Garrod R, Mikelsons C, Paul E A, Wedzicha J A
Academic Respiratory Medicine, St Bartholomew's and Royal London School of Medicine and Dentistry, London Chest Hospital, London, United Kingdom.
Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1335-41. doi: 10.1164/ajrccm.162.4.9912029.
The addition of noninvasive positive pressure ventilation (NPPV) to an exercise training (ET) program in severe chronic obstructive pulmonary disease (COPD) may produce greater benefits in exercise tolerance and quality of life than after training alone. Forty-five patients with severe stable COPD-mean (SD) FEV(1) 0.96 (0.31) L, Pa(O(2)) 65.4 (9.07) mm Hg, Pa(CO(2)) 45.6 (7.89) mm Hg-were randomized to domiciliary NPPV + ET (n = 23) or ET alone (n = 22). Exercise capacity and health status were assessed at baseline and after an 8-wk training program. There was a significant improvement in mean shuttle walk test (SWT) in the NPPV + ET group: from 169 (112) to 269 (124) m (p = 0.001), compared with the ET group: 205 (100) to 233 (123) m (p = 0.19); mean difference (95% confidence interval [CI]): 72 (12.9 to 131) m. Repeated measures analysis of variance (ANOVA) showed that the differences between the two groups became evident only in the final 4 wk of the training program with a mean end study difference (95% 1CI) of 65.8 (17.1 to 114) m. There was a significant improvement in the Chronic Respiratory Disease Questionnaire (CRDQ) of mean (SD) 24.0 (17.4) (p = < 0.001) in the NPPV + ET group and 11.8 (15.8) (p = 0.003) points in the ET group; mean difference: 12.3 (1.19 to 23.4). Only the NPPV + ET group demonstrated a significant improvement in arterial oxygenation; mean difference: 3.70 mm Hg (0.37 to 7.27). This study suggests that domiciliary NPPV can be used successfully to augment the effects of rehabilitation in severe COPD.
在重度慢性阻塞性肺疾病（COPD）的运动训练（ET）项目中加入无创正压通气（NPPV），与单纯训练相比，可能在运动耐力和生活质量方面产生更大益处。45例重度稳定期COPD患者（平均[标准差]FEV(1) 0.96[0.31]L，Pa(O(2)) 65.4[9.07]mmHg，Pa(CO(2)) 45.6[7.89]mmHg）被随机分为居家NPPV+ET组（n = 23）或单纯ET组（n = 22）。在基线和为期8周的训练项目结束后评估运动能力和健康状况。NPPV+ET组的平均往返步行试验（SWT）有显著改善：从169（112）米提高到269（124）米（p = 0.001），而ET组从205（100）米提高到233（123）米（p = 0.19）；平均差异（95%置信区间[CI]）：72（12.9至131）米。重复测量方差分析（ANOVA）显示，两组之间的差异仅在训练项目的最后4周变得明显，平均研究结束时差异（95%CI）为65.8（17.1至114）米。NPPV+ET组慢性呼吸系统疾病问卷（CRDQ）平均（标准差）提高了24.0（17.4）分（p = <0.001），ET组提高了11.8（15.8）分（p = 0.003）；平均差异：12.3（1.19至23.4）。只有NPPV+ET组的动脉氧合有显著改善；平均差异：3.70mmHg（0.37至7.27）。这项研究表明，居家NPPV可成功用于增强重度COPD康复的效果。
