运动心肺功能与慢性阻塞性肺疾病严重程度相关性分析

目的 探讨心肺运动试验(CPET)与慢性阻塞性肺疾病(COPD)GOLD分级间的相关性,明确何者为优.方法 67例稳定期COPD患者经GOLD分级后,先后进行静态肺通气功能(PFT)、CPET检测.记录FEV1%、FVC%、FEV1/FVC,CPET的最大运动功率(Wmax)、最大运功功率与预计值的比(Wmax%)、最大公斤摄氧量(VO2max)、无氧阈(VO2at AT)、氧脉(O2 Pulse)、最大呼吸频率(RRmax)、呼吸储备(BR%)、最大心率(HRmax)、心率储备(HRR)和每分钟通气量(VE).分析各参数与疾病分期之间的相关性.结果 VO2max、Wmax、O2 Pulse各期间差异有统计学意义;BR%、VE在Ⅰ、Ⅱ期间差异无统计学意义;VO2 at AT在各分期间差异无统计学意义;VO2max、O2 Pulse、VE分别与FEV1%或GOLD分期均显著相关;Wmax、VO2 at AT、BR%与FEV1%或GOLD分期均呈显著相关,而RRmax、HRmax与FEV1%或GOLD分期无相关性.运动受限原因主要有(40/67)为下肢乏力,(9/67)为气促,(7/67)为气促伴下肢乏力.结论 CPET参数与COPD的GOLD分期相关,同时CPET参数与FEV1相关性更高,单纯GOLD分期不能全面评估COPD患者疾病的严重程度,此外,CPET有助于明确运动受限原因.     

慢性阻塞性肺疾病患者营养状态对运动心肺功能的影响

目的：探讨营养状态对慢性阻塞性肺疾病（COPD）患运动心肺功能的影响。方法：43例COPD患分为营养不良组（15例），营养正常组（28例）和健康志愿（20名）进行负荷连续递增的运动心肺功能试验。运动行营养评价和常规肺功能检查，结果：（1）COPD营养不良组最大氧耗量（VO2max）、最大运动负荷（Wmax）、最大氧脉搏（O2pulsemax)和无氧阈（AT）低于营养正常组，两组比较差异有显性（P＜0．05）。通气氧耗（VO2／W／VE)和最大运动时的气急指数（DImax)与营养正常组比较，差异有显性（P＜0．05）。（2）COPD患理想体重百分比（IBW％）与VO2max占预计值百分比、Wmax占预计值百分比、O2pulsemax占预计值百分比，AT呈正相关（r=0.696,0.432,0.717,0.822,P均＜0．01）、与DImax,VO2/W/VE呈负相关（r=-0.450,-0.640,P均＜0．01）。结论：营养不良可以导致COPD患肌肉有氧代谢能力和运动耐力降低。     

稳定期COPD患者静息肺功能测定及与最大摄氧量的相关性分析

目的探讨慢性阻塞性肺疾病（COPD）患者静息肺功能、运动耐力变化及两者的关系。方法选择32例稳定期COPD患者（COPD组）和20例健康体检者（对照组）,分别行静息肺功能测定和症状自限最大运动负荷递增试验,记录用力肺活量（FVC）、第1秒用力肺活量（FEV1．0）、FEV1．0占预计值百分比（FEV1．0％）、最大通气量（MVV）、静息状态下一氧化碳弥散量（DLCO）和最大摄氧量（VO2 max）;对COPD静息肺功能指标与VO2 max的关系行直线相关分析。结果COPD组FVC、FEV1．0、FEV1．O％、FEV1．0／FVC、MVV、DLCO和VO2 max均显著低于对照组（P均〈0．05）;COPD组FVC、FEV1．0、FEV1．0％、FEV1．0／FVC、MVV和DLCO与VO2 max均呈显著正相关（P均〈0．05）。结论稳定期COPD患者静息肺功能及运动耐力均有所减退,且两者呈正相关;联合检测此两项指标可综合评价COPD病情进展、预后及指导康复治疗。     

