无创通气加速合并心力衰竭和慢性阻塞性肺疾病患者的氧摄取恢复动力学。
Noninvasive Ventilation Accelerates Oxygen Uptake Recovery Kinetics in Patients With Combined Heart Failure and Chronic Obstructive Pulmonary Disease.
机构信息
Cardiopulmonary Physical Therapy Laboratory (LACAP), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil (Drs Mazzuco and Borghi-Silva and Ms Goulart); Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Federal University of São Paulo (UNIFESP), Brazil (Drs Souza, Medeiros, Sperandio, Alencar, Arbex, and Neder); Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada (Dr Neder); and Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (Dr Arena).
出版信息
J Cardiopulm Rehabil Prev. 2020 Nov;40(6):414-420. doi: 10.1097/HCR.0000000000000499.
PURPOSE
Oxygen uptake (V˙o2) recovery kinetics appears to have considerable value in the assessment of functional capacity in both heart failure (HF) and chronic obstructive pulmonary disease (COPD). Noninvasive positive pressure ventilation (NIPPV) may benefit cardiopulmonary interactions during exercise. However, assessment during the exercise recovery phase is unclear. The purpose of this investigation was to explore the effects of NIPPV on V˙o2, heart rate, and cardiac output recovery kinetics from high-intensity constant-load exercise (CLE) in patients with coexisting HF and COPD.
METHODS
Nineteen males (10 HF/9 age- and left ventricular ejection fraction-matched HF-COPD) underwent 2 high-intensity CLE tests at 80% of peak work rate to the limit of tolerance (Tlim), receiving either sham ventilation or NIPPV.
RESULTS
Despite greater V˙o2 recovery kinetics on sham, HF-COPD patients presented with a faster exponential time constant τ (76.4 ± 14.0 sec vs 62.8 ± 15.2 sec, P < .05) and mean response time (MRT) (86.1 ± 19.1 sec vs 68.8 ± 12.0 sec, P < .05) with NIPPV and greater ΔNIPPV-sham (τ: 5.6 ± 19.5 vs -25.2 ± 22.4, P < .05; MRT: 4.1 ± 32.2 vs -26.0 ± 19.2, P < .05) compared with HF. There was no difference regarding Tlim between sham and NIPPV in both groups (P < .05).
CONCLUSION
Our results suggest that NIPPV accelerated the V˙o2 recovery kinetics following high-intensity CLE to a greater extent in patients with coexisting HF and COPD compared with HF alone. NIPPV should be considered when the objective is to apply high-intensity interval exercise training as an adjunct intervention during a cardiopulmonary rehabilitation program.
目的
在心力衰竭（HF）和慢性阻塞性肺疾病（COPD）患者的功能能力评估中，摄氧量（V˙o2）恢复动力学似乎具有重要价值。无创正压通气（NIPPV）可能有利于运动过程中的心肺相互作用。然而，在运动恢复期的评估尚不清楚。本研究的目的是探讨 NIPPV 对同时患有 HF 和 COPD 的患者进行高强度恒负荷运动（CLE）至耐受极限（Tlim）后 V˙o2、心率和心输出量恢复动力学的影响。
方法
19 名男性（10 名 HF/9 名年龄和左心室射血分数匹配的 HF-COPD）进行了 2 次高强度 CLE 测试，运动强度为峰值工作率的 80%，直至耐受极限，分别接受假通气或 NIPPV。
结果
尽管在 sham 通气下 V˙o2 恢复动力学更好，但 HF-COPD 患者的指数时间常数 τ（76.4 ± 14.0 秒 vs 62.8 ± 15.2 秒，P <.05）和平均反应时间（MRT）（86.1 ± 19.1 秒 vs 68.8 ± 12.0 秒，P <.05）更快，NIPPV 与 sham 通气之间的差异更大（τ：5.6 ± 19.5 秒 vs -25.2 ± 22.4 秒，P <.05；MRT：4.1 ± 32.2 秒 vs -26.0 ± 19.2 秒，P <.05）与 HF 相比。两组 sham 和 NIPPV 之间的 Tlim 没有差异（P <.05）。
结论
我们的研究结果表明，与 HF 相比，NIPPV 在同时患有 HF 和 COPD 的患者中，更大程度地加速了高强度 CLE 后的 V˙o2 恢复动力学。当目标是将高强度间歇训练作为心肺康复计划中的辅助干预措施应用时，应考虑使用 NIPPV。
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