高流量鼻导管通气在重度 AECOPD 患者早期肺康复中的作用：一项随机对照研究。
Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study.
机构信息
Division of Pulmonary Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.
School of Respiratory Therapy, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan.
出版信息
Respir Res. 2020 Apr 15;21(1):84. doi: 10.1186/s12931-020-1328-z.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is airway inflammation characterized and low daily physical activity. Most pulmonary rehabilitation (PR) programs are often provided to stable patients, but fewer training programs are specific for hospitalized patients with acute exacerbation (AE). Patients with AECOPD experience increased dyspnea sensations and systemic inflammation during exercise training. High-flow nasal therapy (HFNT) reduces the minute volume, lowers the respiratory rate, and decreases the work of breathing. However, it is not clear whether HFNT is efficient during exercise training. In this study, we investigated the effects of HFNT during exercise training in an early PR program among hospitalized patients with severe AECOPD.
METHODS
We enrolled COPD patients hospitalized due to AE. They were randomized into two groups according to their status into HFNT PR and non-HFNT PR groups. This study collected basic data, and also assessed a pulmonary function test, 6-min walking test, blood inflammatory biomarkers, and arterial gas analysis at the baseline, and at 4 and 12 weeks of the intervention. Data were analyzed using SPSS statistical software.
RESULT
We recruited 44 AECOPD patients who completed the 12-week PR program. The HFNT PR program produced significant improvements in exercise tolerance as assessed by the 6-min walking distance (6MWD), reduced dyspnea sensations in the modified Medical Research Council (mMRC), and decreased systemic inflammation as evidenced by the a lower C-reactive protein (CRP) level. A reduction in the length of hospitalization was achieved with PR in the 1-year follow-up in the two groups. The HFNT PR group showed better trends of reduced air trapping in the delta inspiration capacity (IC) and an increased quality of life according to the COPD assessment test (CAT) than did the non-HFNT PR group.
CONCLUSIONS
HFNT during exercise training in early PR increases exercise tolerance and reduces systemic inflammation in hospitalized patients with severe AECOPD.
背景
慢性阻塞性肺疾病（COPD）是一种气道炎症，其特点是日常体力活动水平低。大多数肺康复（PR）计划通常提供给稳定的患者，但针对急性加重（AE）住院患者的训练计划较少。AECOPD 患者在运动训练期间会出现呼吸困难感觉增加和全身炎症反应。高流量鼻导管通气（HFNT）可减少分钟通气量，降低呼吸频率，并降低呼吸功。然而，HFNT 在运动训练期间是否有效尚不清楚。在这项研究中，我们调查了 HFNT 在严重 AECOPD 住院患者早期 PR 计划中的运动训练中的作用。
方法
我们招募了因 AE 住院的 COPD 患者。他们根据 HFNT PR 和非 HFNT PR 组的状态随机分为两组。本研究收集了基本数据，还评估了肺功能测试、6 分钟步行测试、血液炎症生物标志物和动脉血气分析在基线时、干预的第 4 周和第 12 周。使用 SPSS 统计软件进行数据分析。
结果
我们招募了 44 名完成 12 周 PR 计划的 AECOPD 患者。HFNT PR 方案显著提高了 6 分钟步行距离（6MWD）评估的运动耐量，降低了改良医学研究委员会（mMRC）的呼吸困难感觉，降低了全身炎症反应，表现为 C-反应蛋白（CRP）水平降低。在两组 1 年的随访中，PR 缩短了住院时间。HFNT PR 组在吸气容量（IC）的呼气保留减少和 COPD 评估测试（CAT）的生活质量增加方面显示出比非 HFNT PR 组更好的趋势。
结论
早期 PR 中运动训练时使用 HFNT 可提高严重 AECOPD 住院患者的运动耐量并减轻全身炎症反应。
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