慢性阻塞性肺疾病患者运动能力与通气效率的相关性分析

目的:通过分析二氧化碳通气当量和运动能力的关系,探讨稳定期慢性阻塞性肺疾病(COPD)患者运动中通气效率与最大运动能力的相关性。方法:选取54例稳定期COPD患者,行运动心肺功能测试,实时监测摄氧量(VO2)、分钟通气量(VE)和二氧化碳排出量(VCO2),根据公式:EqCO2=VE/VCO2计算得出静态二氧化碳通气当量(EqCO2rest)、无氧阈时二氧化碳通气当量(EqCO2at)和最大运动状态下的二氧化碳通气当量(EqCO2max)。结果:1.EqCO2rest、EqCO2at及EqCO2max呈递减趋势,差异有统计学意义(P=0.001)。2.EqCO2at与最大摄氧量(VO2max)(r=-0.294,P<0.05)、EqCO2max与VO2max(r=-0.301,P<0.05)均呈负相关;EqCO2rest与最大摄氧量占预计值的百分比(VO2max/Pred)呈负相关(r=-0.345,P<0.05)。3.肺功能GOLD 3级患者(21例)的VO2max(15.99±3.39)mL·min-1·kg-1明显低于GOLD 2级患者(25例)的VO2max[(18.88±5.36)mL·min-1·kg-1,P=0.038]。两组的EqCO2rest、EqCO2at及EqCO2max差异无统计学意义。结论:稳定期COPD患者运动中通气效率呈进行性下降趋势,这可能是导致其运动能力下降的重要因素之一。     

先天性心脏病患者运动心肺功能表现

目的探讨先天性心脏病患者运动负荷测验特点。方法15例患者，男4例，女11例。其中房缺9例，室缺6例。并与年龄相近健康男性4例、女性11例作对照。进行踏车递增负荷运动测验。结果先天性心脏病组VO2max，VO2max占预计值％（＜正常84％）低于对照组；VO2AT，VO2AT／VO2maxpred低于对照组但在正常范围内；此外VO2／HRmax＜VO2／HRmaxpred。有3例心导管证实为肺动脉高压者，运动后PaO2及SaO2减低；P（A－a）O2加宽；P（a－et）CO2正值；VE／VCO2AT异常增高超过45，但BRmax正常。结论先天性心脏病患者运动负荷表现为最大有氧代谢能力减低。VE／VCO2AT异常增高为肺动脉高压、V／Q比率失调、肺循环障碍提供线索。运动后低血氧考虑有右至左分流。     

运动激发试验过程中目标运动强度指标的对比分析

目的比较运动激发试验中FEV1预计的最大运动功率(WRpeak)与实际WRpeak的差异,并探讨新的运动强度指标。方法共入组39例患者,进行运动激发试验及运动前后常规肺功能检测,比较各运动强度指标预计值与实测值的差异。结果患者的实测WRpeak明显低于预计WRpeak,差异有统计学意义(P0.001);实测最大运动心率(HRmax)明显低于预计HRmax,差异有统计学意义(P0.001)。但HRmax变异率低于WRpeak变异率,差异有统计学意义(P0.05)。WRpeak、HRmax与最大通气量(MVV)具有相关关系(P0.05)。结论用FEV1预计的WRpeak与实际WRpeak有统计学差异,但运动心率的差异较小,用最大预计心率来确定目标运动强度比FEV1预计的目标运动强度更接近受试者的实际最大运动强度。     

