以呼吸生理为导向的康复锻炼对慢性阻塞性肺疾病预后影响的随机对照研究

目的 观察以呼吸生理为导向的呼吸康复锻炼在慢性阻塞性肺疾病(COPD)康复治疗中的价值.方法 按2006年慢性阻塞性肺疾病全球倡议(GOLD)标准选择60例稳定期重度至极重度COPD患者,按随机原则分为3组,每组20例.A组给予以呼吸生理为导向的呼吸康复锻炼8周,每日3次,每次15 min.B组给予缩唇呼吸康复锻炼8周,每日3次,每次15 min.C组不给予呼吸康复锻炼.分别测定锻炼前后6 min步行距离(6MWD)、呼吸困难评分(MRC)、日常生活活动能力(ADL)评分、最大呼气口腔压(MEP)、最大吸气口腔压(MIP)及生存质量(QOL)评分.结果 A、B、C组在呼吸康复锻炼中分别有3、5、5例退出试验.A、B组呼吸康复锻炼后MRC评分较锻炼前有显著下降(P均<0.01),而两组间差异无统计学意义(P>0.05).A、B组呼吸康复锻炼后6MWD、ADL评分、MEP、MIP均较锻炼前显著增加,且A组明显高于B组(P<0.05或P<0.01).A、B组呼吸康复锻炼后身体状况、呼吸短促、社会活动、家务工作以及A组不安评分均较锻炼前显著改善(P<0.05或P<0.01);而锻炼前后心情、头痛和食欲评分差异均无统计学意义(P均>0.05).A、B组间呼吸康复锻炼后QOL评分比较差异均无统计学意义(P均>0.05).结论 缩唇呼吸锻炼和以呼吸生理为导向的呼吸康复锻炼均能明显改善重度至极重度COPD患者的呼吸困难、提高ADL和QOL评分,增加运动耐力和呼吸肌功能;而以呼吸生理为导向的呼吸康复锻炼效果显著,可认为是重度至极重度COPD患者进行呼吸康复锻炼更为有效的方法.

A randomized controlled trial study of pulmonary rehabilitation with respiratory physiology as the guide on prognosis in patients with chronic obstructive pulmonary disease

OBJECTIVE: To observe the effect of pulmonary rehabilitation with respiratory physiology as guide in patients with chronic obstructive pulmonary disease (COPD). METHODS: Sixty patients of severe and very severe COPD as categorized by global proposed diagnostic criteria for COPD (GOLD, 2006) were enrolled for study. They were randomly divided into three groups, and with 20 patients in each group. The patients in group A were given pulmonary rehabilitation guided by respiratory physiology thrice a day, 15 minutes each time for 8 weeks. The patients in group B were given pulmonary rehabilitation with pursed lip respiration thrice a day, 15 minutes per time for 8 weeks. The patients in group C were given no pulmonary rehabilitation. Six minute-walk-distance (6MWD), medical research council (MRC) dyspned scale, activities of daily living (ADL), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), and quality of life (QOL) were determined before and after respective pulmonary rehabilitation course. RESULTS: (1) There were 3, 5, 5 patients in group A, group B, group C dropped off in the course of rehabilitation respectively. (2) The patients' MRC grade after pulmonary rehabilitation in group A and group B decreased compared with that before pulmonary rehabilitation (both P<0.01), but the difference was not significant between two groups (P>0.05). (3) 6MWD, ADL, MEP, MIP of patients in group A and group B increased after pulmonary rehabilitation compared with that before pulmonary rehabilitation, and 6MWD, ADL, MEP, MIP of patients in group A were increased after pulmonary rehabilitation more than those in group B (P<0.05 or P<0.01). (4)The patients' body status, shortness of breath, social activity, home chores in group A and group B, and uneasiness in group A after pulmonary rehabilitation were improved more than those before pulmonary rehabilitation (P<0.05 or P<0.01), but the difference in state of mind, headache, appetite was not markedly different before and after pulmonary rehabilitation in two groups (all P>0.05). The difference in QOL was not marked between group A and group B after pulmonary rehabilitation (all P>0.05). CONCLUSION: (1) The pulmonary rehabilitation with pursed lip respiration and the pulmonary rehabilitation with the guide of respiratory physiology ameliorates dyspnea, improves ADL, QOL, exercise tolerance, function of respiratory muscle in the severe and very severe COPD patients remarkably. (2) The effect of the pulmonary rehabilitation with the guide of respiratory physiology is better than that of the pulmonary rehabilitation with pursed lip respiration, and it can be considered as a more effective pulmonary rehabilitation method for the patients with severe and very severe COPD.