Acute Ventilatory Support During Whole-Body Hybrid Rowing in Patients With High-Level Spinal Cord Injury A Randomized Controlled Crossover Trial
Acute Ventilatory Support During Whole-Body Hybrid Rowing in Patients With High-Level Spinal Cord Injury A Randomized Controlled Crossover Trial
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DOI：
10.1016/j.chest.2019.10.044
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发表时间：
2020-05-01
期刊：
影响因子：
9.6
通讯作者：
Taylor, J. Andrew
中科院分区：
文献类型：
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作者：
Vivodtzev, Isabelle;Picard, Glen;Taylor, J. Andrew
背景：高水平脊髓损伤（SCI）导致严重的脊柱和棘上缺损，在全身混合功能电刺激（FES）划船运动中导致严重的通气限制，这是一种通过电诱导腿部收缩显着增加活动肌肉量的运动形式。本研究检测了无创通气（NIV）对脊髓损伤患者通气和有氧能力的影响。方法：这项盲法、随机交叉研究纳入了19例脊髓损伤患者（损伤程度从C4到T8）。所有患者都熟悉fes赛艇，并且在训练相关的有氧能力增加方面达到了稳定水平。患者在有无NIV（假）的情况下进行了两次fes -划船峰值运动试验。结果：与假手术相比，NIV增加了运动潮气量（峰值，1.50 +/- 0.31 L vs 1.36 +/- 0.34 L, P < 0.05），降低了呼吸频率（峰值，35 +/- 7次/min vs 38 +/- 6次/min， P < 0.05），导致肺泡通气无变化，但有增加吸氧效率的趋势（P = 0.06）。在达到峰值耗氧量（VO(2)峰值）标准的患者中（n = 13）， NIV未能显著提高VO(2)峰值（1.73 +/- 0.66 L/min vs 1.78 +/- 0.59 L/min）；然而，反应范围显示肺泡通气峰值变化与VO(2)峰值之间存在相关性（r = 0.89; P < 0.05）。损伤程度越高，损伤后时间越短，VO(2)峰值升高幅度越大。结论：急性NIV可成功改善脊髓损伤患者FES运动时的通气效率，但可能无法改善所有患者的VO(2)峰值。最受益的似乎是损伤后较短时间内的颈椎脊髓损伤患者。
BACKGROUND: High-level spinal cord injury (SCI) results in profound spinal and supraspinal deficits, leading to substantial ventilatory limitations during whole-body hybrid functional electrical stimulation (FES)-rowing, a form of exercise that markedly increases the active muscle mass via electrically induced leg contractions. This study tested the effect of noninvasive ventilation (NIV) on ventilatory and aerobic capacities in SCI.METHODS: This blinded, randomized crossover study enrolled 19 patients with SCI (level of injury ranging from C4 to T8). All patients were familiar with FES-rowing and had plateaued in their training-related increases in aerobic capacity. Patients performed two FES-rowing peak exercise tests with NIV or without NIV (sham).RESULTS: NIV increased exercise tidal volume (peak, 1.50 +/- 0.31 L vs 1.36 +/- 0.34 L; P < .05) and reduced breathing frequency (peak, 35 +/- 7 beats/min vs 38 +/- 6 beats/min; P < .05) compared with the sham test, leading to no change in alveolar ventilation but a trend toward increased oxygen uptake efficiency (P = .06). In those who reached peak oxygen consumption (VO(2)peak) criteria (n = 13), NIV failed to significantly increase VO(2)peak (1.73 +/- 0.66 L/min vs 1.78 +/- 0.59 L/min); however, the range of responses revealed a correlation between changes in peak alveolar ventilation and VO(2)peak (r = 0.89; P < .05). Furthermore, those with higher level injuries and shorter time since injury exhibited the greatest increases in VO(2)peak.CONCLUSIONS: Acute NIV can successfully improve ventilatory efficiency during FES exercise in SCI but may not improve VO(2)peak in all patients. Those who benefit most seem to be patients with cervical SCI within a shorter time since injury.