稳定期慢性阻塞性肺疾病患者深吸气量测定的临床意义

目的探讨深吸气量测定对稳定期慢性阻塞性肺疾病（COPD）患者气流阻塞变化和呼吸困难严重程度的临床意义。方法对61例中度稳定期COPD患者进行常规肺功能检测，以Borg指数判断受试者呼吸困难的严重程度。所有患者在吸入400μg沙丁胺醇后重复检测肺功能和呼吸困难分级，36例在进行6min步行试验（6MWT）后重复肺功能检测和呼吸困难分级。结果吸入沙丁胺醇后，COPD患者的深吸气量和第一秒用力呼气容积（FEV1）分别为（1．6±0．5）和（1．3±0．4）L，均显著高于吸入前的（1．4±0．5）和（1．1±0．4）L，深吸气量平均改善率为（20±16）％，FEV。平均改善率为（11±4）％，差异有统计学意义（t=-3．970，P〈0．01）；其中深吸气量改善率≥10％的占75．4％（46／61），FEV1改善率≥10％的占39．3％（24／61），差异有统计学意义（x^2=16．190，P〈0．01）。治疗后Borg指数（3．0±0．7）显著低于治疗前（3．9±0．8）。6MWT后，COPD患者深吸气量为（1．1±0．4）L，FEV1为（1．0±0．4）L，均显著低于6MWT前的（1．4±0．5）和（1．1±0．4）L，深吸气量平均恶化率为（26±8）％，FEV1平均恶化率为（14±6）％，差异有统计学意义（t=-7．279，P〈0．01），其中深吸气量恶化率≥10％的占100％（36／36），FEV1恶化率≥10％的占72．2％（26／36），差异有统计学意义（x^2=11．613，P〈0．01）。运动后Borg指数（5．6±1．0）显著高于运动前（3．9±0．9）。治疗前后深吸气量差值与治疗前后Borg指数差值、运动前后深吸气量差值与运动前后Borg指数差值均呈显著正相关。静息状态未吸入沙丁胺醇时深吸气量与功能残气量、治疗前后深吸气量差值与治疗前后功能残气量差值、运动前后深吸气量差值与运动前后功能残气量差值均呈显著负相关。结论与FEV1比较，深吸气量检出稳定期COPD患者气流阻塞变化的敏感性比较高，能较准确地反映患者呼吸困难的严重程度。     

中重度慢性阻塞性肺疾病患者无氧阈和高强度肺康复运动方案的比较

目的 比较无氧阈和高强度肺康复运动方案在中重度COPD患者中的效果.方法 2006年3月至12月在广州呼吸疾病研究所门诊就诊的中重度COPD患者54例入组,13例脱落.随机分为无氧阈组(15例)、高强度组(17例),另设对照组(9例).无氧阈组以无氧阈为运动强度,高强度组以最大可耐受的运动强度,进行12周(每周2次)的康复计划.康复前后分别测静态肺功能、心肺运动试验,记录心肺运动试验中每分钟呼吸困难(Borg)指数.采用SPSS 12.0软件进行统计学处理,受试者一般情况以x±s表示,均数两两比较采用独立样本t检验,试验前后总体均数比较采用配对t检验,两组以上均数比较采用单因素方差分析,率的比较采用Fisher精确概率法,非参数指标(如Borg指数)采用非参数Wilcoxon或Mann-Whitney u检验.结果 无氧阈组和高强度组康复后的峰值摄氧量占预计值%分别为(69±14)%和(79±13)%,明显高于康复前的(61±11)%和(72±12)%;康复后无氧阈组的峰值摄氧量占预计值%提高(14±17)%,高强度组提高(12±13)%,两组的改善程度无明显差别.高强度组康复后的无氧阈占预计值%为(42±9)%,明显高于康复前的(38±8)%.在56 W运动强度时,高强度组康复后的分钟通气量为(33±5)L/min,比康复前的(36±4)L/min明显下降(t=6.167,P<0.01);康复后的呼吸频率为(31±3)次/min,比康复前的(32±1)次/min明显下降(t=2.876,P<0.05);康复后的潮气量为(1.3±0.3)L,比康复前的(1.2±0.3)L明显升高(t=2.587,P<0.05).无氧阈组和高强度组康复后的心率分别为(109±39)次/min和(110±25)次/min,比康复前的(116±39)次/min和(114±42)次/min明显下降;康复后的氧脉分别为(10.4±4.0)ml/次和(9.0±3.2)ml/次,比康复前的(9.6±3.7)ml/次和(8.5±4.3)ml/次明显升高.无氧阈组和高强度组康复后的单位摄氧量下Borg指数分别由8.6±3.2和6.5±2.6下降到7.4±2.5和5.6±2.4,均得到明显改善,但改善程度无明显差别.结论 无氧阈和高强度的肺康复方案均可改善运动能力和呼吸困难症状,且改善程度相似,但高强度方案可额外改善无氧阈和通气形式.     

