吸气压力支持对重度稳定期慢性阻塞性肺疾病患者运动耐力和呼吸困难的影响。
Effect of inspiratory pressure support on exercise tolerance and breathlessness in patients with severe stable chronic obstructive pulmonary disease.
作者信息
Keilty S E, Ponte J, Fleming T A, Moxham J
机构信息
Department of Thoracic Medicine, King's College School of Medicine and Dentistry, London, UK.
出版信息
Thorax. 1994 Oct;49(10):990-4. doi: 10.1136/thx.49.10.990.
BACKGROUND
In patients with chronic obstructive pulmonary disease exercise tolerance is commonly limited by breathlessness. These patients have an increased ventilatory load at rest which is exacerbated during exercise. The purpose of this study was to investigate the effect of supporting ventilation by non-invasive inspiratory pressure support (IPS) during submaximal treadmill exercise in such patients to see if they would experience less breathlessness and improve their exercise capacity.
METHODS
Eight men with disabling breathlessness due to chronic obstructive pulmonary disease (COPD) (mean (SD) FEV1 0.73 (0.2) 1) were studied. Patients walked on a treadmill until their sensation of breathlessness, scored at one minute intervals, reached level 5 ("severe") on the 10-point Borg scale. Studies were performed with IPS (mean airway pressure 12-15 cm H2O), continuous positive airway pressure (CPAP 6 cm H2O), and with oxygen (2 l/min via a mask) in random order on three separate days. Each of these walks was compared with a control walk using a sham circuit (breathing air via an oxygen mask at 2 l/min from an unlabelled cylinder), and with a baseline walk in which patients walked freely on the treadmill. On cessation of exercise, distance achieved and a leg fatigue score were recorded.
RESULTS
No patients stopped due to leg fatigue, all stopping only when their sensation of breathlessness had reached level 5 on the Borg scale. IPS improved median walking distance by 62% compared with the control walk (sham circuit). There was no change in walking distance with either CPAP or oxygen at 2 l/min. There was no difference between the control and the baseline walks.
CONCLUSIONS
Inspiratory pressure support can reduce breathlessness and increase exercise tolerance to submaximal treadmill exercise in patients with COPD. This could have implications for the rehabilitation of these severely disabled patients.
背景
在慢性阻塞性肺疾病患者中，运动耐力通常受呼吸困难限制。这些患者静息时通气负荷增加，运动时会加重。本研究的目的是调查在次极量跑步机运动期间，通过无创吸气压力支持（IPS）辅助通气对这类患者的影响，观察他们是否会感觉呼吸困难减轻并提高运动能力。
方法
研究了8名因慢性阻塞性肺疾病（COPD）导致严重呼吸困难的男性患者（平均（标准差）第一秒用力呼气容积（FEV1）为0.73（0.2）升）。患者在跑步机上行走，直到他们的呼吸困难感觉（每隔1分钟评分一次）在10分制的Borg量表上达到5级（“严重”）。在三个不同的日子里，以随机顺序分别进行了IPS（平均气道压力12 - 15厘米水柱）、持续气道正压通气（CPAP 6厘米水柱）和吸氧（通过面罩2升/分钟）的研究。将每次这样的行走与使用假回路的对照行走（通过氧气面罩从未标记的气瓶以2升/分钟的速度呼吸空气）以及患者在跑步机上自由行走的基线行走进行比较。运动停止时，记录行走距离和腿部疲劳评分。
结果
没有患者因腿部疲劳而停止运动，所有患者均仅在其呼吸困难感觉在Borg量表上达到5级时才停止。与对照行走（假回路）相比，IPS使中位行走距离提高了62%。2升/分钟的CPAP或吸氧时行走距离没有变化。对照行走和基线行走之间没有差异。
结论
吸气压力支持可减轻COPD患者的呼吸困难，并提高其对次极量跑步机运动的运动耐力。这可能对这些严重残疾患者的康复有影响。
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