Karakurt Zuhal, Güven Ayşem Oztin, Moçin Ozlem Yazıcıoğlu, Karavelioğlu Yusuf, Güngör Gökay, Altınöz Hilal, Adıgüzel Nalan, Yarkın Tülay, Baran Reha
Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Multidiscip Respir Med. 2010 Aug 31;5(4):244-9. doi: 10.1186/2049-6958-5-4-244.
To evaluate kyphoscoliosis patients with chronic hypercapnic respiratory failure (CHRF) using the six minute walk test (6MWT) distance (6MWD) and cardio-pulmonary function tests.
This prospective cross-sectional study was carried out in a tertiary training and research hospital in Turkey. Kyphoscoliosis patients with CHRF on home mechanical ventilation (HMV) followed in a respiratory intensive care unit (RICU) out-patient clinic were enrolled. Patients' demographics were recorded as well as transthoracic echocardiography (ECHO), 6MWD, spirometry, arterial blood gas (ABG) values and high resolution chest computed tomography. 6MWT results were compared with other parameters.
Thirty four patients with kyphoscoliosis and chronic respiratory insufficiency admitted to our outpatient clinic were included in the study but 25 (17 M) patients underwent 6MWT (8 patients walked with oxygen supplement due to PaO2 < 60 mm Hg). The mean 6MWD was 274.4 ± 76.2 (median 270) m and median 6MWD predicted rate was 43.7% (inter quartile ratio, IQR, 37.6% to 47.7%). Median HMV use was 3 years (IQR 2-4). 6MWD predicted rate, body mass index (BMI), HMV duration were similar in male and female patients. 6MWD correlated well with age, BMI, dyspnea score for baseline 6MWT (r: - 0.59, p < 0.002, r: - 0.58, p < 0.003, r: - 0.55, p < 0.005 respectively) but modestly with forced expiratory volume in one second, pulse rate for baseline 6MWT, pulse saturation rate, fatigue and dyspnea score at end of 6MWT (r: - 0.44, p < 0.048; r: 0.44, p < 0.027; r: - 0.43, p < 0.031; r: - 0.42, p < 0.036; r: - 0.42, p < 0.034 respectively). 6MWD predicted rate was only correlated with dyspnea score at baseline (r: - 0.46, p < 0.022). The systolic pulmonary arterial pressure (PAPs) in 6 (24%) cases was more than 40 mmHg, in whom mean PaO2/FiO2 was 301.4 ± 55.4 compared to 280.9 ± 50.2 in those with normal PAPs (p > 0.40).
The 6MWT is an easy way to evaluate physical performance limitation in kyphoscoliosis patients with chronic hypercapnic respiratory failure using home mechanical ventilation. Nearly 275 m was the mean distance walked in the 6MWT, but rather than distance in meters, the 6MWD predicted rate according to gender and body mass index equation might be a better way for deciding about physical performance of these patients. Dyspnea score at baseline before the 6MWT may be the most important point that affects 6MWD in this patient population.
采用六分钟步行试验（6MWT）距离（6MWD）和心肺功能测试评估脊柱后凸侧弯合并慢性高碳酸血症呼吸衰竭（CHRF）的患者。
这项前瞻性横断面研究在土耳其一家三级培训和研究医院进行。纳入在呼吸重症监护病房（RICU）门诊随访的接受家庭机械通气（HMV）的脊柱后凸侧弯合并CHRF患者。记录患者的人口统计学资料以及经胸超声心动图（ECHO）、6MWD、肺量计、动脉血气（ABG）值和高分辨率胸部计算机断层扫描结果。将6MWT结果与其他参数进行比较。
本研究纳入了34例因脊柱后凸侧弯和慢性呼吸功能不全入住我院门诊的患者，但25例（17例男性）患者进行了6MWT（8例患者因动脉血氧分压<60 mmHg而在吸氧状态下步行）。6MWD的平均值为274.4±76.2（中位数270）m，6MWD预测率中位数为43.7%（四分位间距，IQR，37.6%至47.7%）。HMV使用时间中位数为3年（IQR 2 - 4）。男性和女性患者的6MWD预测率、体重指数（BMI）、HMV持续时间相似。6MWD与年龄、BMI、6MWT基线时的呼吸困难评分相关性良好（r分别为：-0.59，p<0.002；-0.58，p<0.003；-0.55，p<0.005），但与一秒用力呼气量、6MWT基线时的脉搏率、脉搏血氧饱和度、6MWT结束时的疲劳和呼吸困难评分相关性一般（r分别为：-0.44，p<0.048；0.44，p<0.027；-0.43；p<0.031；-0.42，p<0.036；-0.42，p<0.034）。6MWD预测率仅与基线时的呼吸困难评分相关（r：-0.46，p<0.022）。6例（24%）患者的收缩期肺动脉压（PAPs）超过40 mmHg，这些患者的平均动脉血氧分压/吸入氧分数值为301.4±55.4，而PAPs正常的患者为280.9±50.2（p>0.40）。
6MWT是评估接受家庭机械通气的脊柱后凸侧弯合并慢性高碳酸血症呼吸衰竭患者身体功能受限的一种简便方法。6MWT的平均步行距离约为275 m，但对于这些患者身体功能的评估，根据性别和体重指数公式得出的6MWD预测率可能比步行距离（米）是更好的方式。6MWT前基线时的呼吸困难评分可能是影响该患者群体6MWD的最重要因素。