有氧运动联合抗阻运动对急性心肌梗死患者微循环及梗死面积的影响

目的：探讨急性心肌梗死（AMI）患者应用有氧运动联合抗阻运动对心肌微循环及梗死面积的影响,为临床上治疗AMI提供更广泛的治疗手段。方法选择2013年1月至2014年12月首发入住哈尔滨市第一医院的AMI患者86例,随机分为治疗组（n＝43）及对照组（n＝43）。两组患者均给予药物治疗,治疗组在药物治疗的基础上进行为期12周的有氧运动?抗阻运动治疗。于治疗前和治疗12周后对两组患者的峰值氧耗量（VO2max）、相对最大摄氧量（VO2max/kg）、峰值氧脉搏（VO2max/HR）、最大心率（HRmax）、最大通气量（VEmax）、心肌声学造影（MCE）结果进行评价和比较。结果治疗前,两组间VO2max、VO2max/kg、VO2max/HR、HRmax、VEmax各项指标比较,差异均无统计学意义（P＞0.05）。治疗12周后,两组的VO2max、VO2max/kg、VO2max/HR、HRmax、VEmax比较,差异均有统计学意义（P＜0.05）。治疗前,心肌声学造影显示两组间的A（平台期强度）、κ（再充盈平均速度）、及A·κ值无明显差异（P＞0.05）。12周后,治疗组的3项指标较对照组明显增加（P＜0.05）。结论在急性心肌梗死患者的心脏康复方案中采用有氧运动与抗阻训练相结合的训练方法,可以使患者心肌微循环及梗死面积得到不同程度的改善,该方法为临床上治疗AMI提供一种新的思路及更广泛的治疗手段。     

不同运动频次高强度下肢踏车锻炼对中重度COPD病人肺康复的疗效观察

目的探讨不同运动频次的高强度下肢踏车锻炼对中重度COPD病人肺康复的疗效。方法选择2017年1月至2018年12月入院治疗的中重度COPD病人30例,随机分成对照组、低频组、高频组,每组10例,低、高频组分别接受8周低频率或高频率的高强度下肢踏车锻炼,对比3组治疗前后6 min步行距离、增量负荷运动试验、Borg评分、心率、血压、SpO2、BMI等指标变化情况。结果 (1)低频组和高频组6 min步行距离和代谢当量变化值均大于对照组,差异有统计学意义;(2)高频组SBP变化值小于低频组,差异有统计学意义;(3)高频组FEV1/FVC变化值大于对照组,差异有统计学意义;(4)低频组FEV1变化值大于对照组,高频组大于对照组和低频组,差异均有统计学意义(P0. 05)。结论无论高频或低频的下肢运动锻炼,均可改善COPD病人的运动耐力、运动强度和呼吸肌力。高频锻炼比低频锻炼对于稳定血压、改善气道阻塞更有效。     

Maximum intensity exercise training in patients with chronic obstructive pulmonary disease

We studied high intensity, symptom-limited, endurance exercise training in 52 patients with COPD participating in a pulmonary rehabilitation program. The patients had moderate to severe airway obstruction and reduced exercise tolerance with ventilatory limitation. The target workload for endurance exercise testing was 95 percent of the baseline maximum treadmill work load. At training weeks 1, 4 and 8, they were training at 85, 84, and 86 percent respectively, of baseline maximum. After rehabilitation, there was an increase in maximal treadmill work load, VO2max, and endurance exercise time, and a decrease in perceived symptoms. Patients who did not reach anaerobic threshold (group 2) were able to train at a higher percentage of maximum exercise tolerance than patients who reached anaerobic threshold (group 1). The increase in exercise performance of both groups, however, was similar. We conclude that patients with moderate to severe COPD can perform exercise training successfully at intensity targets which represent higher percentages of maximum than typically recommended in normal individuals or other patients.     

