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吸气肌训练增强比例辅助通气对慢性阻塞性肺疾病患者运动性呼吸困难和运动耐力的有益影响:一项概念验证性随机对照试验

Inspiratory Muscle Training Potentiates the Beneficial Effects of Proportional Assisted Ventilation on Exertional Dyspnea and Exercise Tolerance in COPD: A Proof-of-Concept Randomized and Controlled Trial.

作者信息

Koch Rodrigo, Augusto Tiago Rodrigues de Lemos, Ramos Alessandro Gomes, Müller Paulo de Tarso

机构信息

Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil.

出版信息

COPD. 2020 Aug;17(4):384-391. doi: 10.1080/15412555.2020.1789085. Epub 2020 Jul 21.

Abstract

During pulmonary rehabilitation, a subset of subjects with COPD requires adjunct therapy to achieve high-intensity training. Both noninvasive ventilation (NIV) and inspiratory muscle training (IMT) are available to assist these subjects. We aimed to prime the respiratory muscles before NIV with IMT, anticipating additive effects for maximal exercise tolerance () and dyspnea/leg fatigue relief throughout the exercise as primary outcomes. Changes in the respiratory pattern were secondary outcomes. COPD subjects performed a total of four identical constant work rate tests on a cycle ergometer at 75% of maximum work rate, under control ventilation (SHAM, 4 cm HO) or proportional assisted ventilation (PAV, individually adjusted), before and after 10 sessions of high-intensity IMT (three times/week) during 30 days. Two-way RM ANOVA with appropriate corrections were performed. Final analysis in nine subjects showed improved (Δ = 111 s) and lower minute-ventilation (Δ = 4 Lmin) at exhaustion, when comparing the IMT effects within the PAV modality ( 0.001 and  0.036, respectively) and improved for PAV SHAM (PAV main-effect,  = 0.001; IMT main-effect,  = 0.006; PAV IMT interaction,  = 0.034). In addition, IMT + PAV association, compared to PAV alone, resulted in lower respiratory frequency (IMT main-effect,  = 0.009; time main-effect,  < 0.0001; IMT time interaction,  = 0.242) and lower inspiratory time related to duty cycle (IMT main-effect,  = 0.018; time main-effect,  = 0.0001; IMT time interaction,  = 0.004) throughout exercise. The addition of IMT prior to a PAV-supported aerobic bout potentiates exercise tolerance and dyspnea relief and induces favourable changes in ventilatory pattern in severe COPD during high-intensity training (, RBR-6n3dzz).

摘要

在肺康复期间,一部分慢性阻塞性肺疾病(COPD)患者需要辅助治疗以实现高强度训练。无创通气(NIV)和吸气肌训练(IMT)都可用于帮助这些患者。我们旨在通过IMT在NIV之前对呼吸肌进行预激活,预期对最大运动耐力()产生累加效应,并将运动过程中呼吸困难/腿部疲劳的缓解作为主要结局。呼吸模式的变化作为次要结局。COPD患者在30天内进行10次高强度IMT(每周3次)前后,在控制通气(假手术,4 cm H₂O)或比例辅助通气(PAV,个体化调整)下,于最大功率的75%在自行车测力计上总共进行4次相同的恒定工作率测试。进行了带有适当校正的双向重复测量方差分析。对9名受试者的最终分析显示,在PAV模式下比较IMT效果时,力竭时运动耐力改善(Δ = 111秒)且分钟通气量降低(Δ = 4 L/min)(分别为P < 0.001和P = 0.036),并且PAV与假手术相比运动耐力改善(PAV主效应,P = 0.001;IMT主效应,P = 0.006;PAV×IMT交互作用,P = 0.034)。此外,与单独使用PAV相比,IMT + PAV联合使用在整个运动过程中导致呼吸频率降低(IMT主效应,P = 0.009;时间主效应,P < 0.0001;IMT×时间交互作用,P = 0.242)以及与占空比相关的吸气时间降低(IMT主效应,P = 0.018;时间主效应,P = 0.0001;IMT×时间交互作用,P = 0.004)。在PAV支持的有氧运动前加用IMT可增强运动耐力和缓解呼吸困难,并在重度COPD患者的高强度训练期间诱导通气模式发生有利变化(,RBR - 6n3dzz) 。

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