慢性阻塞性肺疾病患者呼吸锻炼状况的调查及护理对策

目的了解老年慢性阻塞性肺疾病(COPD)患者呼吸锻炼现状,提供开展呼吸锻炼相关教育及护理依据.方法对住院的50名COPD患者呼吸锻炼相关内容进行问卷调查.结果患者对呼吸锻炼知识了解不深,应用方法不正确,绝大多数患者不能系统的锻炼.结论患者不能得到完整有效的呼吸锻炼相关知识,须采取多种形式,普及相关知识,在实践中规范锻炼方式,提高患者的依从性.     

慢性阻塞性肺疾病患者呼吸功能锻炼依从性的影响因素分析

目的了解慢性阻塞性肺疾病(COPD)患者呼吸功能锻炼的依从性,并探讨其影响因素,为开展临床护理干预提供依据。方法选择COPD住院患者236例,采用自行设计及BCKQ设计的问卷调查表对患者进行调查和评估,应用卡方检验和相关性分析等方法,探讨影响呼吸功能锻炼的因素。结果 236例COPD患者中,进行呼吸功能锻炼者80例(33. 9%),其影响因素主要与年龄、文化程度和家庭个人收入有关,同时COPD知识掌握情况与呼吸功能锻炼依从性呈正相关(r=0. 847,P 0. 001)。结论 COPD患者呼吸功能锻炼依从性整体较差,应加强COPD相关知识和呼吸功能锻炼方法的健康教育,同时定期对患者进行督促和鼓励,调动其锻炼积极性。     

慢性阻塞性肺疾病患者呼吸功能锻炼现状调查

目的了解慢性阻塞性肺疾病（COPD）患者呼吸功能锻炼的现状,以找出和发现呼吸功能锻炼依从性差的原因,为开展呼吸功能锻炼和护理提供依据。方法采用问卷调查法对84例COPD患者进行呼吸功能锻炼的情况及可能的影响因素进行了调查。结果84例COPD患者中,没听说过呼吸功能锻炼者28例,听说过但不清楚者25例,知道者31例;从未做过者59例,开始做后来不做者9例,偶尔做者10例,一直坚持做者6例。直线相关分析显示,患者对呼吸功能锻炼的了解程度、必要性认识及实施程度与其文化程度及自我效能呈正相关关系（P〈0．01）。结论COPD患者进行呼吸功能锻炼的现状是不容乐观,护理人员应加强相关知识的宣教,提高患者对呼吸功能锻炼的认识及依从性,真正达到延缓疾病发展,提高患者生活质量的目的。     

老年慢性阻塞性肺疾病患者呼吸功能锻炼依从性的影响因素

目的探讨影响老年慢性阻塞性肺疾病(COPD)患者呼吸功能锻炼依从性的原因。方法对50例老年慢性阻塞性肺疾病患者进行问卷调查分析,了解患者掌握呼吸功能锻炼的状况。结果发现50例COPD患者中知道呼吸功能锻炼并认为对疾病有帮助的患者有30例(60%),其中能每天坚持锻炼的10例,偶尔进行呼吸功能锻炼的15例,开始做后来不做呼吸功能锻炼的5例;没听过呼吸功能锻炼的患者20例(40%)。关于呼吸功能锻炼知识的来源,来自医生的10例(20%),护士18例(36%),其他(媒体、网络、书籍等)2例(4%),有指导地进行呼吸功能锻炼的15例(30%)。结论患者不能得到完整有效的呼吸功能锻炼的相关知识,护理人员须采取多种形式,加强相关知识的宣教,在实践中规范锻炼方式,提高患者的依从性,真正达到延缓疾病发展,提高患者生活质量的效果。     

慢性阻塞性肺疾病患者家属呼吸锻炼知识知晓情况调查

目的：调查慢性阻塞性肺疾病（COPD）患者家属对COPD基本知识及呼吸锻炼相关知识的知晓情况及其需求,为有针对性地对患者家属进行健康教育提供依据。方法：指定专门培训人员采用自行设计的问卷,在出院时调查患者家属对COPD、呼吸锻炼相关知识的知晓情况及其需求,对调查结果进行统计学分析。结果：出院COPD患者家属对呼吸锻炼知识有着强烈的需求,希望能通过电话或医护人员的个别指导获取有关知识。结论：COPD患者家属缺乏患者呼吸锻炼相关知识,健康教育有待加强,根据家属需求采用各种健康教育方式有助于提高患者生活质量。     