Variability of the perceived sense of effort in breathing during exercise in patients with chronic obstructive pulmonary disease

The present study examined the reproducibility with which subjects with stable chronic obstructive pulmonary disease (COPD) scale the sense of effort involved in breathing during exercise. The sense of effort was assessed in 6 subjects with COPD during bicycle exercise continued to a symptom-limited maximal work load using a conventional category scale. Reproducibility of the sensory experience was assessed by comparing results obtained from 3 incremental work tests, 2 on the same day and a subsequent test performed within 1 to 10 days. During all trials in all subjects, sensory scores correlated closely with both minute ventilation and oxygen consumption (r greater than or equal to 0.92 for both VE and VO2). The average coefficients of variation for the maximal Borg Score and Borg Score at 2 min of exercise for the group as a whole were 3 +/- 1 and 3 +/- 2% (SE), respectively. Variability in sensory scores was not significantly different on exercise trials performed either within or between days. Furthermore, variability of sensory scores, oxygen consumption, heart rate, or minute ventilation were similar. We conclude that when using a category scale in subjects with COPD, the perceived sense of effort in breathing during exercise is highly reproducible, correlates closely with physiologic measures defining the intensity of exercise, and is no more variable than physiologic parameters typically measured during an exercise test.     

Exercise outcomes after pulmonary rehabilitation depend on the initial mechanism of exercise limitation among non-oxygen-dependent COPD patients

STUDY OBJECTIVES: Pulmonary rehabilitation (PR) that includes exercise training can improve exercise tolerance and quality of life for patients with COPD. However, the degree of benefit from PR is variable. We hypothesized that the exercise response to PR varies depending on the initial factors that limit exercise. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We retrospectively analyzed the change in exercise capacity after PR in 290 nonhypoxemic patients with COPD. We classified patients into the following subgroups based on the primary limitation seen on initial exercise testing: (1) ventilatory-limited (VL); (2) cardiovascular-limited (CVL); (3) mixed ventilatory/cardiovascular-limited (VLCVL); and (4) non-cardiopulmonary-limited (NL). We compared outcomes among subgroups. RESULTS: In the entire study population, PR led to increased timed walk distance (30.3%; p < 0.0001) and maximal oxygen consumption (VO2max) [84.8 mL/min; p < 0.0001]. Stepwise multiple regression selected age, ventilatory reserve at peak exercise, and exercise arterial oxygen pressure as individual predictors of improvement in VO2max. VO2max increased in the VL subgroup (30.4 mL/min; p = 0.008), the CVL subgroup (109.0 mL/min; p < 0.0001), the mixed VLCVL subgroup (61.3 mL/min; p < 0.0001), and NL subgroups (110.5 L/min; p < 0.0001). The improvement in VO2max was greater in the CVL subgroup than in the VL subgroup (p < 0.0001). Timed walk distance improved to a similar degree in all subgroups (26 to 36%). CONCLUSIONS: Patients with nonventilatory exercise limitations experience the greatest increase in VO2max after PR. However, even patients with severe ventilatory limitation can improve exercise tolerance with PR.     

Effect of nutritional status on exercise performance in patients with chronic obstructive pulmonary disease

