慢性阻塞性肺疾病患者的上肢康复锻炼

上肢康复锻炼在呼吸康复中占有很重要的地位。本文总结了慢性阻塞性肺疾病(COPD)患者在日常生活中上肢活动时出现气促、不同步呼吸的机制。通过运用各种上肢锻炼方法可提高患者上肢的力量和耐力,从而减轻膈肌的负担,缓解患者的气促,改善患者的代谢情况。上肢运动测验则有助于对锻炼效果作出恰当的评价。在制订COPD患者呼吸康复方案时必须包括有上肢康复锻炼计划。     

慢性阻塞性肺疾病稳定期患者肺康复护理研究进展

慢性阻塞性肺疾病(COPD)是一种以气流受限为特征的疾病,病程呈进行性发展,主要累及肺脏,病死率高,严重影响患者运动耐力和生活质量。COPD患者肺康复护理包括患者评估、患者呼吸功能锻炼、肢体运动锻炼、营养治疗、健康指导、心理护理、效果评价等内容。本文就COPD患者肺康复护理的研究进展综述如下。     

慢性阻塞性肺疾病康复治疗进展

慢性阻塞性肺疾病(COPD)作为一种高患病率、高致残率和高死亡率的疾病而严重危害了人民的身体健康,肺康复已被证实能有效减轻COPD患者的呼吸困难,提高运动耐力和健康相关生活质量,不同严重程度的COPD患者均可从肺康复中获益,本文就COPD康复治疗措施及其进展做一综述.     

坐式八段锦锻炼对慢性阻塞性肺疾病患者活动耐力和生活质量的影响

<正>呼吸康复锻炼被证实是可以改善慢性阻塞性肺疾病(COPD)患者气促症状和运动耐力的非药物治疗方法〔1〕。坐式八段锦锻炼属于小运动量的传统保健运动,符合现代研究提出的低强度、长时间有氧运动的特点,特别适合中重度COPD稳定期的患者,活动后不易出现疲劳,便于老年患者长期坚持。本研究拟探讨坐式八段锦(也称床上八段锦)对中重度稳定期COPD患者活动耐力和生活质量的影响。     

间质性肺疾病肺康复治疗研究进展

现已证实肺康复能有效减轻间质性肺疾病(ILD) 患者呼吸困难症状,提高运动耐力,改善健康相关生活质量。 各种类型ILD 患者均可从肺康复中受益。其内容主要包括运动训练、呼吸训练及教育干预,其中,运动训练是肺康 复的核心内容。肺康复应当采取个体化、综合治疗方法。     

COPD肺康复运动处方的研究进展

肺康复作为COPD管理的一项重要内容,能有效减轻COPD患者的呼吸困难症状,提高运动耐量和健康相关生活质量,在国内尚处于起步阶段,对运动训练在COPD肺康复中的具体方式、强度、时间、频率缺乏充分的认识,本文就COPD肺康复运动处方的研究进展进行综述.     

慢性阻塞性肺疾病患者肺康复治疗效果及其评价

慢性阻塞性肺疾病（COPD）大部分中重度患者活动能力受限，并出现心理障碍及社会适应力降低，同时COPD的高患病率、高致残率使其占据了相当大的社会医疗资源。肺康复治疗的目的并非阻止或逆转肺功能的降低，而是通过肺康复计划改善患者的呼吸困难，提高运动耐力及生活质量，改善患者心理障碍及社会适应能力。全球COPD控制策略（GOLD）中首次将肺康复治疗，特别是下肢运动训练列为中重度COPD患者治疗的主要措施之一。目前国内对肺康复的重要性、相关的研究和临床工作与国外差距较大，对运动训练在肺康复中的重要地位缺少认识，且康复效果评价方法欠规范，在此就部分相关内容进行综述。     

