Stevenson N J, Calverley P M A
Clinical Science Centre, University Hospital Aintree, Liverpool L9 7AL, UK.
Thorax. 2004 Aug;59(8):668-72. doi: 10.1136/thx.2003.014209.
The effects of oxygen on recovery from exercise in patients with chronic obstructive pulmonary disease (COPD) are not clearly known. A study was undertaken to determine whether oxygen given after maximal exercise reduced the degree of dynamic hyperinflation and so reduced the perception of breathlessness.
Eighteen patients with moderate to severe COPD performed maximal symptom limited exercise on a cycle ergometer. During recovery they received either air or oxygen at identical flow rates in a randomised, single blind, crossover design. Inspiratory capacity, breathing pattern data, dyspnoea intensity, and leg fatigue scores were collected at regular intervals during recovery. At a subsequent visit patients underwent a similar protocol but with a face mask in situ to eliminate the effects of instrumentation.
When oxygen was given the time taken for resolution of dynamic hyperinflation was significantly shorter (mean difference between air and oxygen 6.61(1.65) minutes (95% CI 3.13 to 10.09), p = 0.001). Oxygen did not, however, reduce the perception of breathlessness during recovery nor did it affect the time taken to return to baseline dyspnoea scores in either the instrumented or non-instrumented state (mean difference 2.11 (1.41) minutes (95% CI -0.88 to 5.10), p = 0.15).
Oxygen reduces the degree of dynamic hyperinflation during recovery from exercise but does not make patients feel less breathless than breathing air. This suggests that factors other than lung mechanics may be important during recovery from exercise, or it may reflect the cooling effect of both air and oxygen.
慢性阻塞性肺疾病(COPD)患者运动后吸氧对恢复的影响尚不清楚。本研究旨在确定最大运动后吸氧是否能减轻动态肺过度充气程度,从而减轻呼吸困难的感觉。
18例中重度COPD患者在功率自行车上进行最大症状限制运动。恢复期间,他们以随机、单盲、交叉设计接受相同流速的空气或氧气。在恢复过程中定期收集吸气容量、呼吸模式数据、呼吸困难强度和腿部疲劳评分。在随后的一次就诊中,患者接受类似的方案,但佩戴面罩以消除仪器的影响。
吸氧时动态肺过度充气消退所需时间显著缩短(空气与氧气的平均差值为6.61(1.65)分钟(95%CI 3.13至10.09),p = 0.001)。然而,吸氧并未减轻恢复过程中的呼吸困难感觉,也未影响在有仪器或无仪器状态下恢复到基线呼吸困难评分所需的时间(平均差值为2.11(1.41)分钟(95%CI -0.88至5.10),p = 0.15)。
吸氧可减轻运动恢复期间的动态肺过度充气程度,但不会使患者感觉比呼吸空气时呼吸困难减轻。这表明在运动恢复过程中,除肺力学因素外的其他因素可能很重要,或者这可能反映了空气和氧气的冷却效应。