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Jeong: The Effects of Breathing Exercise on Respiratory Synergist Muscle Activity and SpO2 in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Purpose:

This study is not a fragmentary study on characteristics of respiratory synergist when breathing, however it was intended to determine the effect of currently available respiratory exercise and to provide basic clinical information through investigation of oxygen demand and respiratory synergist that mobilizes for respiration during application of respiratory exercise.

Methods:

Experimental group I was selected from second grade of severity classification of GOLD, which has the highest percentage among patients with COPD, and experimental group II was selected from third grade of severity classification as a clinical sampling. After respiration pursing up lips and diaphragm respiration exercise were mediated together for six weeks, activity of respiratory muscles and oxygen saturation were measured and analyzed.

Results:

In comparison of change of respiratory synergist and oxygen saturation, activity of respiratory synergist in sternocleidomastoid muscle and scalene muscle showed a meaningful decrease in experimental group I. And, in comparison of change of respiratory synergist and oxygen saturation, activity of respiratory synergist in rectus abdominis muscle showed a meaningful increase in experimental group II. In comparison of change of respiratory synergist and oxygen saturation, activity of respiratory synergist in sternocleidomastoid muscle, scalene muscle, and rectus abdominis muscle showed a meaningful difference between experimental groups.

Conclusion:

Respiratory synergists work mainly as agonist of chest and upper limbs. Therefore it is very important to lower mobilization of respiratory synergist when breathing. It is considered that a multilateral approach and continued clinical research for improvement of respiratory function for patients with COPD will be needed in the future.

