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VitaccaM,PaneroniM,ZampognaE,etal.High-FlowOxygenTherapyDuringExerciseTraininginPatientsWithChronicObstructivePulmonaryDiseaseandChronicHypoxemia:AMulticenterRandomizedControlledTrial.PhysTher.;(8):-.doi:10./ptj/pzaa
慢性阻塞性肺疾病和慢性低氧血症患者运动训练中使用高流量氧疗:一项多中心随机对照试验
Objective:Thestudyaimedtoevaluatewhetherhigh-flowoxygentherapy(HFOT)duringtrainingwasmoreeffectivethanoxygeninimprovingexercisecapacityinhypoxemicchronicobstructivepulmonarydisease(COPD).目的：该研究旨在评估训练过程中的高流量氧疗（HFOT）在改善低氧性慢性阻塞性肺疾病（COPD）患者的运动能力方面是否比常规吸氧更有效。Methods:AtotalofpatientswithCOPDandchronichypoxemiawereconsecutivelyrecruitedin8rehabilitationhospitalsinarandomizedcontrolledtrial.Cycle-ergometerexercisetrainingwasusedin20supervisedsessionsatisoinspiratoryoxygenfractioninbothgroups.Pre-andpost-trainingendurancetime(Tlim),6-minutewalkingdistance(6MWD),respiratoryandlimbmusclestrength,arterialbloodgases,BarthelIndex,BarthelDyspneaIndex,COPDAssessmentTest,MaugeriRespiratoryFailurequestionnaire,andpatientsatisfactionwereevaluated.方法：在8医院连续招募例COPD和慢性低氧血症患者进行随机对照试验。在20次监督训练中，两组均在等吸氧率下进行功率自行车运动训练。评定训练前后耐力时间(Tlim)、6min步行距离(6MWD)、呼吸和肢体肌力、动脉血气、Barthel指数和Barthel呼吸困难指数、COPD评估测验、Maugeri呼吸衰竭问卷和评估患者满意度。Results:Dueto15.4%and24.1%dropoutrates,71and66patientswereanalyzedinHFOTandVenturimask(V-mask)groups,respectively.Exercisecapacitysignificantlyimprovedaftertraininginbothgroupswithsimilarpatientsatisfaction.Between-groupdifferenceinpost-trainingimprovementin6MWD(mean:17.14m;95%CI=0.87to33.43m)butnotinTlim(mean:.85seconds;95%CI=-18.72to.42seconds)wassignificantlyhigherinHFOT.TheminimalclinicallyimportantdifferenceofTlimwasreachedby47%ofpatientsintheV-maskgroupand56%ofpatientsintheHFOTgroup,whereastheminimalclinicallyimportantdifferenceof6MWDwasreachedby51%ofpatientsintheV-maskgroupand69%ofpatientsintheHFOTgroup,respectively.结果：由于脱落率（???）为15.4％和24.1％，并分别对HFOT和文丘里面罩（V-mask）组中的71例和66例患者进行了分析。两组患者接受训练后，运动能力显着提高，患者满意度相似。6分钟步行距离（6MWD）的训练后改善的组间差异（平均值：17.14m；95％CI=0.87至33.43m），但在Tlim中与HFOT的差异不明显（平均值：.85秒；95％CI=-18.72至.42秒）。V-mask组中47％的患者达到了Tlim的临床最小重要性差值，HFOT组中56％的患者达到了Tlim的临床最小重要性差值，而V-mask组和HFOT组分别有51%和69%的患者达到了6MWD的临床最小重要性差值。Conclusion:InpatientswithhypoxemicCOPD,exercisetrainingiseffectiveinimprovingexercisecapacity.结论：对于低氧性COPD患者，运动训练可有效提高运动能力。Impactstatement:TheadditionofHFOTduringexercisetrainingisnotmoreeffectivethanoxygenthroughV-maskinimprovingendurancetime,theprimaryout