Dellweg Dominic, Reissig Karina, Hoehn Ekkehard, Siemon Karsten, Haidl Peter
Department for Pulmonology, Intensive Care and Rehabilitation, Kloster Grafschaft, Annostr. 1, 57392 Schmallenberg, Germany.
Department for Pulmonology, Intensive Care and Rehabilitation, Kloster Grafschaft, Annostr. 1, 57392 Schmallenberg, Germany.
Respir Med. 2017 Feb;123:116-123. doi: 10.1016/j.rmed.2016.12.006. Epub 2016 Dec 14.
This study is aimed to evaluate the effect of inspiratory muscle training (IMT) added to rehabilitation in patients with chronic obstructive pulmonary disease (COPD) who remain hypercapnic and use non-invasive ventilation after successful weaning.
Patients received rehabilitation and were randomized to inspiratory muscle or sham training for 4 weeks. The primary outcome was distance walked within 6 min. Secondary outcomes were inspiratory muscle strength, endurance, lung function, and blood gas levels.
Twenty-nine patients participated in this study. Walking distance of the sham group increased from 93 ± 52 m at baseline to 196 ± 85 m at week 4 (p = 0.019, 95% CI: 11-196 m). Patients in the IMT group significantly improved their walking distance from 94 ± 32 to 290 ± 75 m (p < 0.0001 [107-286 m]; p = 0.04 [3-186 m] for between-group comparison). Patients in the IMT group increased their maximal inspiratory pressure from -35 ± 8 to -55 ± 11 cmHO (p = 0.001; -6 to -33 cmHO), while the increase in the sham group failed to reach significance (-29 ± 10 to -37 ± 13 cmHO [-22 to 6 cmHO]). Inspiratory power increased from 9.6 ± 5.4 to 20.7 ± 9.7 joules/min (2.6-19.5 joules/min, p = 0.003) in the IMT group, while no significant change occurred in the sham group (7.6 ± 4.2 joules/min at study entry and 11.1 ± 6.9 joules/min [-5.2-12.3 joules/min] at study end).
Rehabilitation of successfully weaned patients with COPD and persistent hypercapnia significantly improves functional exercise capacity. Additional IMT significantly enhances functional exercise capacity and increases respiratory muscle strength and power.
本研究旨在评估在成功撤机后仍存在高碳酸血症且使用无创通气的慢性阻塞性肺疾病（COPD）患者中，吸气肌训练（IMT）联合康复治疗的效果。
患者接受康复治疗，并随机分为吸气肌训练组或假训练组，为期4周。主要结局指标为6分钟内步行距离。次要结局指标为吸气肌力量、耐力、肺功能和血气水平。
29例患者参与了本研究。假训练组的步行距离从基线时的93±52米增加至第4周时的196±85米（p = 0.019，95%CI：11 - 196米）。IMT组患者的步行距离从94±32米显著提高至290±75米（p < 0.0001 [107 - 286米]；组间比较p = 0.04 [3 - 186米]）。IMT组患者的最大吸气压从-35±8厘米水柱增加至-55±11厘米水柱（p = 0.001；-6至-33厘米水柱），而假训练组的增加未达到显著水平（-29±10至-37±13厘米水柱[-22至6厘米水柱]）。IMT组的吸气功率从9.6±5.4焦耳/分钟增加至20.7±9.7焦耳/分钟（2.6 - 19.5焦耳/分钟，p = 0.003），而假训练组无显著变化（研究开始时为7.6±4.2焦耳/分钟，研究结束时为11.1±6.9焦耳/分钟[-5.2 - 12.3焦耳/分钟]）。
成功撤机且持续存在高碳酸血症的COPD患者进行康复治疗可显著改善功能运动能力。额外的IMT可显著增强功能运动能力，并增加呼吸肌力量和功率。