์„œ๋ก 

๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜์€ ๋†’์€ ํก์—ฐ์œจ๊ณผ ๋น ๋ฅธ ๊ณ ๋ นํ™”๋กœ ์ธํ•˜์—ฌ ์œ ๋ณ‘๋ฅ ์ด 40์„ธ ์ด์ƒ์—์„œ 11%๋กœ ์ ์  ์ฆ๊ฐ€ํ•˜๊ณ  ์žˆ๊ณ , ํ์งˆํ™˜์œผ๋กœ ์ธํ•œ ์‚ฌ๋ง๋ฅ ์ด 1992๋…„์˜ 8์œ„์—์„œ 2010๋…„์—๋Š” 6์œ„๋กœ ์ฆ๊ฐ€ํ•˜๋Š” ์ถ”์„ธ์ด๋ฉฐ, 10๋…„๊ฐ„ ์‚ฌ๋ง๋ฅ ์€ ์ธ๊ตฌ ์‹ญ๋งŒ ๋ช…๋‹น ํ‰๊ท  18.3๋ช…, 2010๋…„์—๋Š” 14.2๋ช…์œผ๋กœ ๊ตญ๋‚ด 10๋Œ€ ์‚ฌ๋ง์›์ธ์— ํ•ด๋‹นํ•˜๋Š” ์‹ฌ๊ฐํ•œ ์ฃผ์š” ์งˆ๋ณ‘์ด๋‹ค.1 ๋˜ํ•œ ํ˜„์žฌ ์šฐ๋ฆฌ๋‚˜๋ผ 10๋Œ€ ์‚ฌ๋ง์›์ธ ์งˆํ™˜ ์ค‘ ์ˆœํ™˜๊ธฐ๊ณ„ ์งˆํ™˜, ์•”, ์‚ฌ๊ณ ์‚ฌ, ์†Œํ™”๊ธฐ๊ณ„ ์งˆํ™˜ ๋‹ค์Œ์œผ๋กœ 5์œ„๋ฅผ ์ฐจ์ง€ํ•˜๊ณ  ์žˆ์„ ์ •๋„๋กœ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜์„ ํฌํ•จํ•œ ํ˜ธํก๊ธฐ ์งˆํ™˜์˜ ์ค‘์š”์„ฑ์ด ์ปค์ง€๊ณ  ์žˆ์Œ์„ ์‹œ์‚ฌํ•œ๋‹ค.2
๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜์€ ๋งŒ์„ฑ ๊ธฐ๋ฅ˜์ œํ•œ์œผ๋กœ ํ ์šฉ์ ์— ๋”ฐ๋ฅธ ์šด๋™์‹œ์— ๋™์ ์ธ ๊ณผํŒฝ์ฐฝ์ด ์ฆ๊ฐ€๋จ์œผ๋กœ ์ธํ•ด ์ด๋ฅผ ๋ณด์ƒํ•˜๊ธฐ ์œ„ํ•ด์„œ ๊ฐ€์Šด์šฐ๋ฆฌ์˜ ํ˜ธํก๊ทผ์ด ๋งŒ๋“ค์–ด๋‚ด์•ผ ํ•˜๋Š” ์••๋ ฅ์ด ์ƒ๋Œ€์ ์œผ๋กœ ์ฆ๊ฐ€ํ•˜์—ฌ ํ˜ธํก์„ ํ•˜๋Š” ๋ฐ ๋งŽ์€ ํž˜์ด ๋“ค๊ฒŒ ๋˜๋ฉฐ, ์ด๋Ÿฌํ•œ ์›๋ฆฌ๋Š” ํ˜ธํก์— ๋™์›๋˜๋Š” ์ผ์„ ์ฆ๊ฐ€ํ•˜๊ฒŒ ํ•˜๋Š” ์ค‘์š”ํ•œ ๊ธฐ์ „์œผ๋กœ ์ž‘์šฉํ•œ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ๊ธฐ๋ฅ˜์ œํ•œ์€ ํ˜ธํก์˜ ์ฃผ๋™๊ทผ์ธ ๊ฐ€๋กœ๋ง‰์˜ ์—ญํ•™์  ๋ถˆ์ด์ต์„ ์ฃผ๋ฉฐ, ํ˜ธํกํŒจํ„ด๊ณผ ๊ฐ€์Šด์›€์ง์ž„์˜ ๋ณ€ํ™”๋ฅผ ์ผ์œผํ‚ค๋Š” ์›์ธ์ด ๋˜๊ณ ,3 ์ด์— ๋Œ€ํ•œ ๋ณด์ƒ์œผ๋กœ ํ˜ธํก์„ ์ˆ˜ํ–‰ํ•  ๋•Œ ํ˜ธํก๊ทผ์˜ ๊ทผ๋ ฅ ์œ ์ง€์™€ ์ง€๊ตฌ๋ ฅ์„ ๋†’์ด๊ธฐ ์œ„ํ•ด ๊ฐ€์Šด ๋ฒฝ๊ณผ ๊ฐ€๋กœ๋ง‰์˜ ๋ชจ์–‘์ด ๊ทผ ์„ฌ์œ ์˜ ์šฉ๋Ÿ‰ ์ฆ๊ฐ€ ๋ฐ ์ ์‘์„ ์ˆ˜์šฉํ•˜๊ธฐ ์œ„ํ•ด ๋ณ€ํ™”ํ•œ๋‹ค.3 ๋˜ํ•œ ํ˜ธํก์— ๋™์›๋˜๋Š” ์—๋„ˆ์ง€์˜ ๋น„์œจ๊ณผ ํ™˜์ž๋“ค์˜ ํ˜ธํก์„ฑ ์ˆ˜์š”๊ฐ€ ์ผ์น˜๋˜์ง€ ์•Š๊ธฐ ๋•Œ๋ฌธ์— ํ˜ธํก์„ ์œ„ํ•œ ๊ทผ์œก์˜ ๋…ธ๋ ฅ์ด ์ฆ๊ฐ€ํ•จ์—๋„ ๋ถˆ๊ฐ€ํ•˜๊ณ  ์ •์ž‘ ํ˜ธํก๋Ÿ‰์€ ์ค„์–ด๋“ค๊ฒŒ ๋˜๋ฉฐ,4 ํŠนํžˆ ์งˆํ™˜์ด ์•…ํ™”๋ ์ˆ˜๋ก ํ˜ธํก ๋ณด์กฐ๊ทผ๋“ค์˜ ๊ณผ๋‹คํ•œ ์‚ฌ์šฉ์— ๋”ฐ๋ผ ๊ธ‰๊ฒฉํ•˜๊ฒŒ ๋†’์•„์ง„ ์‚ฐ์†Œ ์š”๊ตฌ๋„์™€ ๋” ์ด์ƒ ๋ถ€ํ•ฉ๋˜์ง€ ์•Š๊ณ , ์ด๋Ÿฌํ•œ ํ™˜๊ธฐ์„ฑ ๊ธฐ์ „์˜ ๋‹ค๋ฅธ ๋ณ€ํ˜•๋“ค๋กœ ์ธํ•ด ํ˜ธํก์„ฑ ๋ถ€์ „์ด ๋‚˜ํƒ€๋‚œ๋‹ค.5 ์ด์™€ ๊ฐ™์ด ๋น„์ •์ƒ์ ์ธ ์—ญํ•™์  ๊ธฐ์ „์œผ๋กœ ์ธํ•ด ํ™˜๊ธฐ-๊ด€๋ฅ˜ ๋ถˆ๊ท ํ˜•์ด ์ฆ๊ฐ€๋จ์œผ๋กœ์จ ์‚ฐ์†Œ ์†Œ๋น„๋Ÿ‰์ด ์ฆ๊ฐ€ํ•˜๊ฒŒ ๋˜๋ฉฐ ํ˜ผํ•ฉ์ •๋งฅํ˜ˆ ์‚ฐ์†Œ๋ถ„์••์ด ๊ฐ์†Œํ•˜์—ฌ ๊ฐ€์Šค๊ตํ™˜์˜ ์žฅ์• ๊ฐ€ ๋”์šฑ ์‹ฌํ•ด์ง€๋Š” ์•…์ˆœํ™˜์ด ๋ฐ˜๋ณต๋œ๋‹ค.6
์ด๋Ÿฌํ•œ ๋น„์ •์ƒ์ ์ธ ํ˜ธํก๊ทผ์˜ ๋™์›๊ณผ ์‚ฐ์†Œ์š”๊ตฌ๋„์˜ ๊ณ ๋ฆฌ๋ฅผ ์ œ๊ฑฐํ•˜๊ธฐ ์œ„ํ•ด์„œ๋Š” ํ๊ธฐ๋Šฅ์ด 80% ์ˆ˜์ค€, ์ฆ‰ ๋ถˆํŽธํ•œ ์ฆ์ƒ์„ ๊ฑฐ์˜ ๋Š๋ผ์ง€ ๋ชปํ•˜๋Š” ๊ฒฝ์ฆ ์ˆ˜์ค€์ด๋”๋ผ๋„ ์ดˆ๊ธฐ์— ๋ฐœ๊ฒฌํ•œ ์ˆœ๊ฐ„๋ถ€ํ„ฐ ํ˜ธํก์žฌํ™œ์„ ์‹œ์ž‘ํ•ด์•ผ ํ•œ๋‹ค๊ณ  ๊ถŒ๊ณ ํ•˜๊ณ  ์žˆ๋Š”๋ฐ,7 ์•…ํ™”๋œ ํ๊ธฐ๋Šฅ์˜ ์ฆ์ƒ์ด ๋‚˜ํƒ€๋‚  ๋•Œ๊นŒ์ง€ ์ดˆ๊ธฐ ์ง„๋‹จ์˜ ์–ด๋ ค์›€์ด ์žˆ๋Š” ๊ฒƒ์ด ํ˜„์‹ค์ด๋ฉฐ, ์ด์ƒ ์ง•ํ›„๊ฐ€ ๋‚˜ํƒ€๋‚˜๋Š” ์‹œ์  ๋˜ํ•œ ๋Œ€๋ถ€๋ถ„ ์ค‘๋“ฑ์ฆ ์ด์ƒ์˜ ๋“ฑ๊ธ‰์ด๋‹ค. ๋”ฐ๋ผ์„œ ํ๊ธฐ๋Šฅ์€ ์ค‘์žฌ๋ฅผ ํ•ด๋„ ์†์ƒ ์ด์ „์˜ ์ƒํƒœ๋กœ ํšŒ๋ณต์€ ๋ถˆ๊ฐ€๋Šฅํ•˜๊ธฐ ๋•Œ๋ฌธ์— ๋ฐœ๊ฒฌ ์ฆ‰์‹œ ์ ๊ทน์ ์ธ ์น˜๋ฃŒ์™€ ํ˜ธํก์žฌํ™œ ์šด๋™์„ ์‹œ์ž‘ํ•ด์•ผ ํ•œ๋‹ค.8 ํ์˜ ํ™˜๊ธฐ์ฆ์ง„์„ ์œ„ํ•œ ์ค‘์žฌ๋ฐฉ๋ฒ• ์ค‘ ๊ฐ€๋กœ๋ง‰ ํ˜ธํก์šด๋™์€ ์ „ํ†ต์ ์ธ ํ˜ธํก ๋ฌผ๋ฆฌ์น˜๋ฃŒ ์ค‘์—์„œ ๋งค์šฐ ์ค‘์š”ํ•œ ๊ธฐ๋ฒ• ์ค‘ ํ•˜๋‚˜์ด๋ฉฐ,9 ๊ฐ€์Šด์˜ ํŽŒํ”„ ๊ธฐ๋Šฅ ์žฅ์• ๋กœ ์ธํ•œ ๋น„ํšจ์œจ์  ํ™˜๊ธฐ ๋ฌธ์ œ๋ฅผ ํ•ด๊ฒฐํ•ด ์ฃผ๊ณ , ๋‹จ์ถ•๋œ ํ˜ธํก๊ทผ๊ณผ ์ฃผ์œ„์˜ ํ˜‘๋ ฅ๊ทผ๋“ค์˜ ๋‹จ์ถ• ๋˜ํ•œ ์ด์™„์‹œํ‚ฌ ์ˆ˜ ์žˆ๋‹ค.10 ์˜ค๋ฏ€๋ฆฐ ์ž…์ˆ  ํ˜ธํก๋ฒ•์€ ํ˜ธํก ํŒจํ„ด์„ ์ œ๊ณตํ•˜๊ณ  ์ถ”๊ฐ€์ ์œผ๋กœ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž์—๊ฒŒ ํ˜ธํก ๊ณค๋ž€์„ ๊ฐœ์„ ์‹œํ‚ค๋Š” ํ™•์‹คํ•œ ๊ทผ๊ฑฐ๊ฐ€ ๋˜๊ณ , ๊ฐ€์Šด์šฐ๋ฆฌ์˜ ์šฉ์ ์„ ๋ณ€ํ™” ์‹œํ‚ค๋ฉฐ, ํ˜ธํก ๊ณค๋ž€์˜ ์™„ํ™”์™€ ๋” ๊นŠ์€ ํ˜ธํก์„ ์ด‰์ง„ํ•˜๋Š” ๋Šฅ๋ ฅ๊ณผ ๊ด€๋ จ์ด ์žˆ๋‹ค.11 ๊ณ ๋ นํ™”๋กœ ์ธํ•œ ๋งŒ์„ฑ์ ์ธ ํ์งˆํ™˜ ํ™˜์ž๊ฐ€ ์ฆ๊ฐ€๋˜์–ด ํ˜ธํก์šด๋™์˜ ์ ๊ทน์ ์ธ ์ค‘์žฌ๊ฐ€ ์š”๊ตฌ๋˜๊ณ  ์žˆ์ง€๋งŒ, ์ค‘์ฆ๋„์— ๋ถ„๋ฅ˜์— ๋”ฐ๋ฅธ ํ˜ธํก์šด๋™์ด ์•„๋‹Œ ์‚ฐ์†Œํฌํ™”๋„์™€ ํ˜ธํก๊ทผ์˜ ๋™์›์— ์ œ์•ฝ์ด ๋” ํด ๊ฒƒ์œผ๋กœ ์˜ˆ์ƒ๋˜๋Š” ์ค‘์ฆ๋„๊ฐ€ ์‹ฌํ•œ ํ™˜์ž์—๊ฒŒ๋„ ๋™์ผํ•œ ํ˜ธํก์šด๋™ ์ค‘์žฌ๋ฅผ ์‹œํ–‰ํ•˜๊ณ  ์žˆ๋‹ค. ๋”ฐ๋ผ์„œ ํ˜ธํก ์ˆ˜ํ–‰ ์‹œ ํ˜ธํกํ˜‘๋ ฅ๊ทผ๋“ค์˜ ํŠน์„ฑ์„ ์•Œ์•„๋ณด๊ธฐ ์œ„ํ•œ ๋‹จํŽธ์ ์ธ ์—ฐ๊ตฌ๊ฐ€ ์•„๋‹Œ, ํ˜ธํก์šด๋™์„ ์ค‘์žฌํ•˜์—ฌ ํ˜ธํก์— ๋™์›๋˜๋Š” ํ˜‘๋ ฅ๊ทผ๊ณผ ์‚ฐ์†Œํฌํ™”๋„๋ฅผ ์•Œ์•„๋ด„์œผ๋กœ์จ ํ˜„์žฌ ์‹œํ–‰ํ•˜๊ณ  ์žˆ๋Š” ๋ฌผ๋ฆฌ์น˜๋ฃŒ์  ํ˜ธํก์šด๋™์˜ ์˜ํ–ฅ์„ ์•Œ์•„๋ณด๊ณ  ์ž„์ƒ์  ๊ธฐ์ดˆ์ž๋ฃŒ๋ฅผ ์ œ๊ณตํ•˜๊ณ ์ž ํ•œ๋‹ค.