护理干预对COPD患者呼吸功能锻炼依从性的影响

目的:探讨护理干预对COPD患者呼吸功能锻炼依从性的影响。方法:将120例COPD呼吸功能锻炼患者随机分为观察组和对照组各60例,对照组给予常规护理,观察组给予护理干预,观察比较两组患者呼吸功能锻炼的依从性。结果:两组在呼吸功能锻炼的坚持方面、对目的的了解情况、对相关知识掌握情况比较差异有统计学意义(P0.01)。结论:护理干预可提高COPD患者进行呼吸功能锻炼的依从性,有利于患者疾病的康复。     

慢性阻塞性肺疾病患者对呼吸康复锻炼的认知调查分析

目的：通过对慢性阻塞性肺疾病（COPD）患者对呼吸康复锻炼的认知调查,分析存在的问题,为临床进行护理干预提供依据。方法：回顾性分析2011年12月至2013年1月收治的150例COPD患者的一般临床资料。采用自制的呼吸康复锻炼的认知调查表对患者进行问卷调查。结果：48．0％患者没有听说过COPD,30．0％患者不了解该疾病．14．67％患者不知道疾病的临床症状,22．67％患者不知道疾病的相关危险因素,28．0％患者不知道吸烟是其危险因素,78．0％患者不知道燃料种类与疾病相关;30．0％患者不知道呼吸康复锻炼的作用,52．67％患者对呼吸康复锻炼有一定的了解,但没有进行过呼吸康复锻炼,17．33％患者完全了解呼吸康复锻炼对疾病的作用;能够正确的掌握并运用呼吸康复锻炼的患者仅有9．33％。结论：COPD患者对呼吸康复锻炼的认知行为较差,临床医护人员应定期开展健康教育,进行相关疾病的宣教,以提高患者的疾病意识,树立正确的就医行为防IP晡功能讲一彤下降．     

慢性阻塞性肺疾病21例疾病相关知识了解情况调查分析

目的:调查慢性阻塞性肺疾病(COPD)患者的疾病知识了解情况.方法:应用自行设计的慢性阻塞性肺疾病患者知识了解情况问卷,对21例住院的COPD患者进行调查及分析,并提出有针对性的教育内容和方法.结果:不了解及部分了解的项目有21项,占56.76%,其中完全了解的人数在50%以上的项目占总项目的35.1%,不了解的人数在50%以上的项目占总项目的45.95%.患者对COPD的基本知识有一定了解,对呼吸功能锻炼、氧疗等专业知识缺乏了解,说明患者对知识掌握程度总体偏低,且对不同知识的了解程度具有差异性.此外,患者对健康教育的形式也要求多样化.结论:应加强对患者进行呼吸功能锻炼、氧疗等专业知识的多形式的指导,同时提出护士应更新健康观念,履行教育职能.     

多元化健康教育对COPD患者疾病认知与呼吸功能锻炼依从性的影响

目的 了解慢性阻塞性肺疾病(chronic obstructive pulmonary diseas,COPD)患者对疾病认知和呼吸功能锻炼的现状,探讨多元化健康教育对患者疾病认知和呼吸功能锻炼的影响。方法 采用问卷调查法对2013年1月~2013年8月我院呼吸科住院的COPD患者78例。分为实验组42例,对照组36例,实验组运用多元化健康信念模式进行健康教育干预,对照组按常规方式进行健康教育。干预前后对两组患者进行问卷调查测评,了解患者对COPD知识的认知与呼吸功能锻炼依从性的情况。结论 运用多元化健康教育模式对COPD患者进行疾病认知和呼吸功能锻炼的影响具有统计学意义（P<0.01）,有效提高患者对疾病认知和呼吸功能锻炼的依从性,真正达到延缓疾病发展,提高患者生活质量的目的。     

