Influences of Spinal Anesthesia on Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease
Influences of Spinal Anesthesia on Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease
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DOI：
10.1164/rccm.201203-0404oc
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发表时间：
2012-10-01
影响因子：
24.7
通讯作者：
Maltais, Francois
中科院分区：
文献类型：
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作者：
Gagnon, Philippe;Bussieres, Jean S.;Maltais, Francois
理论基础：慢性阻塞性肺疾病(COPD)患者的运动耐量增加与下肢肌肉功能障碍有关。目的：研究脊髓麻醉对慢性阻塞性肺疾病患者恒定作业率自行车运动耐量和心肺反应的影响。方法：采用交叉双盲随机设计，8例慢性阻塞性肺疾病患者(FEV1，预计67+/-8%)在假手术(生理盐水，椎间L-3-L-4)或主动(芬太尼25，g)后完成恒定作业量自行车运动。鞘内注射L-3-L-4)腰麻。测量和主要结果：与安慰剂相比，芬太尼腰麻后的耐受时间显著延长(639+/-87 S vs.423+/-38 S[均值+/-扫描电子显微镜]；P=0.01)。芬太尼条件下相同时间点的通气量和呼吸频率降低，而通气率和死腔通气量增加。腰麻患者在相同时间点表现出较少的动态过度充气。结论：腰麻提高了COPD患者的自行车运动耐量，主要是通过减少运动时的呼吸反应和呼吸困难，这些作用可能是通过抑制III/IV组下肢感觉肌传入而实现的。临床试验在www.Clinicaltrials.gov(NCT01522729)注册。
Rationale Lower limb muscle dysfunction contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). We hypothesized that signaling from lower limb muscle group III/IV sensory afferents to the central motor command could be involved in premature cycling exercise termination in COPD.Objectives: To evaluate the effects of spinal anesthesia, which presumably inhibited central feedback from the lower limb muscle group III/IV sensory afferents on exercise tolerance and cardiorespiratory response during constant work-rate cycling exercise in patients with COPD.Methods: In a crossover and double-blind randomized design, eight patients with COPD (FEV1, 67 +/- 8% predicted) completed a constant work-rate cycling exercise after sham (NaCl, interspinous L-3-L-4) or active (fentanyl 25 g, intrathecal L-3-L-4) spinal anesthesia.Measurements and Main Results: When compared with placebo, endurance time was significantly prolonged after spinal anesthesia with fentanyl (639 +/- 87 s vs. 423 +/- 38 s [mean +/- SEM]; P = 0.01). Ventilation and respiratory rate were reduced at isotime points under the fentanyl condition, whereas ventilatory efficiency and dead space ventilation were improved. Patients exhibited less dynamic hyperinflation at isotime points with spinal anesthesia. consequently, the rise in dyspnea was significantly flatter during the fentanyl condition than with placebo.Conclusions: Spinal anesthesia enhanced cycling exercise tolerance in patients with COPD, mostly by reducing ventilatory response and dyspnea during exercise; these effects were possibly mediated through the inhibition of group III/IV lower limb sensory muscle afferents. Clinical trial registered with www.clinicaltrials.gov (NCT01522729).