์—ฐ๊ตฌ ๋ฐฉ๋ฒ•

1. ์—ฐ๊ตฌ ๋Œ€์ƒ

์—ฐ๊ตฌ ๋Œ€์ƒ์ž๋Š” 2014๋…„ 10์›”๋ถ€ํ„ฐ 2015๋…„ 2์›”๊นŒ์ง€ ์ „๋ผ๋‚จ๋„์— ์†Œ์žฌํ•œ A ๋ณ‘์›์—์„œ ์น˜๋ฃŒ ์ค‘์ธ 55-65์„ธ ์—ฐ๋ น๋ฒ”์œ„์˜ ๋‚จ์„ฑ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž 32๋ช…์œผ๋กœ, GOLD stage ๋ฒ”์œ„๊ฐ€ II-III ์ธ ๋Œ€์ƒ์ž ์ค‘, ์ฃผ์š” ๋‚ด๊ณผ์  ์งˆํ™˜ (ํ—ˆํ˜ˆ์„ฑ ์‹ฌ์žฅ์งˆํ™˜, ๊ฐ„ํ—์„ฑ ํŒŒํ–‰์ฆ, ๋ณธ ํ”„๋กœ๊ทธ๋žจ์„ ์ดํ–‰ํ•˜๊ธฐ ๋ถˆ๊ฐ€๋Šฅ ํ•˜๋‹ค๊ณ  ํŒ๋‹จ๋˜๋Š” ํ•ฉ๋ณ‘์ฆ)์„ ๋ณ‘ํ•ฉํ•˜์ง€ ์•Š์€ ์ž, ์„ ์ฒœ์ ์ธ ๊ฐ€์Šด์šฐ๋ฆฌ์˜ ๋ณ€ํ˜•์ด๋‚˜ ๋Š‘๊ณจ์˜ ๊ณจ์ ˆ ๋“ฑ์˜ ๋™๋ฐ˜์†์ƒ์ด ์—†๋Š” ์ž, ๊ธ‰์ง„์  ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ์ฆ์ƒ์ด ์—†๋Š” ์ž๋กœ ๋ณธ ์—ฐ๊ตฌ์˜ ๋ชฉ์ ์„ ์ดํ•ดํ•˜๊ณ  ์—ฐ๊ตฌ์— ์ฐธ์—ฌํ•˜๊ธฐ๋กœ ๋™์˜ํ•œ ์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ํ•˜์˜€๋‹ค.

2. ์‹คํ—˜๋ฐฉ๋ฒ•

1) ์—ฐ๊ตฌ์„ค๊ณ„

๋ณธ ์—ฐ๊ตฌ๋Š” ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ์ค‘ ๊ฐ€์žฅ ๋งŽ์€ ๋น„์œจ์„ ๋‚˜ํƒ€๋‚ด๋Š” GOLD์˜ ์ค‘์ฆ๋„ ๋ถ„๋ฅ˜ II๋“ฑ๊ธ‰(์ค‘๋“ฑ์ฆ)์„ ์‹คํ—˜๊ตฐ I๋กœ, III๋“ฑ๊ธ‰(์ค‘์ฆ)์„ ์‹คํ—˜๊ตฐ II๋กœ ์ž„์ƒ ํ‘œ๋ณธ ์ถ”์ถœํ•˜์—ฌ, 5์ฃผ๊ฐ„, ์ฃผ 4ํšŒ, 1์ผ 1ํšŒ, 1ํšŒ 30๋ถ„๊ฐ„ ํšก๊ฒฉ๋ง‰ํ˜ธํก์šด๋™๊ณผ ์ž…์ˆ ์˜ค๋ฏ€๋ฆฌ๊ธฐ ํ˜ธํก์„ ๋ณตํ•ฉํ•˜์—ฌ ์ค‘์žฌํ•œ ํ›„, ํ˜ธํกํ˜‘๋ ฅ๊ทผํ™œ์„ฑ๋„์™€ ์‚ฐ์†Œํฌํ™”๋„๋ฅผ ์ธก์ •ํ•˜์—ฌ ๋น„๊ต๋ถ„์„ํ•˜์˜€๋‹ค.

2) ์ธก์ •๋„๊ตฌ

(1) ํ๊ธฐ๋Šฅ ์ธก์ •
ํ๊ธฐ๋Šฅ ์ธก์ •์€ Chestgraph HI-701 (Chest, Japan)์„ ์ด์šฉํ•˜์—ฌ ์ธก์ •ํ•˜์˜€์œผ๋ฉฐ, ํ๊ธฐ๋Šฅ์€ ๋Œ€์ƒ์ž์—๊ฒŒ ์•‰์€ ์ž์„ธ์—์„œ ํ˜ธํก๊ธฐ๊ณ„๋ฅผ ์ž…์— ๋ฌผ๊ณ  ์ตœ๋Œ€ํ•œ ์ˆจ์„ ๋“ค์ด ์‰ฐ ํ›„, ํž˜๊ป ๋‚ด๋ฑ‰๊ฒŒ ํ•˜์—ฌ ์ธก์ •๋œ ์ˆ˜์น˜๋ฅผ ๊ธฐ๋กํ•˜์—ฌ ์ธก์ •ํ•˜์˜€๋‹ค. ํํ™œ๋Ÿ‰ ์ธก์ •์€ ์ตœ์†Œ 3ํšŒ ์ด์ƒ ์‹ค์‹œํ•˜์˜€๊ณ  ๊ฒ€์‚ฌ์น˜ ์ค‘์—์„œ ๊ฐ€์žฅ ํฐ ์ˆ˜์น˜์™€ ๊ทธ ๋‹ค์Œ ํฐ ์ˆ˜์น˜ ์‚ฌ์ด์˜ ์ฐจ์ด๊ฐ€ 5% ์ด๋‚ด ๋˜๋Š” 200 mL ์ด๋‚ด์ธ ์ˆ˜์น˜๋ฅผ ์ธก์ •ํ•˜์˜€๋‹ค.
(2) ํ˜ธํก๋ณด์กฐ๊ทผ ํ™œ์„ฑ๋„ ์ธก์ •
ํ˜ธํก๋ณด์กฐ๊ทผ์˜ ๊ทผํ™œ์„ฑ๋„ ์ธก์ •์€ ํ‘œ๋ฉด ๊ทผ์ „๋„ MP 100 system (Biopac, USA) 3์ฑ„๋„์„ ์‚ฌ์šฉํ•˜์˜€์œผ๋ฉฐ, ๊ทผ์ „๋„ ์‹ ํ˜ธ ์ˆ˜์ง‘์„ ์œ„ํ•œ ํ‘œ๋ณธ ์ถ”์ถœ๋ฅ (sampling rate)์€ 1,000์œผ๋กœ ํ•˜์˜€๊ณ , ์ฃผํŒŒ์ˆ˜ ๋Œ€์—ญ ํ•„ํ„ฐ๋Š” 20-450 Hz๋กœ ์„ค์ •ํ•˜์˜€๋‹ค. ๊ทผ์ „๋„ ์‹ ํ˜ธ์˜ ํ”ผ๋ถ€์ €ํ•ญ์„ ์ตœ์†Œํ™”ํ•˜๊ธฐ ์œ„ํ•ด ๋Œ€์ƒ์ž๋“ค์˜ ํ”ผ๋ถ€์—์„œ ํ„ธ์„ ์ œ๊ฑฐํ•˜๊ณ  ๊ฐ€๋Š” ์‚ฌํฌ๋ฅผ ์ด์šฉํ•˜์—ฌ ๊ฐ์งˆ์„ ์ œ๊ฑฐํ•œ ๋’ค ์•Œ์ฝ”์˜ฌ ์†œ์œผ๋กœ ๋ฌธ์งˆ๋Ÿฌ ํ”ผ๋ถ€๋ฅผ ์ฒญ๊ฒฐํžˆ ์œ ์ง€ํ•˜์˜€๋‹ค. 2๊ฐœ์˜ Ag/Agcl ํ‘œ๋ฉด ์ „๊ทน์„ ์‚ฌ์šฉํ•˜์—ฌ ๊ฐ ๊ทผ์œก์˜ ๊ทผ๋ณต์— ๊ทผ์„ฌ์œ ์™€ ํ‰ํ–‰ํ•œ ๋ฐฉํ–ฅ์œผ๋กœ 2 cm ๊ฐ„๊ฒฉ์œผ๋กœ ๋ถ€์ฐฉํ•˜์˜€๋‹ค. ๊ธฐ์ค€ ์ „๊ทน์€ ๋Œ์ถœ๋œ ๋ถ€์œ„์ธ ์–ด๊นจ๋ผˆ ๊ฐ€์‹œ์™€ 12๋ฒˆ์งธ ๋“ฑ๋ผˆ์˜ ๊ฐ€์‹œ๋Œ๊ธฐ์— ๋ถ€์ฐฉํ•˜์˜€๋‹ค. ์ธก์ • ๊ทผ์œก์€ ์˜ค๋ฅธ์ชฝ ๋ชฉ๋น—๊ทผ, ๋ชฉ๊ฐˆ๋น„๊ทผ, ๊ทธ๋ฆฌ๊ณ  ๋ฐฐ๊ฐ€๋กœ๊ทผ์˜ ๊ทผ๋ณต์—์„œ ๊ทผ์ „๋„ ์‹ ํ˜ธ๋ฅผ ์ˆ˜์ง‘ํ•˜์˜€๋‹ค.
์ธก์ • ๊ทผ์œก๋“ค์˜ ์‹ ํ˜ธ๋“ค์€ ์‹คํšจ์น˜ ์ง„ํญ(root mean square, RMS)์œผ๋กœ ๋ณ€ํ™˜ํ•˜์˜€์œผ๋ฉฐ, ๊ทผ์ „๋„ ์‹ ํ˜ธ ๋ถ„์„์€ Acqknowledge 3.9.1 software program (Biopac, USA)์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ๋˜ํ•œ ๋Œ€์ƒ์ž๋“ค์˜ ๊ทผ์ „๋„ ์‹ ํ˜ธ๋ฅผ ์ •๊ทœํ™”(normalizing)ํ•˜๊ธฐ ์œ„ํ•ด ๋จผ์ € ํ™˜์ž๋“ค์„ ํŽธ์•ˆํ•˜๊ฒŒ ์•‰์€ ์ž์„ธ๋ฅผ ์ทจํ•˜๊ฒŒ ํ•œ ํ›„ ๋“ค์ˆจํ˜ธํก์šด๋™๊ธฐ๊ตฌ์ธ Threshold Inspiratory Muscle Trainer (New Jersey, USA)์„ ์ด์šฉํ•˜์—ฌ ์ตœ๋Œ€ ๋“ค์ˆจ์••์˜ 30%์˜ ์ˆ˜์ค€์œผ๋กœ ํ˜ธํก์„ 10ํšŒ ์‹œํ–‰ํ•˜์—ฌ ์‹œ์ž‘๊ณผ ๋ 2ํšŒ๋ฅผ ์ œ์™ธํ•œ 8ํšŒ ํ˜ธํก ์‹œ ์‹คํšจ์น˜ ์ง„ํญ๊ฐ’์œผ๋กœ %RMS๊ฐ’์„ ์ •๋Ÿ‰ํ™”ํ•˜์˜€๋‹ค(Figure 1).
Figureย 1
Measurement of surface EMG and SpO2.
JKPT_27_234_fig_1.tif
(3) ์‚ฐ์†Œํฌํ™”๋„ ๋ถ„์„
์‚ฐ์†Œํฌํ™”๋„๋Š” Fingertip Pulse Oximeter (Zondan Med, China)์œผ๋กœ ๊ฐ€์žฅ ํŽธ์•ˆํ•œ ์ž์„ธ๋กœ ์ค‘๋ ฅ์„ ์ œ๊ฑฐํ•œ ๋ฐ”๋กœ๋ˆ„์šด์ž์„ธ์—์„œ 20๋ถ„๊ฐ„ ์•ˆ์ •์‹œํ‚จ ํ›„ ๊ฒ€์ง€์— ์ฐฉ์šฉํ•˜์—ฌ ๊ฒฐ๊ณผ๊ฐ’์„ ๋ถ„์„ํ•˜์˜€๋‹ค(Figure 1).

