慢性阻塞性肺疾病患者生活质量及其影响因素

目的分析慢性阻塞性肺疾病(COPD)患者生活质量的现状,并探讨影响其生活质量的相关因素。方法选取2013年3月至2014年3月在大连医科大学附属第一医院三部呼吸科住院的COPD稳定期患者88例作为研究对象。将患者一般情况调查表、圣乔治呼吸问卷(SGRQ)、疾病家庭负担量表(FBS)、领悟社会支持量表(PSSS)、焦虑量表(SAS)、抑郁量表(SDS)相结合,采用SPSS17.0统计软件进行分析。结果不同疾病COPD患者SQ无差异。年龄、家庭经济收入对COPD患者生活质量有影响。相关分析显示,患者心理状况与生活质量有很强的关联,抑郁、焦虑的情况越重,SQ越差。多因素分析显示,经济收入越低、经济负担越重、自我活动能力越小、焦虑程度越重,家庭成员躯体健康越差,影响单项得分越高,SQ越差。结论 COPD患者的生活质量普遍较低。影响COPD患者生活质量的主要因素是年龄、经济收入、心理因素、疾病负担等。     

家庭肺康复对慢性阻塞性肺疾病患者的干预效果

目的探讨家庭肺康复对慢性阻塞性肺疾病(COPD)患者的影响。方法电子检索1991年10月至2015年12月国内外家庭肺康复对COPD患者影响的随机对照试验(RCT)。采用Rev Man5.3软件对数据进行合并分析,无法转换合并的数据采用描述性分析。结果共纳入13个RCT研究,包含464例患者。Meta分析显示,家庭肺康复能够有效改善患者健康相关的生活质量,提高患者的身体机能。结论家庭肺康复与其他形式的肺康复相比能更有效地改善患者的生活质量和身体技能。     

小剂量泼尼松对极重度慢性阻塞性肺疾病患者生活质量的影响研究

目的探讨小剂量泼尼松对极重度慢性阻塞性肺疾病(COPD)患者生活质量的影响。方法选择2007年7月—2011年7月在我院呼吸内科门诊治疗并获得随访的极重度COPD患者58例,根据患者意愿并综合临床将其分为对照组30例和治疗组28例。对照组给予常规氧疗+氨茶碱+沙丁胺醇气雾剂等,治疗组在对照组基础上加用泼尼松5~10 mg/d。门诊随访2年,比较两组患者随访期间病死率、因急性加重住院频率、治疗前和随访2年末患者圣乔治呼吸问卷(SGRQ)评分及随访期间不良反应情况。结果治疗组患者病死率为20.0%,与对照组的21.4%比较,差异无统计学意义(P0.05);治疗组患者住院频率为(4.10±0.84)次,低于对照组的(5.43±1.01)次(P0.05);随访2年末治疗组SGRQ评分为(51.3±11.3)分,低于对照组的(50.9±10.5)分(P0.05);对照组不良反应发生率为25.0%,与治疗组的26.7%比较,差异无统计学意义(P0.05)。结论小剂量泼尼松能够降低患者SGRQ评分,提高患者生活质量,且未增加病死率和不良反应发生率,可以在部分极重度COPD患者中推广应用。     

慢性阻塞性肺疾病患者生活质量评估方法的研究进展

健康相关生活质量量表对于慢性阻塞性肺疾病患者生活质量的评估起着非常重要的作用.迄今为止,相关学者已相继研发了许多种量表.COPD评估测试不仅简便短小,而且拥有与以往复杂问卷相似的评估能力,值得在全球推广.     

