者成功屏住呼吸，平均5.3分钟。 Br J Radiol. 2016 Jun;89(1062):20150741. Reducing the within-patient variability of breathing for radiotherapy delivery in conscious, unsedated cancer patients using a mechanical ventilator. Parkes MJ, Green S, Stevens AM, Parveen S, Stephens R, Clutton-Brock TH. National Institute for Health Research (NIHR)/Wellcome Trust Birmingham Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Hall Edwards Radiotherapy Research Group, Department of Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Department of Oncology , University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Department Anaesthesia and Intensive Care Medicine , University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. OBJECTIVE: Variability in the breathing pattern of patients with cancer during radiotherapy requires mitigation, including enlargement of the planned treatment field, treatment gating and breathing guidance interventions. Here, we provide the first demonstration of how easy it is to mechanically ventilate patients with breast cancer while fully conscious and without sedation, and we quantify the resulting reduction in the variability of breathing. METHODS: 15 patients were trained for mechanical ventilation. Breathing was measured and the left breast anteroposterior displacement was measured using an Osiris surface-image mapping system (Qados Ltd, Sandhurst, UK). RESULTS: Mechanical ventilation significantly reduced the within-breath variability of breathing frequency by 85% (p < 0.0001) and that of inflation volume by 29% (p < 0.006) when compared with their spontaneous breathing pattern. During mechanical ventilation, the mean amplitude of the left breast marker displacement was 5 ± 1 mm, the mean variability in its peak inflation position was 0.5 ± 0.1 mm and that in its trough inflation position was 0.4 ± 0.0 mm. Their mean drifts were not significantly different from 0 mm min(-1) (peak drift was -0.1 ± 0.2 mm min(-1) and trough drift was -0.3 ± 0.2 mm min(-1)). Patients had a normal resting mean systolic blood pressure (131 ± 5 mmHg) and mean heart rate [75 ± 2 beats per minute (bpm)] before mechanical ventilation. During mechanical ventilation, the mean blood pressure did not change significantly, mean heart rate fell by 2 bpm (p < 0.05) with pre-oxygenation and rose by only 4 bpm (p < 0.05) during pre-oxygenation with hypocapnia. No patients reported discomfort and all 15 patients were always willing to return to the laboratory on multiple occasions to continue the study. CONCLUSION: This simple technique for regularizing breathing may have important applications in radiotherapy. ADVANCES IN KNOWLEDGE: Variations in the breathing pattern introduce major problems in imaging and radiotherapy planning and delivery and are currently addressed to only a limited extent by asking patients to breathe to auditory or visual guidelines. We provide the first demonstration that a completely different technique, of using a mechanical ventilator to take over the patients' breathing for them, is easy for patients who are conscious and unsedated and reduces the within-patient variability of breathing. This technique has potential advantages in radiotherapy over currently used breathing guidance interventions because it does not require any active participation from or feedback to the patient and is therefore worthy of further clinical evaluation. PMID: 26959610 DOI: 10.1259/bjr.20150741 |
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