吸氧对慢性阻塞性肺疾病患者运动能力的影响：随机、安慰剂对照、交叉试验。
Effect of Breathing Oxygen-Enriched Air on Exercise Performance in Patients with Chronic Obstructive Pulmonary Disease: Randomized, Placebo-Controlled, Cross-Over Trial.
机构信息
Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland.
Pulmonary Clinic, University Hospital Zurich and Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
出版信息
Respiration. 2020;99(3):213-224. doi: 10.1159/000505819. Epub 2020 Feb 12.
BACKGROUND
Patients with chronic obstructive pulmonary disease (COPD) experience dyspnea and hypoxemia during exercise.
OBJECTIVE
The aim of this study was to evaluate the effects of breathing oxygen-enriched air on exercise performance and associated physiological changes in patients with COPD.
METHODS
In a randomized, placebo-controlled, single-blind, cross-over trial, 20 patients with COPD (11 women, age 65 ± 6 years, FEV1 64 ± 19% pred., resting SpO2 ≥90%) performed 4 cycle ergospirometries to exhaustion using an incremental exercise test (IET) and a constant work rate (at 75% maximal workload with air) exercise test (CWRET), each with ambient (FiO2 0.21) and oxygen-enriched (FiO2 0.5) air. The main outcomes were the change in maximal workload in the IET and the change in exercise duration in the CWRET with oxygen versus air. Electrocardiogram, pulmonary gas exchange, thoracic volumes by inductance plethysmography, arterial blood gases, and cerebral and quadriceps muscle tissue oxygenation (CTO and MTO) were additionally measured.
RESULTS
In the IET, maximal workload increased from 96 ± 21 to 104 ± 28 W with oxygen. In the CWRET, exercise duration increased from 605 ± 274 to 963 ± 444 s with oxygen. At end-exercise with oxygen, CTO, MTO, PaO2, and PaCO2 were increased, while V'E/V'CO2 was reduced and thoracic volumes were similar. At the corresponding time to end of exercise with ambient air, oxygen decreased heart rate, respiratory rate, minute ventilation, and V'E/V'CO2, while oxygenation was increased.
CONCLUSION
In COPD patients without resting hypoxemia, breathing oxygen-enriched air improves exercise performance. This relates to a higher arterial oxygen saturation promoting oxygen availability to muscle and cerebral tissue and an enhanced ventilatory efficiency. COPD patients may benefit from oxygen therapy during exercise training.
背景
慢性阻塞性肺疾病（COPD）患者在运动时会经历呼吸困难和低氧血症。
目的
本研究旨在评估吸入富氧空气对 COPD 患者运动表现和相关生理变化的影响。
方法
在一项随机、安慰剂对照、单盲、交叉试验中，20 名 COPD 患者（11 名女性，年龄 65 ± 6 岁，FEV1 64 ± 19%预计值，静息 SpO2 ≥90%）使用递增运动试验（IET）和恒定工作率（在空气下 75%最大工作负荷）运动试验（CWRET）进行 4 次至力竭的踏车运动测试，每次测试均使用环境（FiO2 0.21）和富氧（FiO2 0.5）空气。主要结局是 IET 中最大工作负荷的变化和 CWRET 中用氧与用空气时的运动时间的变化。此外，还测量了心电图、肺气体交换、电感容积描记法测量的胸容积、动脉血气和脑和股四头肌组织氧合（CTO 和 MTO）。
结果
在 IET 中，最大工作负荷从 96 ± 21 增加到 104 ± 28 W 用氧。在 CWRET 中，运动时间从 605 ± 274 增加到 963 ± 444 s 用氧。在氧终末运动时，CTO、MTO、PaO2 和 PaCO2 增加，而 V'E/V'CO2 降低，胸容积相似。在相应的环境空气运动结束时，氧降低了心率、呼吸频率、分钟通气量和 V'E/V'CO2，同时增加了氧合。
结论
在没有静息低氧血症的 COPD 患者中，吸入富氧空气可改善运动表现。这与动脉血氧饱和度升高有关，从而增加了肌肉和脑组织的氧可用性，并提高了通气效率。COPD 患者在运动训练期间可能受益于氧疗。
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