3. ์ค‘์žฌ๋ฐฉ๋ฒ•

ํ˜ธํก์šด๋™์€ 5์ฃผ๊ฐ„, ์ฃผ 4ํšŒ, 1์ผ 1ํšŒ, 1ํšŒ 30๋ถ„๊ฐ„ ํšก๊ฒฉ๋ง‰ํ˜ธํก์šด๋™๊ณผ ์ž…์ˆ ์˜ค๋ฏ€๋ฆฌ๊ธฐ ํ˜ธํก์„ ๋ณตํ•ฉํ•˜์—ฌ ์ค‘์žฌํ•˜์˜€๋‹ค. ํ˜ธํก์šด๋™์„ ์‹ค์‹œํ•˜๊ธฐ ์œ„ํ•ด ํ™˜์ž๋ฅผ ๋ฐ”๋กœ ๋ˆ„์›Œ์„œ ํŽธ์•ˆํ•œ ์ž์„ธ๋กœ ์ค€๋น„์‹œํ‚ค๊ณ  ๋“ค์ˆจ์„ฑ ๊ฐ€๋กœ๋ง‰ ํ˜ธํก์šด๋™์ด ๋๋‚˜๋ฉด ๊ณง๋ฐ”๋กœ ๋‚ ์ˆจ์„ฑ ์ž…์ˆ  ์˜ค๋ฏ€๋ฆฌ๊ธฐ ํ˜ธํก์šด๋™์„ ์‹œํ–‰ํ•˜์˜€๋‹ค. ์ด 4 session์œผ๋กœ ๊ตฌ์„ฑ๋˜๋ฉฐ 1 session์ด ๋๋‚œ ํ›„ 1๋ถ„๊ฐ„์˜ ํœด์‹์‹œ๊ฐ„์„ ์ œ๊ณตํ•˜์˜€์œผ๋ฉฐ, 1 session์€ ์ด 5 set๋กœ ์ด๋ฃจ์–ด์ง€๋ฉฐ 1 set ๋‹น ๋ถ„๋‹น 4-5ํšŒ์˜ ํ˜ธํก์šด๋™์„ ์‹œํ–‰ํ•˜๊ณ  30์ดˆ์˜ ํœด์‹์‹œ๊ฐ„์„ ์ œ๊ณตํ•˜์˜€๋‹ค.
๋“ค์ˆจ์„ฑ ๊ฐ€๋กœ๋ง‰ ํ˜ธํก์šด๋™์˜ ์šด๋™๋ฐฉ๋ฒ•์€ ์น˜๋ฃŒ์‚ฌ์˜ ์†์€ ์ „๋ฐฉ ๊ฐˆ๋น„์—ฐ๊ณจ ๋ฐ”๋กœ ์•„๋ž˜ ์œ„์น˜ํ•œ ๋ณต์ง๊ทผ์— ์˜ฌ๋ ค๋†“์€ ๋‹ค์Œ ํ™˜์ž์—๊ฒŒ ๋Š๋ฆฌ๊ณ  ๊นŠ๊ฒŒ ์ฝ”๋กœ ์ˆจ์„ ๋“ค์ด๋งˆ์‹œ๋„๋ก ๋“ค์ˆจ์„ฑ ๊ฐ€๋กœ๋ง‰ ํ˜ธํก์„ ์œ ๋„ํ•œ๋‹ค. ์ด๋•Œ ์น˜๋ฃŒ์‚ฌ๋Š” ๋ฐฐ๊ณง์€๊ทผ์ด ์ƒ์Šน๋  ๋•Œ ์ ์ ˆํ•œ ์ €ํ•ญ์„ ๊ฐ€ํ•˜๋ฉฐ ํ™˜์ž์˜ ๊นŠ์€ ๋“ค์ˆจ์„ ์œ ๋„ํ•˜๋ฉฐ, ํ™˜์ž๋Š” ๊นŠ์€ ๋“ค์ˆจ์„ ํ•˜๋Š” ๋™์•ˆ ์–ด๊นจ๋ฅผ ์ด์™„์‹œ์ผœ ์œ ์ง€ํ•˜๊ฒŒ ํ•˜๊ณ  ์œ„์ชฝ ๊ฐ€์Šด๋ถ€๋Š” ์›€์ง์ด์ง€ ์•Š๊ฒŒ ํ•˜๋ฉฐ ๋ณต๋ถ€์˜ ์ƒ์Šน๋งŒ ํ—ˆ์šฉํ•œ๋‹ค. ๋‚ ์ˆจ์„ฑ ์ž…์ˆ  ์˜ค๋ฏ€๋ฆฌ๊ธฐ ํ˜ธํก์šด๋™ ์šด๋™๋ฐฉ๋ฒ•์€ ํ™˜์ž๋Š” ๊นŠ์€ ๋“ค์ˆจ์„ ์ด์šฉํ•˜์—ฌ ์ž…์ˆ ์„ ์˜ค๋ฏ€๋ฆฌ๊ณ  ์ผ์ •ํ•œ ์‹œ๊ฐ„ ๋™์•ˆ ๊ณต๊ธฐ๋ฅผ ๋ฐ–์œผ๋กœ ๋‚ด์‰ฌ๋„๋ก ํ•œ๋‹ค.12

4. ์ž๋ฃŒ๋ถ„์„

์ž๋ฃŒ๋ถ„์„ ๋ฐฉ๋ฒ•์€ Window์šฉ SPSS 18.0์„ ์ด์šฉํ•˜์—ฌ ์—ฐ๊ตฌ๋Œ€์ƒ์ž์˜ ์ผ๋ฐ˜์  ํŠน์„ฑ ๋ฐ ์ง‘๋‹จ์˜ ํ˜ธํก๊ทผํ™œ์„ฑ๋„์™€ ์‹ ์ฒด์  ๊ธฐ๋Šฅ์„ Shapiro-wilk๋กœ ์ •๊ทœ์„ฑ ๊ฒ€์ • ํ•˜์˜€๋‹ค. ์ง‘๋‹จ ๋‚ด ๋ณ€ํ™” ๋น„๊ต๋Š” ๋Œ€์‘ํ‘œ๋ณธ t-๊ฒ€์ •(Paired t-test)์„ ์‚ฌ์šฉํ•˜์˜€์œผ๋ฉฐ, ์ง‘๋‹จ ๊ฐ„ ๋ณ€ํ™” ๋น„๊ต๋Š” ๊ณต๋ถ„์‚ฐ๋ถ„์„(ANCOVA)์„ ์‚ฌ์šฉํ•˜์˜€๊ณ , ์œ ์˜์ˆ˜์ค€์€ ฮฑ=0.05๋กœ ์„ค์ •ํ•˜์˜€๋‹ค.