肺康复治疗对稳定期COPD患者肺功能及血气分析的影响

目的探讨肺康复治疗对稳定期慢性阻塞性肺疾病（COPD）患者肺功能及血气分析的影响。方法将80例稳定期COPD患者随机分为肺康复组（n=40）与对照组（n=40）,肺康复组给予体能锻炼、呼吸肌锻炼、氧疗、心理与行为干预等肺康复治疗措施,治疗6～8周,治疗前后测定肺功能及血气分析,比较两组患者肺功能及血气分析的变化。结果观察组治疗后肺功能、血气分析较治疗前及对照组治疗后均显著改善（P〈0．01）。结论肺康复治疗可提高稳定期COPD患者肺功能及血气分析,从而提高患者的生存质量。     

慢性阻塞性肺疾病患者肺康复的临床研究进展

<正>慢性阻塞性肺疾病(COPD)是一种常见的以持续性呼吸道症状和气流受限为特征的可以预防和治疗的疾病~([1]),具有致残率高和病死率高等特点,影响患者的生活质量,给其家庭和社会带来沉重的经济负担。目前主要通过戒烟和流感疫苗预防COPD,药物治疗缓解症状,但由于COPD患者严重程度不同,所以需要采用个体化方案进行综合管理。肺康复作为患者整体管理的一部分,是多学科共同参与的综合性治疗,内容主要包括呼吸肌训练、运动     

慢性阻塞性肺疾病患者的康复治疗和营养支持治疗

慢性阻塞性肺疾病（COPD）是一种慢性呼吸系统疾病，患病率及病死率高，严重影响患者的劳动能力和生活质量。COPD是一种系统性疾病，不仅肺功能进行性下降，还可伴发全身性炎症、骨骼肌萎缩、体重下降，给患者带来严重的心理负担，影响患者的生存状态。肺康复治疗目前已成为治疗COPD的热点，在药物治疗的基础上进行康复锻炼及营养支持治疗已成为治疗COPD的主要方法。正确的康复治疗可以减轻COPD患者的症状，提高活动能力，改善生活质量。     

肺康复对稳定期慢性阻塞性肺疾病的疗效分析

目的探讨肺康复锻炼对稳定期慢性阻塞性肺疾病患者的临床疗效及意义。方法 300例稳定期慢阻肺患者,采用前瞻性随机对照法分为两组:康复组(n=149)给予门诊慢阻肺健康宣教,包括饮食干预,戒烟教育,用药指导;肺康复锻炼(呼吸运动训练联合步行运动训练)。对照组(n=151)仅给予门诊慢阻肺健康宣教。比较6个月后两组患者的血气分析、肺功能、6MWD(6分钟步行距离)及慢阻肺急性加重期住院的次数等。结果 6个月后共234例完成试验,康复组(n=121)较对照组(n=113)的6MWD,血气分析等指标有明显改善,具有统计学意义(P0.05),而两组间肺功能FEV_1/FVC、FEV_1%和慢阻肺急性加重期住院的次数无统计差异(P0.05)。结论肺康复锻炼(呼吸运动训练联合步行运动训练)能有效提高PaO_2及降低PaCO_2,提高6MWD,适度改善运动耐力,是一种简便易行的康复锻炼方法,值得临床应用及推广。     

Practical approach to establishing pulmonary rehabilitation for people with non‐COPD diagnoses

Pulmonary rehabilitation is a core aspect in the management of patients with chronic respiratory diseases. This paper describes a practical approach to establishing pulmonary rehabilitation for patients with non‐COPD diagnoses using examples from the interstitial lung disease (ILD), pulmonary hypertension (PH), bronchiectasis and lung cancer patient populations. Aspects of pulmonary rehabilitation, including the rationale, patient selection, setting of programmes, patient assessment and training components (both exercise and non‐exercise aspects), are discussed for these patient groups. Whilst there are many similarities in the rationale and application of pulmonary rehabilitation across these non‐COPD populations, there are also many subtle differences, which are discussed in detail in this paper. With consideration of these factors, pulmonary rehabilitation programmes can be adapted to facilitate the inclusion of respiratory patients with non‐COPD diagnoses.     

Exercise training during pulmonary rehabilitation in chronic obstructive pulmonary disease

Exercise training is an essential part of a pulmonary rehabilitation program. Different forms of exercise training can be prescribed in COPD patients, depending on the mechanism of the exercise limitation in the individual patient.     

