Ventilatory support during whole-body row training improves oxygen uptake efficiency in patients with high-level spinal cord injury: A pilot study.
Ventilatory support during whole-body row training improves oxygen uptake efficiency in patients with high-level spinal cord injury: A pilot study.
复制标题
全身划船训练期间的通气支持可提高高度脊髓损伤患者的摄氧效率：一项试点研究。
DOI：
10.1016/j.rmed.2020.106104
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发表时间：
2020
影响因子：
4.3
通讯作者：
Taylor,JAndrew
中科院分区：
文献类型：
--
作者：
Vivodtzev,Isabelle;Napolitano,Anthony;Picard,Glen;Taylor,JAndrew
高位脊髓损伤（SCI）以严重的呼吸损伤为特征。结果之一是全身运动康复受到限制，降低了其心脏保护作用。我们调查了在训练中使用呼吸支持对运动心肺反应的影响。9名重度脊髓损伤（T3-C4）患者被纳入这项双盲假对照研究。在参加这项研究之前，所有人都有超过6个月的训练适应停滞期。在完成基线评估后，参与者被随机分配继续进行无创通气（NIV: n = 6: IPAP = 20±2,EPAP: 3 cmH2O）或假手术（n = 3: IPAP = 5, EPAP: 3 cmH2O） 3个月的训练，并再次进行最大运动测试。我们比较了训练前后的摄氧量效率斜率（OUES， vo2的增加速率与VE的增加有关）。与基线（4.1±1.1 vs. 3.4±1.0，即+20±12%，p < 0.05）和Sham （p = 0.01）相比，NIV训练增加了OUES，表明在给定通气条件下吸氧能力增加。这一结果在试验过程中没有NIV，表明心肺储备得到改善。反应最好的是最年轻的人，他们的特征与假参与者非常相似。此外，NIV倾向于使每周划船距离增加24% （p = 0.09，而假手术组为10%）。我们的研究结果非常提示在高位脊髓损伤患者全身运动期间进行通气支持的积极作用。训练适应性的发现是非常重要的，因为这一亚群患者最需要以运动为基础的心脏保护。
High-level spinal cord injury (SCI) is characterized by profound respiratory compromise. One consequence is a limitation of whole-body exercise-based rehabilitation, reducing its cardioprotective effect. We investigated the use of ventilatory support during training on cardiorespiratory response to exercise.Nine subjects with high-level SCI (T3-C4) were included in this double-blind sham-controlled study. All had training adaptations plateauing for more than 6 months before enrolling in the study. After performing baseline assessment, participants were randomly assigned to continue training with non-invasive ventilation (NIV: n = 6: IPAP = 20 ± 2, EPAP: 3 cmH2O) or sham (n = 3: IPAP = 5, EPAP: 3 cmH2O) for 3 months and performed again maximal exercise tests. We compared the oxygen uptake efficiency slope (OUES, the rate of increases in VO2in relation to increasing VE) before and after training.Training with NIV increased OUES both compared to baseline (4.1 ± 1.1 vs. 3.4 ± 1.0, i.e. +20 ± 12%, p < 0.05) and Sham (p = 0.01), representing an increase in ability to uptake oxygen for a given ventilation. This result was sustained without NIV during the test, suggesting improved cardiopulmonary reserve. Best responders were the youngest whose characteristics were very similar to sham participants. In addition, NIV tended to increase weekly rowing distance by 24% (p = 0.09, versus 10% in sham).Our results are very suggestive of a positive effect of ventilatory support during whole-body exercise in high-level SCI. Training adaptations found are of great importance since this sub-population of patients have the greatest need for exercise-based cardio-protection.