๊ฒฐ๊ณผ

1. ์—ฐ๊ตฌ๋Œ€์ƒ์ž๋“ค์˜ ์ผ๋ฐ˜์  ํŠน์„ฑ

ํ๊ธฐ๋Šฅ์— ๋”ฐ๋ฅธ ์‹คํ—˜๊ตฐ์„ ๋ถ„๋ฅ˜ํ•˜๊ธฐ ์œ„ํ•œ 1์ดˆ๊ฐ„๋…ธ๋ ฅ์„ฑ๋‚ ์ˆจ๋Ÿ‰(Forced Expired Volume in one second, FEV1)๊ณผ 1์ดˆ๊ฐ„๋…ธ๋ ฅ์„ฑ๋‚ ์ˆจ๋Ÿ‰/๋…ธ๋ ฅ์„ฑํํ™œ๋Ÿ‰(Forced Expired Volume in one second/Forced Vital Capacity, FEV1/FVC) ์ด์™ธ์— ์‹คํ—˜์ง‘๋‹จ ๊ฐ„ ํ‚ค, ๋‚˜์ด, ๋ชธ๋ฌด๊ฒŒ, ๊ทธ๋ฆฌ๊ณ  ์ฒด์งˆ๋Ÿ‰์ง€์ˆ˜ ๋“ฑ์—์„œ ์ •๊ทœ์„ฑ์„ ๋‚˜ํƒ€๋‚ด์—ˆ๋‹ค(Table 1).
Tableย 1
Characteristic of subjects
Experimental group I (n=15) MยฑSD Experimental group II (n=17) MยฑSD t p
Age 63.05ยฑ5.05 64.7ยฑ6.36 -0.721 0.789
hight (cm) 164.71ยฑ6.41 165.87ยฑ4.89 -0.876 0.827
weight (kg) 66.4ยฑ3.91 64.03ยฑ4.01 1.389 0.289
BMI 23.79ยฑ3.25 22.38ยฑ4.19 0.409 0.523
FEV1 (%) 61.38ยฑ4.83 48.74ยฑ8.95 0.047 0.018
FEV1/FVC (%) 59.6ยฑ4.65 47.15ยฑ7.84 0.078 0.007

BMI, Body Mass Index: FEV1, Forced Expired Volume in one second: FEV1/FVC, Forced Expired Volume in one second/Forced Vital Capacity.

2. ์‹คํ—˜๊ตฐ I๊ณผ ์‹คํ—˜๊ตฐ II์˜ ์ง‘๋‹จ ๋‚ด, ์ง‘๋‹จ ๊ฐ„ ๋ณ€ํ™” ๋น„๊ต

์‹คํ—˜๊ตฐI์˜ ์ง‘๋‹จ ๋‚ด ํ˜ธํกํ˜‘๋ ฅ๊ทผ ํ™œ์„ฑ๋„์™€ ์‚ฐ์†Œํฌํ™”๋„ ๋ณ€ํ™”๋น„๊ต์—์„œ๋Š” ๋ชฉ๋น—๊ทผ๊ณผ ๋ชฉ์‚ฌ๊ฐ๊ทผ์—์„œ ํ™œ์„ฑ๋„๊ฐ€ ์œ ์˜ํ•˜๊ฒŒ ๋‚ฎ์•„์ง€๋Š” ๊ฒฐ๊ณผ๊ฐ€ ๋‚˜ํƒ€๋‚ฌ์ง€๋งŒ(p<0.05), ์‚ฐ์†Œํฌํ™”๋„๋Š” ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ์—†์—ˆ์œผ๋ฉฐ(Table 2), ์‹คํ—˜๊ตฐ II์˜ ์ง‘๋‹จ ๋‚ด ํ˜ธํกํ˜‘๋ ฅ๊ทผ ํ™œ์„ฑ๋„์™€ ์‚ฐ์†Œํฌํ™”๋„ ๋ณ€ํ™”๋น„๊ต์—์„œ๋Š” ๋ฐฐ๊ณง์€๊ทผ์—์„œ๋งŒ ํ™œ์„ฑ๋„๊ฐ€ ํ†ต๊ณ„ํ•™์ ์œผ๋กœ ์œ ์˜ํ•˜๊ฒŒ ๋†’์•„์ง€๋Š” ๊ฒฐ๊ณผ๊ฐ€ ๋‚˜ํƒ€๋‚ฌ์ง€๋งŒ(P<0.05), ์‚ฐ์†Œํฌํ™”๋„๋Š” ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ์—†์—ˆ๋‹ค(Table 3). ๊ทธ๋ฆฌ๊ณ  ์‹คํ—˜์ง‘๋‹จ ๊ฐ„ ํ˜ธํกํ˜‘๋ ฅ๊ทผ ํ™œ์„ฑ๋„์™€ ์‚ฐ์†Œํฌํ™”๋„ ๋ณ€ํ™”๋น„๊ต์—์„œ๋Š” ๋ชฉ๋น—๊ทผ, ๋ชฉ์‚ฌ๊ฐ๊ทผ ๊ทธ๋ฆฌ๊ณ  ๋ฐฐ๊ณง์€๊ทผ์—์„œ ํ†ต๊ณ„ํ•™์ ์œผ๋กœ ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ๋‚˜ํƒ€๋‚ฌ์ง€๋งŒ ์‚ฐ์†Œํฌํ™”๋„์—์„œ๋Š” ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ์—†์—ˆ๋‹ค(p<0.05) (Table 4).
Tableย 2
Comparison of change in respiratory synergist muscle activity and SpO2 within experimental group I
Experimental group I (n=15) t p

pre-test MยฑSD post-test MยฑSD
%RMS SCM 41.75ยฑ3.91 36.26ยฑ4.31 7.283 0.042*
Scalenius 55.89ยฑ6.74 49.26ยฑ4.28 7.551 0.045*
Rectus abdominis 35.93ยฑ2.31 32.47ยฑ1.85 2.24 0.138
SpO2 93.67ยฑ2.01 94.92ยฑ1.19 -0.089 0.639

%RMS, %Root Mean square: SpO2, Saturation pulse oximetry Oxygen.

* p<0.05.

Tableย 3
Comparison of change in respiratory synergist muscle activity and SpO2 within experimental group II
Experimental group II (n=17) t p

pre-test MยฑSD post-test MยฑSD
%RMS SCM 47.35ยฑ3.43 45.96ยฑ5.31 0.323 0.752
Scalenius 59.99ยฑ4.74 57.66ยฑ5.98 1.552 0.144
Rectus abdominis 34.17ยฑ2.85 39.93ยฑ4.31 -6.248 0.047*
SpO2 92.87ยฑ1.31 93.01ยฑ3.19 -0.023 0.889

%RMS, %Root Mean square: SpO2, Saturation pulse oximetry Oxygen.

* p<0.05.

Tableย 4
Comparison of change in respiratory synergist muscle activity and SpO2 between experimental group I and experimental group II
Experimental group I (n=15) Experimental group II (n=17) F p


Pre-test (MยฑSD) Post-test (MยฑSD) Pre-test (MยฑSD) Post-test (MยฑSD)
%RMS SCM 41.75ยฑ3.91 36.26ยฑ4.31 47.35ยฑ3.43 45.96ยฑ5.31 7.233 0.038*
Scalenius 55.89ยฑ6.74 49.26ยฑ4.28 59.99ยฑ4.74 57.66ยฑ5.98 8.147 0.046*
Rectus abdominis 35.93ยฑ2.31 32.47ยฑ1.85 34.17ยฑ2.85 39.93ยฑ4.31 7.893 0.041*
SpO2 93.67ยฑ2.01 94.92ยฑ1.19 92.87ยฑ1.31 93.01ยฑ3.19 0.879 0.831

%RMS, %Root Mean square: SpO2, Saturation pulse oximetry Oxygen.

* p<0.05.