慢性阻塞性肺疾病患者呼吸功能锻炼依从性的调查及护理对策

目的：了解慢性阻塞性肺疾病（COPD）患者呼吸功能锻炼依从性的现状，提供开展功能锻炼的护理依据。方法：采用自行设计的问卷调查50例COPD患者呼吸功能锻炼的情况，并对其效果进行比较。结果：50例患者坚持进行锻炼16例（32％）；偶尔锻炼25例（50％），从未进行过锻炼9例（18％）；坚持锻炼的患者6min行走距离明显高于未或偶尔进行锻炼的患者（P〈0.05）。结论：呼吸功能锻炼能改善患者的肺功能，部分患者由于功能锻炼的知识严重缺乏，依从性差，限制了临床推广；采取多种形式大力普及功能锻炼知识，并加强对COPD患者功能锻炼的管理，可以提高COPD患者功能锻炼的依从性，达到提高自我保健能力，控制疾病发展的目的。     

Breathing retraining in patients with chronic fatigue syndrome: a pilot study

The study aimed to 1) examine the point prevalence of asynchronous breathing in chronic fatigue syndrome (CFS) patients; 2) examine whether CFS patients with an asynchronous breathing pattern present with diminished lung function in comparison with CFS patients with a synchronous breathing pattern; and 3) examine whether one session of breathing retraining in CFS patients with an asynchronous breathing pattern is able to improve lung function. Twenty patients fulfilling the diagnostic criteria for CFS were recruited for participation in a pilot controlled clinical trial with repeated measures. Patients presenting with an asynchronous breathing pattern were given 20-30 minutes of breathing retraining. Patients presenting with a synchronous breathing pattern entered the control group and received no intervention. Of the 20 enrolled patients with CFS, 15 presented with a synchronous breathing pattern and the remaining 5 patients (25%) with an asynchronous breathing pattern. Baseline comparison revealed no group differences in demographic features, symptom severity, respiratory muscle strength, or pulmonary function testing data (spirometry). In comparison to no treatment, the session of breathing retraining resulted in an acute (immediately postintervention) decrease in respiratory rate (p < 0.001) and an increase in tidal volume (p < 0.001). No other respiratory variables responded to the session of breathing retraining. In conclusion, the present study provides preliminary evidence supportive of an asynchronous breathing pattern in a subgroup of CFS patients, and breathing retraining might be useful for improving tidal volume and respiratory rate in CFS patients presenting with an asynchronous breathing motion.     

运动训练对缓解期老年重度COPD患者肺功能和运动耐力的影响及其相关性研究*

目的：探讨运动训练对缓解期老年重度慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者肺功能和运动耐力的影响及二者的相关性。方法：30例缓解期老年重度COPD住院患者随机分为对照组10例,运动训练组20例。运动训练组除常规内科治疗外进行步行训练和改编的呼吸体操训练,持续训练3个月。对照组10例,给予内科常规药物治疗。训练前后分别评价运动耐力（6MWD以及记步器步数）和Borg呼吸困难评分, 同时测定肺功能。结果：COPD 患者训练前后肺功能无明显差异     

呼吸训练对缓解期老年重度COPD患者生存质量及日常生活活动的影响

目的：探讨呼吸训练对缓解期老年重度慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者的生存质量及日常生活活动的影响.方法：选择缓解期老年重度COPD患者30例,随机分为对照组10例,呼吸训练组20例.对照组常规内科治疗,呼吸训练组除常规内科治疗外采用缩唇呼吸和腹式呼吸训练3个月.呼吸训练前后分别评价生存质量（QOL）和日常生活活动（ADL）,同时测定肺功能和呼吸次数/分钟,与非训练组及训练前进行比较.结果：尽管呼吸训练组呼吸训练后与对照组及与训练前比较肺功能和ADL均无明显差异,但呼吸训练组呼吸频率与训练前比较明显降低（P＜0.05）,与对照组比较呼吸频率明显降低（P＜0.01）,呼吸短促症状明显减轻（P＜0.05）,QOL部分提高.结论：①生存质量指标中呼吸短促症状评价,结合呼吸次数/分钟评估呼吸康复效果较好;②即使是老年严重的COPD患者,也能通过呼吸训练使他们在生存质量上得到改善,呼吸康复适用于所有COPD患者.     

