Fritz Celina, Müller Jan, Oberhoffer Renate, Ewert Peter, Hager Alfred
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany.
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany; Institute of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Germany.
Int J Cardiol. 2020 Apr 15;305:50-55. doi: 10.1016/j.ijcard.2020.01.015. Epub 2020 Jan 9.
Patients with Fontan circulation have no subpulmonary ventricle and a passive pulmonary perfusion. Considerable percentage of the pulmonary blood flow is driven by pressure shift due to respiration. Impairments in respiratory musculature strength are associated with a reduced exercise capacity. This study investigated the effect of a daily six months inspiratory muscle training (IMT) on exercise and lung capacity in adult Fontan patients.
After a lung function and cardiopulmonary exercise test (CPET), 42 Fontan patients (50% female; 30.5 ± 8.1 years) were randomized into either an intervention group (IG), or a control group (CG). The IG performed a telephone-supervised, daily IMT of three sets with 10-30 repetitions for six months.
After six months of IMT, the IG did not improve in any exercise and lung capacity parameter compared to CG. VOpeak (ΔVOpeak: IG: 0.05 [-1.53; 1.33] ml/kg/min vs. CG: -0.50 [-1.20; 0.78] ml/kg/min; p = .784) and FVC (ΔFVC: IG: 0.07 [-0.16; 0.22] l vs. CG:-0.05 [-0.24; 0.18] l; p = .377) remained unchanged, while FEV1 trended to improve (ΔFEV: IG: 0.05 [-0.07; 0.13] l vs. CG: -0.10 [-0.19; 0.03] l; p = .082). Only oxygen saturation at rest improved significantly (ΔSpO: IG: 1.50 [-0.25; 3.00] % vs. CG: -0.50 [-1.75; 0.75] %; p = .017).
A daily six months IMT did not improve exercise and lung capacity and lung volumes in Fontan patients.
接受Fontan循环手术的患者没有肺下心室且肺灌注为被动式。相当比例的肺血流由呼吸引起的压力变化驱动。呼吸肌肉力量受损与运动能力下降有关。本研究调查了为期六个月的每日吸气肌训练（IMT）对成年Fontan患者运动能力和肺功能的影响。
在进行肺功能和心肺运动试验（CPET）后，42例Fontan患者（50%为女性；年龄30.5±8.1岁）被随机分为干预组（IG）或对照组（CG）。干预组进行电话监督的每日IMT，每组10 - 30次重复，共三组，持续六个月。
经过六个月的IMT，与对照组相比，干预组在任何运动和肺功能参数方面均未改善。峰值摄氧量（Δ峰值摄氧量：干预组：0.05[-1.53；1.33]毫升/千克/分钟，对照组：-0.50[-1.20；0.78]毫升/千克/分钟；p = 0.784）和用力肺活量（Δ用力肺活量：干预组：0.07[-0.16；0.22]升，对照组：-0.05[-0.24；0.18]升；p = 0.377）保持不变，而第一秒用力呼气量有改善趋势（Δ第一秒用力呼气量：干预组：0.05[-0.07；0.13]升，对照组：-0.10[-0.19；0.03]升；p = 0.082）。仅静息时的血氧饱和度显著改善（Δ血氧饱和度：干预组：1.50[-0.25；3.00]%，对照组：-0.50[-1.