Long-term effectiveness of an inpatient pulmonary rehabilitation program for elderly COPD patients: comparison between young-elderly and old-elderly groups

OBJECTIVE: To evaluate the long-term effects of pulmonary rehabilitation in elderly COPD patients, we monitored patients for 1 year after they completed a 2-week inpatient pulmonary rehabilitation program. We also compared the effects of pulmonary rehabilitation on young-elderly (age 65-74 years) and old-elderly (age 75 years or over) COPD patients. METHODOLOGY: Fifty-nine elderly COPD patients (mean age 72.8 years) were studied. They underwent a comprehensive 2-week inpatient pulmonary rehabilitation program incorporating 10 exercise sessions, each of which included endurance training of the lower extremities, peripheral muscle conditioning training of the upper and lower extremities, and stretching, along with various education sessions. The effects of pulmonary rehabilitation were evaluated at 3, 6, and 12 months after completion of the program. RESULTS: Overall, patient health-related quality of life (HRQoL) as assessed by a QoL scale, and dyspnoea as assessed by an oxygen cost diagram, improved significantly over the 12-month period. Exercise capacity assessed by a 6-min walking distance test (6MWD) was similarly significantly improved. However, there was some fall-off in terms of the distance walked 12 months after pulmonary rehabilitation. The improvements in exercise capacity, dyspnoea, and HRQoL did not differ between the two groups, with the exception that the 6MWD (P < 0.01) and the QoL scale (P < 0.05) at 3 months post-pulmonary rehabilitation were significantly higher in the old-elderly group. CONCLUSIONS: Pulmonary rehabilitation is an effective treatment in terms of improving dyspnoea, exercise capacity and HRQoL in elderly COPD patients, and the benefits are almost comparable for young-elderly and old-elderly patients.     

慢性阻塞性肺疾病2种肺康复策略的疗效比较

目的:比较2种不同的肺康复干预策略对慢性阻塞性肺疾病(COPD)患者BODE指数评分、焦虑抑郁及日常生活活动能力的改善及脱落率。方法:采用随机、对照的方法将155例稳定期COPD患者分为3组,肺康复干预Ⅰ组给予康复宣教、有氧呼吸操及体能训练;肺康复干预Ⅱ组仅给予康复宣教及有氧呼吸操,对照组不给予肺康复干预,为期20周。比较康复前后3组患者BODE指数、焦虑抑郁及日常生活活动能力评分及脱落的差异。结果:经过20周的肺康复干预,肺康复干预Ⅰ、Ⅱ组较对照组在焦虑抑郁评分、6 min步行距离、呼吸困难程度评分均明显改善(P<0.01),但脱落率明显高于其他2组(P     

Pulmonary rehabilitation for COPD: are programs with minimal exercise equipment effective?

Pulmonary rehabilitation is an essential component of chronic obstructive pulmonary disease (COPD) management with strong evidence supporting the efficacy of pulmonary rehabilitation to improve exercise capacity and quality of life, as well as reduce hospital admissions. However, it is estimated that only 2-5% of people with COPD who could benefit from pulmonary rehabilitation have access to programs. Most research on the benefits of pulmonary rehabilitation has used equipment such as cycle ergometers and treadmills for endurance training and weight machines for resistance training. To enable greater availability of pulmonary rehabilitation, the efficacy of exercise training using minimal equipment needs to be evaluated. Randomised controlled trials that used minimal, low cost equipment for endurance (eight trials) and strength training (three trials) compared to no training in people with COPD were evaluated. Statistically and clinically significant differences in functional exercise capacity and quality of life, as well as improvements in strength were demonstrated when exercise training with minimal equipment was compared to no training [six-minute walk test: mean difference 40 (95% CI: 13 to 67) metres; St George’s Respiratory Questionnaire: mean difference -7 (95% CI: -12 to -3) points]. While the number of studies is relatively small and of variable quality, there is growing evidence that exercise training using minimal, low cost equipment may be an alternative to equipment-intensive pulmonary rehabilitation programs.     