"Living up to par"--a golf tournament for persons with COPD.

An attempt to provide an improved quality of life for COPD patients led to the development of a prototype training program. The final outcome of an initial five-month program was a COPD golf tournament. The program included didactic education sessions, practice golf sessions to increase physical endurance, and the final competitive tournament. The expectations for this program were (1) that because these patients' self-confidence would improve through training, they could serve as role models for other COPD individuals in the community; and (2) that by learning breathing retraining techniques and coupling them with exercise, these patients would raise their tolerance levels, which could benefit other forms of activity in addition to golfing. We found that 7 of the 8 patients involved did increase their self-confidence, as evidenced by their being able to compete in a tournament that was covered by the news media. They also served as role models, as shown by an increase in physicians referrals to the overall program and by other persons with COPD calling the hospital to inquire about rehabilitation training. The second expectation proved to be correct as 7 of the 8 patients began by being able to comfortably play 4 to 6 holes in 2 hours, and 7 of the 8 showed improvement by being able to play 6 to 9 holes in the same time span. There appeared to be subjective improvement as well when the patients applied techniques learned to daily routine activities. We conclude that our innovative method of pulmonary rehabilitation was successful in achieving standard rehabilitation goals, was not costly, and was a safe, enjoyable means of outpatient rehabilitation.     

Does manual therapy provide additional benefit to breathing retraining in the management of dysfunctional breathing? A randomised controlled trial

Abstract

Purpose: Dysfunctional breathing (DB) is associated with an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study sought to investigate whether MT produces additional benefit when compared with breathing retraining alone in patients with DB. Methods: Sixty subjects with primary DB were randomised into either breathing retraining (standard treatment; n?=?30) or breathing retraining plus MT (intervention; n?=?30) group. Both the groups received standardised respiratory physiotherapy, which included: DB education, breathing retraining, home regimen, and audio disc. Intervention group subjects additionally received MT following further assessment. Data from 57 subjects were analysed. Results: At baseline, standard treatment group subjects were statistically younger (41.7?+?13.5 versus 50.8?+?13.0 years; p?=?0.001) with higher Nijmegen scores (38.6?+?9.5 versus 31.5?+?6.9; p?=?0.001). However, no significant difference was found between the groups for primary outcome Nijmegen score (95% CI (?1.1, 6.6) p?=?0.162), or any secondary outcomes (Hospital Anxiety & Depression Score, spirometry or exercise tolerance). Conclusion: Breathing retraining is currently the mainstay of treatment for patients with DB. The results of this study suggest MT provides no additional benefit in this patient group.

• Implications for Rehabilitation

• Dysfunctional breathing (DB) is associated with significant patient morbidity but often goes unrecognised, leading to prolonged investigation and significant use of health care resources.

• Breathing retraining remains the primary management of this condition. However, physiotherapists are also using manual therapy (MT) as an adjunctive treatment for patients with DB.

• However, the results of this study suggest that MT provides no further benefit and cannot be recommended in the clinical management of this condition.

     

Using Self-Efficacy Theory to Educate Patients with Chronic Obstructive Pulmonary Disease

The predominant debilitating symptom in patients with chronic obstructive pulmonary disease (COPD) is shortness of breath. Self-efficacy theory has been used in a case study approach to begin examining the expectations of a patient with COPD who attended a pulmonary education program. Mr. M. was selected for the case study because his condition typifies many of the problems encountered by patients with COPD. Mr. M.'s self-confidence in managing his breathing difficulty was measured by using the COPD Self-Efficacy Scale (CSES) before an educational program began and again 1 month and 6 months after the program. The CSES measures patients' confidence in their ability to manage or avoid breathing difficulty in a variety of situations. Mr. M.'s scores on the CSES improved in most areas. Incorporating programs to increase patients' self-efficacy may have implications for rehabilitation nurses who help patients with COPD manage their breathing difficulty.     