The purpose of our study was to examine the nutritional status of patients with severe chronic obstructive pulmonary disease (COPD) (mean predicted FEV1, 30 +/- 11%) and to explore its relationship to functional capacity. Functional capacity was evaluated by measuring peak oxygen consumption (VO2max) using an incremental cycle ergometry test, a 6-min walk test, self-perceived level of dyspnea, and quality of life. The percentage ideal body weight (%IBW) was less than 90% in 33 of 135 subjects. Triceps skinfold thickness was less than 60% of normal in 19 of 33 of these subjects. Total lymphocyte count was not different between groups, whereas hemoglobin (14.9 versus 15.9 g/dl) and albumin (4.0 versus 4.1 g/dl) were marginally reduced in underweight subjects. Dyspnea and overall quality of life were unaffected by nutritional status. Maximal inspiratory (Pimax) and expiratory mouth pressures (PEmax) were weakly associated with %IBW (R2 = 0.04; p = 01 and R2 = 0.15; p less than 0.01, respectively). The %IBW was a predictor of VO2max (percent predicted) after controlling for FEV1 in regression analysis (partial R2 = 0.08; p less than 0.001). Despite the association of weight status with VO2max, the 6-min walk was not influenced by %IBW. The perceived intensity of exercise as judged by the Borg score was far greater with the bicycle exercise that with the 6-min walk (mean score, 10.6 +/- 1.2 versus 4.6 +/- 1.9). This was supported by the difference in heart rate after these two tests.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of high-intensity exercise training in a pulmonary rehabilitation programme for patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES: The benefits of pulmonary rehabilitation for patients with COPD depend on the intensity of training. Traditional pulmonary rehabilitation programmes (PRPs) do not consistently achieve high-intensity training and have variable training effects. This study examined the effects of high-intensity exercise training on cardiac and pulmonary function in COPD patients. METHODS: Patients with COPD participated in a 6-week, cardiopulmonary exercise test-based PRP. Spirometry, 6-min walking distance and cardiopulmonary exercise test were used to evaluate cardiopulmonary function, respiratory muscle strength and endurance at rest, during exercise and before and after the programme. Patients were encouraged to complete high-intensity exercise with a targeted training intensity of at least 75% maximum oxygen uptake (VO(2)). RESULTS: Thirty-four COPD patients were enrolled into the study; 16 completed the high-intensity training, 18 did not. At the end of the 12-session PRP, submaximal exercise capacity (6-min walking distance, 461.8 +/- 77.2-502.7 +/- 66.9 m, P < 0.001) improved in both the patients who completed high-intensity training and those who did not. Only the patients who completed high-intensity training had significant improvements in FVC (2.47 +/- 0.70-2.70 +/- 0.62 L, P = 0.024) at rest, maximal exercise capacity (peak VO(2), 1001.6 +/- 286.4-1116.1 +/- 320.4 mL/min, P = 0.020) and work efficiency (7.3 +/- 1.4-8.4 +/- 1.8 mL/min/watt, P = 0.026). There was no statistically significant difference between the two groups in the change in the physiological parameters before and after exercise. CONCLUSIONS: Exercise training in a PRP improved submaximal exercise capacity. Only patients who completed high-intensity exercise training showed improvements in maximal exercise capacity, FVC and work efficiency.     

Psychological outcomes of an outpatient pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease

STUDY/PRINCIPLES: The effects of an outpatient pulmonary rehabilitation program on psychological morbidity (anxiety and depressive symptoms) were examined in patients with chronic obstructive pulmonary disease (COPD). METHODS: The 26 rehabilitation patients with COPD were compared with 19 control patients with COPD similar in age, gender, COPD severity and other variables. Initial assessment included lung function testing, health status, exercise tolerance, dyspnea intensity and psychiatric interviews using Hamilton depression rating scale (HAM-D) and Hamilton anxiety rating scale (HAM-A). A pulmonary rehabilitation program was carried out during the following 2 months; psychiatric interviews and measurements of health status, exercise tolerance and dyspnea intensity were done again on completion of the study at 2 months. RESULTS: There was a decrease in HAM-A scores in the rehabilitation group and the decrease was statistically significant (P=0.010). On the contrary the HAM-A scores did not change in control group. The decrease in HAM-A scores in rehabilitation group was also statistically significant compared with the control group (P=0.042). There was no significant difference in HAM-D scores within the two groups and also there was no significant difference between the two groups in HAM-D scores. The health status, exercise tolerance and dyspnea intensity improved significantly in the rehabilitation group compared to the control group. CONCLUSION: This study shows that our outpatient rehabilitation program leads to a benefit in anxiety and depressive symptoms in COPD patients. The benefit was especially significant in anxiety symptoms. In addition to the improvement in psychological symptoms, the health status, exercise tolerance and dyspnea intensity were also significantly improved in COPD patients who underwent the rehabilitation program. This outpatient-based rehabilitation program was well accepted by the patients. The relatively simple design of the program makes it feasible independently of expensive equipment.     