慢性阻塞性肺疾病患者肺康复诊治进展

慢性阻塞性肺疾病(COPD)是目前普遍存在的以长期性呼吸道症状及气流受阻为特点的可避免和诊治的病症,气流受阻主要是有毒元素导致的气道及(或)肺泡不正常造成的[1]。COPD是当前在全世界范围内最常见且高发的非传染性慢性疾病。其患病率和病死率均较高,危害重大,是一个全球性亟待解决的公共卫生问题。有调查显示:中国COPD患者过去1年平均急性加重次数2次(1~3次)[2]。因此,除了明确诊断及精准治疗外,科学认识及早期预防COPD已经成为临床上面临的重大挑战。肺部康复治疗的目的是通过综合康复措施改善患者呼吸困难,使其活动耐力增强,生活质量、心理状态得到改善,患者社会适应能力得到提高[3]。2011年世界COPD控制策略(GOLD)中开始把肺康复诊治当做中重度COPD患者诊治的关键方式[4],此后指南多次更新均强调了肺康复在治疗中的地位。近年来,肺康复在我国虽然有了一定的发展,但很多医务人员及COPD患者仍对其缺乏认识,导致COPD患者不能有效利用肺康复进行自我管理。本文就肺康复的相关内容进行综述,为COPD患者的肺康复提供理论依据,进一步促进肺康复在我国的发展。     

肺康复治疗对慢性阻塞性肺疾病患者生活质量的影响

慢性阻塞性肺疾病（COPD）是一种具有气流受限为特征的疾病,发病率和病死率呈逐年增加趋势,患者常因肺功能受损而引起呼吸困难和活动耐力的下降,从而影响其生活质量[1]。因此,如何对COPD患者进行康复训练,减少反复发作次数,减轻家庭负担和社会负担,延长发作间期是具有十分重要的意义。本文对COPD缓解期患者进行呼吸肌康复训练,     

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     

慢性阻塞性肺疾病的康复治疗

肺康复可以使慢性阻塞性肺疾病( 慢阻肺) 患者减轻呼吸困难症状、提高运动耐力、改善生活质量和身心状态。 各个时期、各年龄段的慢阻肺患者均可进行肺康复训练,并从中获益。肺康复应采用多学科、个体化的治疗方案。     

肺外合并症对稳定期慢性阻塞性肺疾病男性患者生活质量的影响

摘要：目的观察肺外合并症对稳定期慢性阻塞性肺疾病（慢阻肺）男性患者生活质量的影响。方法选择稳定期慢阻肺男性患者86例,根据合并肺外合病症的数量分为0个（16例）、1个（38例）、2个（26例）、3个（6例）;根据有无单一合并症分为有肌肉萎缩（16例）和无肌肉萎缩（70例）,有抑郁症状（5例）和无抑郁症状（81例）,有骨折高风险（62例）和无骨折风险（24例）,有心血管合并症（25例）和无心血管合并症（61例）。采用慢阻肺评估测试（CAT）问卷中文版及改良的英国医学研究理事会调查问卷（mMRC量表）对所有慢阻肺患者进行生活质量及呼吸困难程度进行评估,记录过去12个月急性加重次数。结果0、1、2、3个合并症者CAT评分分别为（14．25±7．11）、（14．00±7．90）、（14．96±6．70）、（25．67±7．06）分,有0、1、2个合并症者分别与有3个合并症者比较,P均〈0．05。有肌肉萎缩者CAT评分、mMRC评分、过去12个月急性加重次数分别为（14．94±8．26）分、（2．44±1．26）分、（2．06±1．98）次,无肌肉萎缩者分别为（14．06±7．32）分、（1．514±1．32）分、（0．604±0．91）次,两两比较,P均〈0．05;有抑郁症状者CAT评分、mMRC评分、过去12个月急性加重次数分别为（26．00±6．44）分、（3．004±0．71）分、（2．40±2．30）次,无抑郁症状者分别为（14．48±7．40）分、（1．604±1．34）分、（0．78±1．17）次,两两比较,P均〈0．05;有、无骨折高风险者mMRC评分分别为（1．90±1．38）、（1．13±1．08）分,两者比较,P〈0．05。结论肺外合并症影响稳定期慢阻肺男性患者的生活质量,合并症数量越多,患者的生活质量越差。     

Pulmonary rehabilitation improves exercise capacity and quality of life in underweight patients with chronic obstructive pulmonary disease