Breathing efficiency during inspiratory threshold loading in patients with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease (COPD) demonstrate an increased oxygen cost of breathing. It is as yet unclear whether this is related to a decreased breathing efficiency. The aim of the present study was to compare breathing efficiency in 16 patients with COPD (11 men, five women) and 16 healthy elderly subjects (seven men, nine women), and to investigate a possible relationship between breathing efficiency and resting energy expenditure (REE). REE was measured using a ventilated hood system. Breathing efficiency was assessed by measuring oxygen consumption (V ^′O ₂), mean inspiratory mouth pressure (MIP) and flow during breathing at rest and subsequently during breathing against an inspiratory threshold (40% of maximal inspiratory pressure). During loaded breathing there was a significant increase in V ^′O ₂, MIP, and external work of breathing compared with unloaded breathing in both groups. As intended, ventilation did not increase significantly during the breathing efficiency test in the patients with COPD. The breathing efficiency (median, range) of the patients with COPD was similar (3·7%, 1·4–8·7%) to that of the healthy elderly subjects (3·2%, 1·7–8·3%). Breathing efficiency was not correlated with REE in either group. In the present study, in which dynamic hyperinflation was probably prevented, no difference in breathing efficiency was found between healthy elderly subjects and COPD patients when breathing against an external inspiratory threshold. Furthermore, breathing efficiency was not related to REE in both groups.     

"Ineffective breathing pattern" care for COPD patients

Chronic obstructive pulmonary disease (COPD) is a long-term, chronic respiratory disease from which patients never fully recover. COPD patients usually face abnormal aeration caused by the disease. Patients that are unable to breathe and aspirate adequately and maintain lung appropriate expansion and contraction are considered to have ineffective breathing patterns. This causes physical, psychological and behavioral changes in COPD patients and impacts their emotional condition, daily activities and quality of life. Nurses who care for COPD patients with ineffective breathing patters can improve breathing muscle functions, improve respiration and keep the airway clean. In this paper, the author reviews and integrates relevant findings on this subject from the empirical literature in order to assist clinical nurses responsible for the care of COPD patients.     

缓解期慢性阻塞性肺疾病患者呼吸氦氧混合气后肺活量及其组成的变化

目的　探讨缓解期慢性阻塞性肺疾病 (COPD)患者呼吸氦氧混合气 (He O2 )后肺活量 (VC)及其组成的变化。方法　测定 37例缓解期COPD患者的VC及其组成补呼气容积 (ERV)和深吸气量 (IC) ,并对所得数据进行统计学处理。结果　呼吸He O2 后VC和ERV分别较呼吸空气时平均增加 2 2 .7%和 15 0 .1% ,二者比较差异显著 (P <0 .0 5 ) ,IC平均下降 3.89% ,但无显著性差异 (P >0 .0 5 )。结论　缓解期COPD患者呼吸He O2 后肺活量及其组成具有健康人呼吸He O2 后类似的反应 ,表明He O2 具有对肺组织进一步回缩的作用 ,这可能是He O2 具有治疗阻塞性呼吸道疾病的一种非物理性原因 ,其机理有待研究阐明。     

Trapped in my lungs and fighting a losing battle. A phenomenological study of patients living with chronic obstructive and pulmonary disease

Chronic obstructive and pulmonary disease (COPD) has detrimental effects on individuals with the disease. COPD causes breathlessness, morbidity and associated psychosocial distress. This study was guided by the phenomenological question what is it like to have COPD and situated in Van Manen's phenomenology of practice. Experiential material was gathered through phenomenological interviews. Four themes emerged from the lived experiences of patients living with COPD: breath as a possibility; being vigilant; fighting a losing battle; and feeling isolated from others. For patients with COPD, breathing becomes ever-present and shifts from the invisible background of daily living to the central activity around which everyday life is organised. COPD patients always monitor their own breath and scrutinise the environment on possible dangers that can affect their breathing. Whenever moving or being involved in an activity, a part of their mind is preoccupied with the breathing. Although COPD patients realise that no amount of good behaviour will matter and that the decline of their lungs is inevitable, they make every effort to take good care of their body. They anticipate and avoid triggers of breathlessness isolating them from social interactions and activities. The appearance of the body as a source of social embarrassment also has an isolating effect. This study shows that breathlessness is a constant horizon that frames the experience of COPD patients. It is a limiting factor and determines their entire life. A more profound understanding of these experiences in healthcare professionals will contribute to person-centred care for COPD patients.