The effects of pulmonary rehabilitation with chronic obstructive pulmonary disease (COPD)]

It is controversial whether pulmonary rehabilitation is effective in patients with chronic obstructive pulmonary disease (COPD). To test the effect of pulmonary rehabilitation, 7 patients with COPD (aged 76.0 +/- 2.6 years) were enrolled in pulmonary rehabilitation program for 6 weeks. The program consisted of relaxation, pursed lip breathing, diaphragmatic breathing, panic control, muscle stretch gymnastics, and exercise training. The distance of the 6-minute walking test increased significantly from 246.4 +/- 38.0 (m) to 304.3 +/- 28.4 (m) (p < 0.05). The minimum SpO2 during the 6-minute walking test increased from 86.0 +/- 2.8 (%) to 90.1 +/- 1.3 (%) and dyspnea as measured with Borg scale decreased from 5.6 +/- 1.1 to 4.6 +/- 0.5, although they were not significantly different. These results suggest that pulmonary rehabilitation might improve exercise tolerance in elderly patients with COPD.     

慢性阻塞性肺疾病患者运动能力与其呼吸驱动及呼吸肌功能关系的研究

目的探究慢性阻塞性肺疾病（COPD）患者运动能力与呼吸驱动及呼吸肌功能之间的关系。方法对28例COPD患者和26名正常对照者分别检测静息常规肺功能、肺弥散功能（DLCO）、口腔阻断压（P0.1）、最大吸气压（PImax）及最大呼气压（PEmax）,并进行运动负荷试验观测氧耗量（VO2）、二氧化碳产生量（VCO2）、分钟通气量（E）、潮气量（T）等气体代谢指标,同时记录受试者运动中的呼吸困难指数（BorgScale）。运动负荷前、后检测动脉血气分析。结果（1）COPD组患者PImax（40±15）mmHg明显低于正常人组（53±19）mmHg（P<0.05）,PEmax在两组中差异无显著性（P>0.05）,COPD组患者P0.1（2.8±0.9）mmHg明显高于正常人组（2.0±0.7）mmHg（P<0.05）,P0.1/PImax（0.069±0.021）也明显高于正常人组（0.037±0.009）（P<0.01）。（2）COPD组患者VO2max与P0.1及PImax未发现明显的相关关系（P>0.05）,但与P0.1/PImax明显正相关（r=0.66,P<0.01）,BorgScale与P0.1/PImax明显正相关（r=0.49,P<0.05）。结论COPD患者运动能力下降除与气道阻塞程度及气体交换障碍等有关外,呼吸驱动相对增高及呼吸肌功能障碍也是其运动能力的限制因素。     

Managing chronic obstructive pulmonary disease in the community. A randomized controlled trial of home-based pulmonary rehabilitation for elderly housebound patients

PURPOSE: Pulmonary rehabilitation is essential for managing chronic obstructive pulmonary disease (COPD). Housebound COPD patients are frequently excluded from this treatment because they are unable to access outpatient pulmonary rehabilitation programs because of the severity of their disease. This randomized controlled trial assesses the effects of a 12-week home-based pulmonary rehabilitation program for 60 housebound COPD patients older than 60 years. METHODS: Intervention patients received an individually tailored supervised walking and arm exercise program as well as individual multidisciplinary education sessions on COPD and its management. Outcomes were assessed using the 6-minute walk test, St George's respiratory questionnaire, and Borg score of perceived breathlessness. Healthcare utilization was assessed using hospital admission rates with exacerbation of COPD and average length of stay at readmission. RESULTS: Complete data for 23 patients in each group were available for analysis. There was no significant difference between groups on baseline measures. Compared with the control group, intervention patients demonstrated a significant improvement in 6-minute walk test (P = .023), Borg score of perceived breathlessness (P = .024), St George's respiratory questionnaire total score (P = .020), and impact subscore (P = .024). At 6 months, the intervention group had a significantly shorter average length of stay at readmission to hospital with exacerbation (P = .035). CONCLUSION: A 12-week home-based pulmonary rehabilitation is effective in improving exercise tolerance, perception of breathlessness, and quality of life for housebound COPD patients. To manage COPD in the community more effectively, health services should focus on expanding home-based pulmonary rehabilitation.