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长期氧疗的 COPD 慢性呼吸衰竭患者感知疲劳与神经肌肉疲劳的关系:一项横断面研究。

Relationship between perceived and neuromuscular fatigue in COPD patients with chronic respiratory failure with long-term oxygen therapy: a cross-sectional study.

机构信息

Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy.

Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Lumezzane, 25065, Brescia, Italy.

出版信息

Eur J Appl Physiol. 2022 Nov;122(11):2403-2416. doi: 10.1007/s00421-022-05021-2. Epub 2022 Aug 11.

DOI:10.1007/s00421-022-05021-2
PMID:35951129
Abstract

PURPOSE

To evaluate perceived fatigue (PF) and neuromuscular fatigue (NMF) in patients with COPD and chronic respiratory failure (CRF) on long-term oxygen therapy (CRF-COPD group), and the relationships between PF, NMF, patient's characteristics, comparing severe patients with COPD to patients without CRF (COPD group).

METHODS

This cross-sectional study compared 19 CRF-COPD patients with 10 COPD patients attending a rehabilitation program. PF was determined by Fatigue Severity Scale (FSS), while dyspnea by the Barthel Dyspnea Index (BDI). We assessed quadriceps NMF via electrical nerve stimulation during and following a Maximal Voluntary Contraction (MVC) detecting changes after a Constant Workload Cycling Test (CWCT) at 80% of the peak power output at exhaustion.

RESULTS

CRF-COPD patients showed higher PF (+ 1.79 of FSS score, p = 0.0052) and dyspnea (+ 21.03 of BDI score, p = 0.0023) than COPD patients. After the fatiguing task and normalization for the total work, there was a similar decrease in the MVC (CRF-COPD -1.5 ± 2.4 vs COPD -1.1 ± 1.2% baseline kJ, p = 0.5819), in the potentiated resting twitch force (CRF-COPD -2.8 ± 4.7 vs COPD -2.0 ± 3.3% baseline kJ, p = 0.7481) and in the maximal voluntary activation (CRF-COPD -0.1 ± 3.9 vs COPD -0.9 ± 1.2 -2.0 ± 3.3% baseline kJ, p = 0.4354). FSS and BDI were closely related (R = 0.5735, p = 0.0011), while no correlation between PF and NMF was found.

CONCLUSION

Patients with CRF-COPD develop higher levels of perceived fatigue and dyspnea than patients with COPD; while neuromuscular fatigue is similar, suggesting a mismatch between symptoms and neuromuscular dysfunction.

摘要

目的

评估长期氧疗的慢性阻塞性肺疾病(COPD)合并慢性呼吸衰竭(CRF)患者(CRF-COPD 组)的感知疲劳(PF)和神经肌肉疲劳(NMF),并比较严重 COPD 患者与无 CRF(COPD 组)患者之间的 PF、NMF、患者特征之间的关系。

方法

这项横断面研究比较了 19 例 CRF-COPD 患者和 10 例参加康复计划的 COPD 患者。PF 通过疲劳严重程度量表(FSS)确定,而呼吸困难通过巴氏呼吸困难指数(BDI)确定。我们通过在最大用力收缩(MVC)期间和之后对股四头肌进行电神经刺激,在以 80%的最大功率输出进行恒功循环测试(CWCT)后检测到疲劳后的变化。

结果

CRF-COPD 患者的 PF(FSS 评分增加 1.79,p=0.0052)和呼吸困难(BDI 评分增加 21.03,p=0.0023)均高于 COPD 患者。在疲劳任务和总工作量归一化后,MVC(CRF-COPD -1.5±2.4 与 COPD -1.1±1.2%基线 kJ,p=0.5819)、增强的静息抽搐力(CRF-COPD -2.8±4.7 与 COPD -2.0±3.3%基线 kJ,p=0.7481)和最大自愿激活(CRF-COPD -0.1±3.9 与 COPD -0.9±1.2-2.0±3.3%基线 kJ,p=0.4354)的下降幅度相似。FSS 和 BDI 密切相关(R=0.5735,p=0.0011),但 PF 和 NMF 之间无相关性。

结论

CRF-COPD 患者的感知疲劳和呼吸困难水平高于 COPD 患者;而神经肌肉疲劳相似,表明症状与神经肌肉功能障碍不匹配。

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