Background and objective: An estimated 20–40% of COPD patients are underweight. We sought to confirm the physiological and psychosocial benefits of pulmonary rehabilitation programmes (PRP) in underweight compared with non‐underweight patients with COPD. Methods: Twenty‐two underweight COPD patients with BMI <20 kg/m², and 22 non‐underweight COPD patients, who were matched for FEV₁ and age, were studied. All patients had moderate‐to‐very severe COPD. All patients participated in 12‐week, hospital‐based outpatient PRP consisting of two sessions per week. Baseline and post‐PRP status were evaluated by spirometry, cardiopulmonary exercise testing, ventilatory muscle strength and the St. George's Respiratory Questionnaire (SGRQ). Results: At baseline, the age distribution and airflow obstruction were similar in underweight and non‐underweight patients with COPD. Baseline exercise capacity, inspiratory muscle strength and SGRQ total and symptoms scores were significantly lower in the underweight patients (all P < 0.05). After the PRP, there was significant weight gain in the underweight COPD patients (mean increase 0.8 kg, P = 0.01). There were also significant improvements in peak oxygen uptake, peak workload and the SGRQ total, symptoms, activity and impact scores in both underweight and non‐underweight patients with COPD (all P < 0.05). Conclusions: Underweight patients with COPD have impaired exercise capacity and health‐related quality of life (HRQL). Exercise training with supplemental oxygen may result in significant weight gains and improvements in exercise capacity and HRQL. Exercise training is indicated for underweight patients with COPD.     

Outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Objective

To evaluate an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease COPD, using St.George’s Respiratory questionnaire (SGRQ), the 6-minutes walking test (6-MWT) and BODE index as the primary outcome measures.

Methods

A prospective, parallel-group controlled study of an outpatient rehabilitation program in 80 patients with COPD (67 men and 13 women; mean age 64.8 ± 10.6 years; FEV₁, 42.8% ± 7.6% of the predicted value. The active group (n = 40) took part in a 14-week rehabilitation program [3 h/wk, 1.5 h of education and exercise and 1.5 h of cycling]. The control group (n = 40) was reviewed routinely as medical outpatients. The following evaluations were carried out at study entry and after14 weeks: (1) pulmonary function studies; (2) 6-minutes walking test 6MWT; (3) quality of life; and (4) BODE index.

Results

The following patients completed the study: 35 patients (87.5%) from the active group (mean age, 63.7 ± 11.9 years; mean forced expiratory volume in one second (FEV₁), 41.9 ± 2.6% of the predicted value); and 36 patients (88%) from the control group (mean age, 65.9 ± 10.3 years; mean FEV₁, 43.33 ± 3.6% of the predicted value). We found no changes in pulmonary function parameters in the active group and the control one at 14weeks. On the other hand, there were significant changes within the components of the SGRQ (12.3 for the score total) for the patients of the active group but not for the patients of the control one (only 1.5 for the score total), we observed also a significant increase in the distance of the 6-MWT in the patients of the active group but not for the patients of the control one, and finally a decrease of two points (from 6 to 4) was noted in the score of the active group’s BODE index without any change in the control group’s one.

Conclusion

An outpatient-based of 14-week rehabilitation program significantly improved the quality of life and exercise tolerance without any change in the pulmonary function in patients with moderate COPD, and there was also a large decrease in the risk of death in rehabilitated patients as measured using the BODE index.     

Pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in India. Drug treatment alone does not optimize therapy. Pulmonary rehabilitation has been found to improve the physical efficiency of COPD patients. Therefore, we evaluated the effect of domiciliary pulmonary rehabilitation programme in patients of COPD. METHODS: Forty patients of stable COPD having severe airflow obstruction were included in the study. They were divided into control and experimental groups randomly. Rehabilitation included walking, breathing exercises, postural drainage, controlled coughing and changes in life style activities. Exercises of 30 minutes duration were performed at home twice daily for four weeks supervision. Six-minute walking distance, forced expiratory volume in one seocond (FEV1) and various indices of chronic respiratory disease questionnaire (CRDQ) were measured in both experimental and control groups before and after completion of the study. RESULTS: In the experimental group, after four weeks, the mean (+/- SD) difference in six-minute walking distance, dyspnoea, mastery, fatigue and emotion scores were 54.2 (26.7) meters, 0.96 (0.26), 0.89 (0.44), 0.90 (0.40) and 0.91 (0.32) respectively. Changes in all these parameters were statistically significant (p < 0.001) as compared to the control group. There was no significant change in FEV1. CONCLUSION: It was concluded that domiciliary pulmonary rehabilitation for four weeks results in significant improvement in the quality of life and exercise tolerance, even without improvement in FEV1.     