๊ณ ์ฐฐ

๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž๋“ค์€ ํ˜ธํกํŒจํ„ด์˜ ๋น„์ •์ƒ์ ์š”์†Œ๋กœ ์ธํ•ด ๊ธฐ๊ณ„์ ์ธ ์ด๋“์„ ๋ณด์ถฉํ•˜๊ธฐ ์œ„ํ•ด ๋ชฉ๋ผˆ ๋ถ€์œ„์˜ ๊ทผ์œก๋“ค์„ ์ฃผ๋กœ ์‚ฌ์šฉํ•˜๊ฒŒ ๋œ๋‹ค. ํ˜ธํก ์‹œ์˜ ์ฃผ๋™๊ทผ์ธ ๊ฐ€๋กœ๋ง‰๊ณผ ๋ฐ”๊นฅ๊ฐˆ๋น„์‚ฌ์ด๊ทผ์˜ ์•ฝํ™”๋กœ ์ธํ•œ ํ˜ธํกํŒจํ„ด์˜ ๋ฌธ์ œ๋“ค์„ ์•ผ๊ธฐํ•˜๋Š”๋ฐ ํŠนํžˆ ํ˜ธํกํ˜‘๋ ฅ๊ทผ ์ค‘ ๋ชฉ๋น—๊ทผ๊ณผ ๋ชฉ๊ฐˆ๋น„๊ทผ์€ ํ˜ธํก ์‹œ์— ํ˜ธํก์ฃผ๋™๊ทผ์˜ ์•ฝํ™”๋กœ ์ธํ•œ ๊ธฐ๊ณ„์ ์ธ ๋ณด์ƒ์„ ์œ„ํ•ด ๋” ๋งŽ์ด ํ™œ์„ฑํ™” ๋œ๋‹ค.13 Duiverman ๋“ฑ14์€ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž์™€ 10๋ช…์„ ๋Œ€์ƒ์œผ๋กœ 10๋ถ„ ๋™์•ˆ ๊ณ ์ •์‹ ์‚ฌ์ดํด์„ ์ค‘์žฌ ํ›„ ๊ทผํ™œ์„ฑ๋„๋ฅผ ๋น„๊ตํ•œ ๊ฒฐ๊ณผ, ์šด๋™์„ ํ•˜๋Š” ๋™์•ˆ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž์—์„œ ๊ฐˆ๋น„์‚ฌ์ด๊ทผ๊ณผ ๋ชฉ๊ฐˆ๋น„๊ทผ์˜ ๊ทผํ™œ์„ฑ๋„๊ฐ€ ํฌ๊ฒŒ ์ฆ๊ฐ€๋˜๊ณ , ์ด๋Ÿฌํ•œ ๊ฒฐ๊ณผ๋Š” ํ˜ธํก๊ณค๋ž€์œผ๋กœ ์ธํ•œ ํ˜ธํก๊ทผ์˜ ์—ญํ•™์  ์ด๋“์„ ์ฆ๊ฐ€ํ•˜๊ธฐ ์œ„ํ•œ ํ˜„์ƒ์ด๋ฉฐ, Gandevia ๋“ฑ15์€ ๋“ค์ˆจ๊ทผ์œก๋“ค์˜ ์ˆ˜์ถ• ์—ฌ๋ถ€๋ฅผ ํ™•์ธํ•˜๊ธฐ ์œ„ํ•ด ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ๋ชฉ๊ฐˆ๋น„๊ทผ๊ณผ ๊ฐˆ๋น„์‚ฌ์ด๊ทผ์— ๋‹จ์ผ์šด๋™์žฅ์น˜๋ฅผ ๊ธฐ๋กํ•œ ๊ฒฐ๊ณผ, ๋ชฉ๊ฐˆ๋น„๊ทผ์—์„œ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ์ง‘๋‹จ์ด ๋” ํฌ๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋Š”๋ฐ, ๋ณธ ์—ฐ๊ตฌ์—์„œ๋„ ์ค‘์žฌ ์ „์—๋Š” ์‹คํ—˜๊ตฐ II์—์„œ ์‹คํ—˜๊ตฐ I๋ณด๋‹ค ๋”์šฑ ๋†’์€ ํ˜ธํกํ˜‘๋ ฅ๊ทผ์˜ ํ™œ์„ฑ๋„๊ฐ€ ๋‚˜ํƒ€๋‚˜ ์งˆํ™˜์ด ์ค‘์ฆ์œผ๋กœ ์‹ฌํ™”๋ ์ˆ˜๋ก ํ˜ธํกํ˜‘๋ ฅ๊ทผ์ด ๋ณด๋‹ค ๋งŽ์€ ๊ทผํ™œ๋™์„ ๋ณด์กฐํ•˜๋Š” ๊ฒฐ๊ณผ๋ฅผ ๋„์ถœํ•˜์—ฌ ์„ ํ–‰์—ฐ๊ตฌ๋ฅผ ์ง€์ง€ํ•˜๊ณ  ์žˆ๋‹ค. Guedes ๋“ฑ16์€ ํŒŒํ‚จ์Šจ ๋ณ‘ ํ™˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ 10๋ช…์˜ L-Dopa ํˆฌ์—ฌ๋ฅผ ์ค‘์žฌํ•œ ์‹คํ—˜๊ตฐ๊ณผ ์ค‘์žฌ๋ฅผ ํ•˜์ง€ ์•Š์€ ๋Œ€์กฐ๊ตฐ์œผ๋กœ ๋ถ„๋ฅ˜ํ•˜์—ฌ ๋ชฉ๋น—๊ทผ์˜ ๊ทผ์ „๋„ ํ™œ๋™์„ ๋ถ„์„ํ•œ ๊ฒฐ๊ณผ, ํ˜ธํก์„ ํ•˜๋Š” ๋™์•ˆ ๋Œ€์กฐ๊ตฐ์—์„œ ํ˜ธํกํ˜‘๋ ฅ๊ทผ์ธ ๋ชฉ๋น—๊ทผ์˜ ํ™œ์„ฑ๋„๊ฐ€ ๋ณด๋‹ค ๋” ๋†’์•˜์Œ์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ๋Š”๋ฐ, ๋ณธ ์—ฐ๊ตฌ์—์„œ๋„ ์ค‘์žฌ ํ›„์—๋Š” ์‹คํ—˜๊ตฐ I์—์„œ ๋“ค์ˆจํ˜‘๋ ฅ๊ทผ์ธ ๋ชฉ๋น—๊ทผ๊ณผ ๋ชฉ๊ฐˆ๋น„๊ทผ์˜ ๊ทผํ™œ์„ฑ๋„๊ฐ€ ์œ ์˜ํ•˜๊ฒŒ ๊ฐ์†Œ๋˜์–ด ๊ฐ€๋กœ๋ง‰ํ˜ธํก์šด๋™๊ณผ ์ž…์ˆ ์˜ค๋ฏ€๋ฆฌ๊ธฐ ํ˜ธํก์ค‘์žฌ๋ฐฉ๋ฒ•์ด ํ˜ธํก ์‹œ ๊ธฐ๊ณ„์ ์ธ ํ˜ธํก ๋ถ€ํ•˜๋ฅผ ๊ฐ์†Œ์‹œํ‚ค๋Š” ๋ฐ ํšจ๊ณผ์ ์ž„์„ ์•Œ ์ˆ˜ ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์‹คํ—˜๊ตฐ II์—์„œ๋Š” ๋ชฉ๋น—๊ทผ๊ณผ ๋ชฉ๊ฐˆ๋น„๊ทผ์—์„œ ์œ ์˜ํ•œ ๊ฐ’์„ ๋„์ถœํ•˜์ง€๋Š” ๋ชปํ•˜์˜€์œผ๋‚˜, ๋‚ ์ˆจ๊ทผ์ธ ๋ฐฐ๊ณง์€๊ทผ์˜ ํ™œ์„ฑ๋„๊ฐ€ ์œ ์˜ํ•˜๊ฒŒ ์ฆ๊ฐ€๋˜๋Š” ๊ฒƒ์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ๋Š”๋ฐ, ์ •์ƒ์ ์ธ ํ˜ธํก์€ ์ฃผ๋กœ ๋“ค์ˆจ๊ทผ์œก์ธ ๊ฐ€๋กœ๋ง‰๊ณผ ๋ฐ”๊นฅ๊ฐˆ๋น„์‚ฌ์ด๊ทผ์„ ์‚ฌ์šฉํ•˜์ง€๋งŒ ๊ฒฉ๋ ฌํ•œ ํ˜ธํก๊ณผ ๋‚ ์ˆจ์˜ ํ˜ธํก์ƒํ™ฉ์ด ์•…ํ™”๋ ์ˆ˜๋ก ๋ฐฐ๋ถ€์˜ ๊ทผ์œก์ด ๋‚ ์ˆจ์„ ์ง€์›ํ•ด์•ผ ํ•œ๋‹ค. ํŠนํžˆ ๋ณด์กฐํ˜ธํก๊ทผ์œก์ธ ๋ชฉ๋น—๊ทผ, ๋ชฉ๊ฐˆ๋น„๊ทผ ๊ฐ€์Šด๊ทผ ๋“ฑ์€ ํ˜ธํก์— ๋ฌธ์ œ๊ฐ€ ์žˆ์„ ๋•Œ ์‚ฌ์šฉ๋˜๋ฉฐ, ๋‚ ์ˆจ๊ธฐ๋Šฅ์ด ๋–จ์–ด์ง€๋Š” ํ™˜์ž๋Š” ๊ธฐ๊ณ„์  ์—ญํ•™์„ ๋ณด์ƒํ•˜๊ธฐ ์œ„ํ•ด ๋Šฅ๋™์ ์œผ๋กœ ๋ฐฐ๊ณง์€๊ทผ์˜ ๊ทผ๋™์›์„ ๋”์šฑ ํ•„์š”๋กœ ํ•˜๋Š”๋ฐ,17 ์ด๋Ÿฌํ•œ ๋“ค์ˆจ๊ทผ๊ณผ ๋‚ ์ˆจ๊ทผ์˜ ์ €ํ•ญ์€ ๋‚ด์ œ๋œ ๋™์••๋ ฅ์— ์˜ํ•ด ๋‚˜ํƒ€๋‚˜๋ฉฐ, ๋Œ€๋ถ€๋ถ„ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž๋“ค์€ ์ค‘์ฆ์œผ๋กœ ์ง„ํ–‰๋ ์ˆ˜๋ก ์—ญํ•™์  ํ์šฉ๋Ÿ‰์˜ ์ €ํ•˜๋กœ ์ธํ•ด ๋‚ ์ˆจ๊ทผ์˜ ๊ธฐ๋ฅ˜์ œํ•œ์„ ๋ณด์ƒํ•˜๊ธฐ ์œ„ํ•˜์—ฌ ๋ชฉ๋น—๊ทผ๊ณผ ๋‚ ์ˆจ๊ทผ์„ ๋™์›์‹œํ‚ด์œผ๋กœ์จ ์‹คํ—˜๊ตฐ II์—์„œ ๋“ค์ˆจํ˜‘๋ ฅ๊ทผ์˜ ์œ ์˜๊ฐ’์€ ๋‚˜ํƒ€๋‚˜์ง€ ์•Š์€ ๊ฒƒ์œผ๋กœ ์—ฌ๊ฒจ์ง„๋‹ค. Toppin ๋“ฑ18์€ ๋“ค์ˆจ๊ทผ์˜ ํ™œ๋™์„ฑ์€ ํ์˜ ์šฉ์ ์ด๋‚˜ ๊ทผ์œก์˜ ๊ธธ์ด์— ๋Œ€ํ•œ ๊ตฌ์‹ฌ์„ฑ ํ”ผ๋“œ๋ฐฑ์— ์ „์ ์œผ๋กœ ์˜์กดํ•œ๋‹ค๊ณ  ํ•˜์˜€์œผ๋ฉฐ ์ƒ๋ช…์œ ์ง€์— ๊ด€๋ จ๋œ ํ˜ธํกํ™œ๋™์„ ํ•˜๊ธฐ ์œ„ํ•ด์„œ๋Š” ์ •ํ˜•ํ™”๋œ ํŒจํ„ด ์ฆ‰ ๋ฏธ๋ฆฌ ๊ณ„ํš๋œ ํ‹€์—์„œ ๋ฒ—์–ด๋‚˜๊ธฐ ํž˜๋“ค๊ธฐ ๋•Œ๋ฌธ์— ํ˜ธํก์— ์˜ํ–ฅ์„ ์ฃผ๋Š” ๊ตฌ์กฐ์ ์ธ ๋ฌธ์ œ๋ฅผ ๊ทผ๋ณธ์ ์œผ๋กœ ํ•ด๊ฒฐํ•˜๋ ค๋ฉด ํ˜‘๋ ฅ ๋ณด์กฐ์ ์ธ ์—ญํ• ์€ ํ˜ธํก์œ ์ง€๋ฅผ ์œ„ํ•ด ์ค‘์š”ํ•˜๋ฉฐ, ํŠนํžˆ ์ค‘์ฆ๋‹จ๊ณ„์˜ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜์œผ๋กœ ์ง„ํ–‰๋˜๊ธฐ ์ „์— ์ ์ ˆํ•œ ํ˜ธํก์ค‘์žฌ๋ฅผ ์‹œํ–‰ํ•ด์•ผ ๋ณด๋‹ค ๋” ํšจ์œจ์ ์ธ ๊ธฐ๊ณ„์  ์ด๋“์„ ํ˜ธํกํ˜‘๋ ฅ๊ทผ์—์„œ ์–ป์„ ์ˆ˜ ์žˆ์„ ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋œ๋‹ค.
๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜์€ ์‚ฐ์†Œ์˜ ๋ณ€ํ™”์— ๋ฏผ๊ฐํ•œ ์งˆํ™˜์œผ๋กœ ์‚ฐ์†Œ๋ถˆํฌํ™” ๋ฐ˜์‘์€ ํ™˜๊ธฐ-๊ด€๋ฅ˜ ์žฅ์• , ํ ํ™•์‚ฐ์˜ ์ œํ•œ, ํํฌ ์ €ํ™˜๊ธฐ, ํ๋กœ ํšŒ๊ท€ํ•˜๋Š” ํ˜ผํ•ฉ์ •๋งฅํ˜ˆ์˜ ๊ฐ์†Œ๋œ ์‚ฐ์†Œ ๋“ฑ ๋‹ค์–‘ํ•œ ์›์ธ์— ์˜ํ•ด ๋ฐœ์ƒํ•  ์ˆ˜ ์žˆ์œผ๋ฉฐ, ์‚ฐ์†Œํฌํ™”๋„๋Š” ์šด๋™ ํ›„ ์‚ฐ์†Œ๋ถˆํฌํ™” ๋ฐ˜์‘๊ณผ ์œ ์˜ํ•œ ์ƒ๊ด€๊ด€๊ณ„๊ฐ€ ์žˆ๋‹ค.19 Jehn ๋“ฑ20์€ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž 62๋ช…์„ ๋Œ€์ƒ์œผ๋กœ ํ˜ธํกํ›ˆ๋ จ์„ ์ค‘์žฌํ•˜์—ฌ 6๋ถ„ ๊ฑท๊ธฐ๊ฒ€์‚ฌ์—์„œ๋Š” ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ์žˆ์—ˆ์ง€๋งŒ ์‚ฐ์†Œํฌํ™”๋„๋Š” ์œ ์˜ํ•œ ๊ฒฐ๊ณผ๋ฅผ ๋„์ถœํ•˜์ง€ ๋ชปํ•˜์˜€๊ณ , Mariana ๋“ฑ21๋„ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž 15๋ช…์„ ๋Œ€์ƒ์œผ๋กœ ์Šค๋งˆํŠธํฐ ์–ดํ”Œ๋ฆฌ์ผ€์ด์…˜(aplication)์„ ์ด์šฉํ•œ ํ˜ธํกํ›ˆ๋ จ์„ ์ค‘์žฌํ•˜์—ฌ ํ˜ˆ์ค‘ ์‚ฐ์†Œํฌํ™”๋„๊ฐ€ ยฑ2% ์ˆ˜์ค€์œผ๋กœ ์šด๋™ ๊ณผ์ •์— ๊ฑธ์ณ ๋Œ€์ฒด๋กœ ์ผ์ •ํ•œ ๊ฒฐ๋ก ์„ ์–ป์„ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ๋˜ํ•œ Xuemin ๋“ฑ22์€ ์ค‘์ฆ์˜ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ์˜ค๋ฏ€๋ฆฐ ์ž…์ˆ ํ˜ธํก์šด๋™๊ณผ ๊ฐ€๋กœ๋ง‰ํ˜ธํก์šด๋™์„ ๊ฒฐํ•ฉํ•˜์—ฌ 3๊ฐœ์›” ๋™์•ˆ ์ค‘์žฌํ•œ ๊ฒฐ๊ณผ, ์‚ถ์˜ ์งˆ๊ณผ ํ๊ธฐ๋Šฅ์—๋Š” ํšจ๊ณผ๊ฐ€ ์žˆ์—ˆ์ง€๋งŒ ์‚ฐ์†Œํฌํ™”๋„์˜ ์œ ์˜ํ•œ ์ฐจ์ด๋Š” ์—†์—ˆ๋Š”๋ฐ, ๋ณธ ์—ฐ๊ตฌ์—์„œ๋„ ์‹คํ—˜๊ตฐ ๊ฐ„์— ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋‚˜ํƒ€๋‚ด์ง€ ๋ชปํ•˜์—ฌ ์„ ํ–‰์—ฐ๊ตฌ๋“ค์„ ์ง€์ง€ํ•˜๊ณ  ์žˆ๋‹ค. ๊ทธ ์ด์œ ๋กœ๋Š” ๊ฐ€๋กœ๋ง‰ํ˜ธํก์šด๋™๊ณผ ์ž…์ˆ ์˜ค๋ฏ€๋ฆฌ๊ธฐ ํ˜ธํก์ค‘์žฌ๊ฐ€ ๊ณ ๊ฐ•๋„์˜ ์šด๋™์œผ๋กœ ์‚ฐ์†Œํฌํ™”๋„์˜ ๋ณ€ํ™”๋ฅผ ์ด๋Œ์–ด๋‚ด๊ธฐ์—๋Š” ํ•œ๊ณ„๊ฐ€ ์žˆ๋Š” ๊ฒƒ์œผ๋กœ ์—ฌ๊ฒจ์ง„๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ Muhammad ๋“ฑ23์€ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž 50๋ช…์„ ๋Œ€์ƒ์œผ๋กœ ์ „ํ†ต์  ๊ฐ€์Šด๋ฌผ๋ฆฌ์น˜๋ฃŒ์™€ ๋งจ์† ๊ณผํŒฝ์ฐฝ์„ ์œ ๋„ํ•œ ์ฒด์œ„๋ฐฐ๋‹ด๋ฒ•(manual hyperinflation during postural drainage)์„ ์ค‘์žฌํ•œ ๊ฒฐ๊ณผ, ํ˜ธํก๋ฅ ๊ณผ ์‚ฐ์†Œํฌํ™”๋„๊ฐ€ ์œ ์˜ํ•˜๊ฒŒ ํ–ฅ์ƒ๋˜์—ˆ์Œ์„ ๋ณด๊ณ ํ•˜์—ฌ ๋ณธ ์—ฐ๊ตฌ์™€ ์ƒ๋ฐ˜๋˜๋Š” ๊ฒฐ๊ณผ๋ฅผ ๋„์ถœํ•˜์˜€๋Š”๋ฐ, ๋ณธ ์—ฐ๊ตฌ์™€์˜ ์ฐจ์ด์ ์€ ํ™˜์ž์˜ ์ฒด์œ„๋ฐฐ๋‹ด๋ฒ•์„ ์ด์šฉํ•œ ๋งจ์†์šด๋™์„ ์ค‘์žฌํ•˜์—ฌ ํ˜ธํก์œจ๊ณผ ์‚ฐ์†Œํฌํ™”๋„๋ฅผ ๊ฐœ์„ ํ•˜๊ณ ์ž ํ์˜ ๊ฐ๋„์— ๋”ฐ๋ฅธ ์—ญํ•™์ ์ธ ์š”์†Œ๊นŒ์ง€ ๋”ํ•จ์œผ๋กœ์จ ํ์™€ ๊ธฐ๋„์˜ ๋ถ„๋น„๋ฌผ๋“ค์„ ํšจ๊ณผ์ ์œผ๋กœ ์ œ๊ฑฐํ•˜๊ณ  ํ™˜๊ธฐ๋ฅ ์„ ๋†’์—ฌ ๊ฐ€์Šค๊ตํ™˜์ด ๋ณด๋‹ค ํšจ์œจ์ ์œผ๋กœ ์ด๋ฃจ์–ด์กŒ๋‹ค๊ณ  ์‚ฌ๋ฃŒ๋œ๋‹ค. ๋˜ํ•œ Katayama ๋“ฑ24์€ ์˜ฌ๋ฐ”๋ฅธ ํ˜ธํก์€ ๊ต๊ฐ ์‹ ๊ฒฝ๊ณ„์˜ ํ™œ๋™์„ ์ž๊ทนํ•˜์—ฌ ๋ชธ์„ ์ด์™„์‹œํ‚ค๋Š” ๊ธฐ๋Šฅ์ด ์žˆ๊ณ , ์ด์— ๋”ฐ๋ผ ๋ฐ”๋กœ๋ˆ„์šด์ž์„ธ์—์„œ์˜ ๋‚ ์ˆจ๊ทผํ›ˆ๋ จ๊ณผ ๊ฐ€๋กœ๋ง‰ํ˜ธํก์„ ํ†ตํ•œ ๋ชธ์˜ ์ด์™„์ƒํƒœ์—์„œ๋Š” ์‚ฐ์†Œ ์†Œ๋ชจ๊ฐ€ ๊ฐ์†Œ๋จ์œผ๋กœ ์„ธํฌ ๋‚ด ์‚ฐ์†Œํฌํ™”๋„๊ฐ€ ์ฆ๊ฐ€ํ•˜๊ฒŒ ๋˜์–ด ์‚ฐ์†Œํฌํ™”๋„๋ฅผ ์ฆ๊ฐ€์‹œํ‚ฌ ์ˆ˜ ์žˆ์Œ์„ ์•Œ ์ˆ˜ ์žˆ๋‹ค.25
๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž๋“ค์€ ํ˜ธํก ํ˜‘๋ ฅ๊ทผ์˜ ํ™œ์„ฑ๋„๊ฐ€ ๋ชจ๋‘ ์ฆ๊ฐ€ํ•˜์˜€๋Š”๋ฐ ์ด๋Ÿฌํ•œ ํ˜„์ƒ์€ ๋ณ€ํ˜•๋œ ๊ฐ€์Šด์šฐ๋ฆฌ๋กœ ์ธํ•ด ๋ฐœ์ƒ๋˜๋Š” ์ฃผ๋ณ€๊ทผ์œก๋“ค์˜ ๋‹จ์ถ•์„ ์—ญํ•™์  ์ด๋“์œผ๋กœ ํ•ด์†Œํ•˜์—ฌ ํ˜ธํก๊ธฐ๋Šฅ์œ ์ง€๋ฅผ ์œ„ํ•œ ๋ณด์ƒ์œผ๋กœ ํ˜ธํกํ˜‘๋ ฅ๊ทผ๋“ค์˜ ๋™์›์„ ๋†’์ด๋ ค๊ณ  ํ•œ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ํ˜ธํกํ˜‘๋ ฅ๊ทผ์€ ๋Œ€๋ถ€๋ถ„ ๊ฐ€์Šด์ด๋‚˜ ์ƒ์ง€์˜ ์ฃผ๋™๊ทผ์œผ๋กœ์จ ์ž‘์šฉํ•˜๊ธฐ ๋•Œ๋ฌธ์— ํ˜ธํก ์‹œ์˜ ํ˜‘๋ ฅ๊ทผ์˜ ๋™์›์„ ๋‚ฎ์ถ”๋Š” ๊ฒƒ์€ ๋งค์šฐ ์ค‘์š”ํ•œ ์š”์†Œ์ด๋‹ค. ์ดํ›„์—๋„ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž๋“ค์˜ ํ˜ธํก๊ธฐ๋Šฅ ๊ฐœ์„ ์„ ํ†ตํ•œ ๋‹ค๊ฐ์ ์ธ ์ ‘๊ทผ๋ฐฉ๋ฒ•์ด ํ•„์š”ํ•  ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋˜๋ฉฐ ์ง€์†์ ์ธ ์ž„์ƒ์—ฐ๊ตฌ๊ฐ€ ํ•„์š”ํ•  ๊ฒƒ์ด๋‹ค.
๋ณธ ์—ฐ๊ตฌ๋Š” ์—ฐ๊ตฌ๋Œ€์ƒ์ž๋“ค์ด 1๊ฐœ์˜ ์˜๋ฃŒ๊ธฐ๊ด€ ๋‚ด์—์„œ ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž๋“ค๋กœ ์ œํ•œํ•˜์˜€์œผ๋ฏ€๋กœ ๋ชจ๋“  ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž์— ๋Œ€ํ•œ ์ผ๋ฐ˜ํ™”์— ์žˆ์–ด์„œ๋Š” ํ•œ๊ณ„๊ฐ€ ์žˆ๊ณ , ํ˜„์žฌ ํˆฌ์—ฌํ•˜๊ณ  ์žˆ๋Š” ์•ฝ๋ฌผ์— ๋Œ€ํ•ด์„œ๋„ ํ†ต์ œํ•˜๋Š” ๋ฐ ์–ด๋ ค์›€์ด ์žˆ์–ด ๋ณ€์ˆ˜๊ฐ€ ๋ฐœ์ƒํ•  ์ˆ˜ ์žˆ๋Š” ํ•œ๊ณ„๊ฐ€ ์žˆ๋‹ค. ๋งŒ์„ฑํ์‡„์„ฑํ์งˆํ™˜ ํ™˜์ž๋“ค์˜ ํ˜ธํกํ˜‘๋ ฅ๊ทผ์˜ ํ™œ์„ฑ์„ ๋‚ฎ์ถ”๊ณ  ํ˜ธํก์ฃผ๋™๊ทผ์˜ ํ™œ์„ฑ์„ ๋†’์ด๋Š” ๊ฒƒ์€ ํ˜ธํก๊ธฐ๋Šฅ ๊ฐœ์„ ์— ์ค‘์š”ํ•œ ์š”์†Œ๋กœ ์•ž์œผ๋กœ๋„ ํ˜ธํก๊ทผ์— ๊ด€ํ•œ ์—ฐ๊ตฌ๊ฐ€ ํ•„์š”ํ•  ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋œ๋‹ค.

ACKNOWLEDGEMENTS

This paper was supported by the Sehan University Research Fund in 2015.

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