慢性阻塞性肺疾病稳定期患者综合康复治疗疗效观察

目的观察慢性阻塞性肺疾病（COPD）患者康复治疗前、后症状评分、6分钟步行试验（6MWT）及肺功能的变化。方法采用前瞻性随机对照研究,将60例COPD稳定期患者分为治疗组和对照组各30例;其中治疗组进行综合康复治疗（包括心理康复治疗、呼吸肌康复治疗、长期家庭氧疗）,康复治疗前和48周后分别测定第1秒用力肺活量（FEV1）、第1秒用力肺活量／用力肺活量（FEV1／FVC）和FEV,占正常预计值的百分比（FEV1％）及6MWT运动距离;并通过问卷调查的形式进行症状评价。结果治疗组咳嗽、咯痰及呼吸困难等症状明显改善,6MWT运动距离明显提高,与对照组比较有显著差异（P〈0．05）,但肺功能指标的改变无统计学意义（P〉0．05）。结论对COPD稳定期患者进行长期、综合程序康复治疗可以显著提高运动耐力,减轻临床症状。     

Developing the model of pulmonary rehabilitation for chronic heart failure

Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) commonly suffer from exertional symptoms of breathlessness and fatigue. The similar systemic manifestations of the conditions, including skeletal muscle dysfunction, are a major contributing factor to the limitation in exercise capacity. A period of exercise training has been shown to improve exercise performance and health-related quality of life for both conditions. Exercise training is a key component of pulmonary rehabilitation (PR) which is now a standard of care for patients with COPD and is symptom based. Although it may be assumed that patients with CHF could be incorporated into cardiac rehabilitation, this is predominantly a secondary prevention programme for patients who are largely asymptomatic. It has been shown that patients with CHF can be successfully trained together with patients with COPD by the same therapists within PR. There are comparable outcome measures that can be used for both COPD and CHF. Many patients with CHF still do not have access to an exercise rehabilitation programme and incorporating them into the PR model of care could be one solution. This article reviews the (1) similar symptoms, mechanisms and consequences between COPD and CHF, (2) rationale and evidence for exercise training in CHF, (3) model of PR, (4) safety of exercise training in CHF, (5) evidence for combined exercise rehabilitation for CHF and COPD, (6) adaptations necessary to include patients with CHF into PR, (7) the chronic care model and (8) summary.     

Exercise training combined with psychological interventions for people with chronic obstructive pulmonary disease

Previous systematic reviews have confirmed the benefits of both exercise training and psychological interventions in people with chronic obstructive pulmonary disease (COPD). The objective of this systematic review was to examine the effect of interventions which combine exercise training and psychological interventions for a range of health outcomes in people with COPD. Database searches identified randomized controlled trials of people with COPD participating in interventions that combined exercise training with a psychological strategy compared with control (usual care, waiting list) or active comparators (education, exercise, psychological interventions alone). Health outcomes included dyspnoea, anxiety, depression, quality of life or functional exercise capacity. Standardized mean differences (SMD) were calculated for each intervention arm/control comparison. Across the 12 included studies (738 participants), compared with control conditions, SMD consistently favoured interventions which included both exercise + psychological components (SMD range dyspnoea ?1.63 to ?0.25; anxiety ?0.50 to ?0.20; depression ?0.46 to ?0.18; quality of life 0.09 to 1.16; functional exercise capacity 0.22 to 1.23). When compared with active comparators, SMD consistently favoured interventions that included exercise training + psychological component for dyspnoea (SMD range ?0.35 to ?0.97), anxiety (SMD range ?0.13 to ?1.00) and exercise capacity (SMD range 0.64 to 0.71) but were inconsistent for depression (?0.11 to 1.27) and quality of life (0.02 to ?2.00). The magnitude of effect for most interventions was greater than the minimum required for clinical significance (i.e. > 0.32) in behavioural medicine. While interventions, outcomes and effect sizes differed substantially between studies, combining exercise training with a psychological intervention may provide a means of optimizing rehabilitation in people with COPD.