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所有的慢性阻塞性肺疾病(COPD)患者都能从运动训练中受益,它可以减轻呼吸困难,提高运动耐力和健康相关的生活质量,运动训练的介入时机已从稳定期扩展到急性加重期。肺康复内容包括评估、运动训练、教育、营养干预和心理支持等,其中运动训练是核心。鼓励因地制宜开展肺康复,鼓励家庭活动或锻炼,鼓励长期坚持。立足社区,在社区医生中普及肺康复知识和技能,中西医结合或是适合中国国情的策略。     

肺呼吸康复治疗在慢性阻塞性肺疾病稳定期患者中的应用研究

目的 分析探讨肺呼吸康复治疗在慢性阻塞性肺疾病稳定期患者中的应用效果.方法 选择2018年1月至2020年3月间收治的80例慢阻肺稳定期患者,随机分为常规治疗组和肺呼吸康复治疗组.常规治疗组予以常规治疗,肺呼吸康复治疗组在常规治疗基础上,采用呼吸训练器进行吸气和呼气训练.观察比较两组患者出院随访4周后的肺功能、生活质量...     

社区管理对老年慢性阻塞性肺疾病患者生活质量的影响

目的探讨社区管理对老年慢性阻塞性肺疾病患者生活质量的影响。方法选取社区老年慢阻肺稳定期患者108例,随机分为实验组和对照组各54例,实验组给予全方位的社区管理措施,而对照组患者实施常规护理,观察并比较两组患者的心理状况、肺功能指标、慢阻肺急性发生情况以及生活质量等指标。结果实验组患者社区管理后心理状态及肺功能指标显著优于对照组,差异均有统计学意义(P0.05)。实验组患者社区管理后躯体功能、心理功能、社会功能以及物质功能评分显著高于对照组,差异均有统计学意义(P0.05)。实验组患者社区管理后慢阻肺急性发生次数≤1次/年例数(39例)显著多于对照组(22例),差异具有统计学意义(χ~2=10.887,P=0001)。结论对老年慢性阻塞性肺疾病患者进行全方面的社区管理,能有效改善患者心理状态和肺功能,并有助于慢阻肺急性发作的控制,从而进一步提高患者的生活质量。     

Success in pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

BACKGROUND:

Pulmonary rehabilitation (PR) is beneficial for some, but not all, patients with chronic lung disease.

OBJECTIVES:

To determine the success rate of a comprehensive PR program for patients with chronic obstructive pulmonary disease (COPD) and to characterize the differences between responders and nonresponders.

METHODS:

A chart review was performed on patients with a clinical diagnosis of COPD who were referred for PR. Success was defined according to clinically important changes in St George’s Respiratory Questionnaire scores and/or 6 min walk test distance.

RESULTS:

The majority of subjects were men (58%) with a mean (± SD) age of 69±10 years (n=177). Sixty-two per cent of participants had a successful outcome with PR, with proportionally more responders noting subjective improvement than objective improvement on a 6 min walk test (73% versus 51%). Subjects with poor baseline St George’s Respiratory Questionnaire scores tended to improve the most (P=0.011 [ANOVA]). Successful participants had a greater forced expired volume in 1 s (1.1 L versus 0.9 L; P<0.05) and a lower BODE index (body mass index, airflow obstruction, dyspnea, and exercise capacity index) at baseline (9.6 versus 10.3; P<0.05). Success of PR was not correlated with age, sex, chronic hypoxemic respiratory failure or other chronic conditions. Successful participants were more likely to be compliant and to experience fewer adverse events (P≤0.001).

CONCLUSIONS:

Our study reinforced the belief that the majority of participants with COPD benefit from PR. Few baseline characteristics were predictive of success. Subjectively measured improvement occurred more frequently than objectively measured improvement and was greatest in those with the poorest baseline values.