综合治疗对稳定期重度COPD生活质量的影响

目的评价综合治疗对稳定期重度COPD患者的生活质量的影响。方法选择30例稳定期重度COPD患者,予以综合治疗,包括药物治疗,膳食营养指导,心理康复治疗,体能训练指导,健康宣教等方法,临床观察1年,采用前瞻性及回顾性研究方法,记录治疗前及观察期间患者急性加重次数的变化,以及治疗前后患者肺功能的变化。结果综合治疗能减少患者急性加重次数,改善肺功能。结论综合治疗有利于COPD患者改善肺功能,提高生活质量。     

肺康复运动治疗对老年COPD稳定期患者肺功能、生活质量及运动耐力的影响

目的 探讨肺康复运动治疗对老年慢性阻塞性肺疾病(COPD)稳定期患者肺功能、生活质量及运动耐力的影响。方法 选择老年COPD稳定期患者94例,依据随机表法分为观察组与对照组各47例。对照组采用常规有氧运动,观察组在对照组基础上结合肺康复运动治疗。两组干预时间3个月。比较两组干预前与干预3个月肺功能[用力肺活量(FVC)、每分钟最大通气量(MV)、1 s用力呼气容积(FEV1)/FVC]、BODE指数(B:体重指数、O:气道阻塞程度、D:呼吸困难分级、E:运动耐量)、运动耐力[6 min步行距离(6MWD)]、血气分析[氧分压(PaO₂)、二氧化碳分压(PaCO₂)]和生活质量[COPD临床问卷(CCQ)评分]变化。结果 两组干预3个月FVC、MVV和FEV1/FVC显著高于干预前(P<0.05);且观察组显著高于对照组(P<0.05)。两组干预3个月BODE指数显著低于干预前(P<0.05);且观察组显著低于对照组(P<0.05)。两组干预3个月6MWD显著高于干预前(P<0.05);且观察组显著高于对照组(P&...     

综合性肺康复治疗对稳定期COPD患者肺功能及血气指标的影响

将同期收治的60例慢性阻塞性肺疾病（COPD）稳定期患者随机分为观察组和对照组各30例,两组均予COPD基础治疗,观察组在此基础上给予呼吸功能锻炼、呼吸体操、有氧训练、氧疗、营养支持、心理与行为干预和教育等综合性肺康复治疗,观察两组肺功能及血气指标变化。结果观察组治疗前、后肺功能及血气指标均明显改善,效果优于对照组（P〈0．05）。认为综合性肺康复治疗有利于提高稳定期COPD患者的生存质量。     

体重指数与慢性阻塞性肺疾病及生活质量的关系

目的在2002至2004年中国7个地区（北京、上海、广东、辽宁、天津、重庆和陕西）慢性阻塞性肺疾病（COPD）现况调查的基础上，探讨体重指数（BMI）与COPD的关系。方法现况调查采用多阶段分层整群随机抽样方法，对40岁及以上的居民进行问卷调查、身高和体重的测量及肺功能检测。调查有效人数为20245名，男8705名，女11540名，以支气管扩张试验后第一秒用力呼气容积／用力肺活量（FEV1／FVC）〈70％作为COPD的诊断标准，并排除其他已知的气流受限的疾病，共筛查出1668例COPD和18577例非COPD进行BMI与COPD的关系分析。结果COPD患者的BMI[（22．7±3．5）kg／m^2]较非COPD患者[（24．1±3．4）kg／m^2]低，吸烟者BMI为[（23．6±3．4）kg／m^2]较不吸烟者[（24．2±3．5）ks／m^2]低，差异均有统计学意义（F分别为158．31、49．10，P均〈0．01），且COPD与吸烟存在对BMI的交互作用（F=6．03，P〈0．05）。COPD病情程度分级越高BMI越低（F=45．46，P〈0．01），COPD病情程度分级与BMl分级存在负相关（r=-0．08，P〈0．01）。BMI越低COPD的患病率越高（趋势x^2=102．68，P〈0．01），多因素logistic回归分析显示，与正常BMI（18．5～23．9kg／m^2）比较，1级BMI（〈18．5kg／m^2）、3级BMI（24．0～27．9kg／m^2）和4级BMI（≥28．0ks／m^2）患COPD的D尺值分别为[2．12（1．73～2．59）、0．67（0．59～0．76）、0．60（0．49～0．73），P均〈0．05]；且BMl分级与吸烟存在对COPD的交互作用（x^2=4．73，P〈O．05）。与2级BMI的COPD患者比较，1级BMI的COPD患者生活质量差（心理指数评分：55±8、57±6，F=2．96，P〈0．05；躯体指数评分：42±10、46±9，F=4．21，P〈0．01）；气促分数高（1．4±1．5、1．1±1．3，x^2=14．32，P〈0．01）。结论1级BMI与COPD关系密切，其可能是COPD患病的独立于吸烟的危险因素，而低BMI也可能是COPD病情严重程度的一个重要指标。     

COPD患者血清hs-CRP、TNF-α和IL-6的检测及其与肺功能和生活质量的相关性研究

目的探讨COPD患者血清hs-CRP、TNF-α和IL-6的检测及其与肺功能和生活质量的相关性。方法选择120例COPD患者为观察组研究对象,选取同期体检的80例健康者为对照组。采用国内COPD生活质量评分表评估生活质量,比较两组血清hs-CRP、TNF-α和IL-6的差别,并对三者与COPD患者肺功能及生活质量的相关性进行探讨。结果观察组血清hs-CRP、TNF-α和IL-6水平显著高于对照组（P〈0.05）;在COPDⅡ级、Ⅲ级和Ⅳ级患者中,血清hs-CRP、TNF-α和IL-6水平逐渐升高（P〈0.05）,肺功能FEV1%、FEV1/FVC%逐渐降低（P〈0.05）,COPD生活质量评分逐渐减少（P〈0.05）;血清hs-CRP、TNF-α和IL-6水平与患者肺功能、生活质量呈负相关（P〈0.05）。结论 COPD患者血清hs-CRP、TNF-α和IL-6水平异常升高,且与肺功能及生活质量显著相关。     

呼吸肌康复训练改善COPD的肺功能和生活质量

目的观察呼吸肌康复训练对慢性阻塞性肺疾病(COPD)患者的肺功能和生活质量的影响。方法将92例老年COPD患者采用数字表法随机分成2组,康复组51例,对照组41例,康复组患者进行呼吸肌康复训练,并定期随访督导,对照组给予COPD常规的治疗方法。两组患者观察治疗前后用力肺活量(FVC)和第一秒用力肺活量(FEV1)占预计值的百分比,检测卧位时动脉血氧分压(PO2)和二氧化碳分压(PCO2)的变化。结果经呼吸肌康复训练组患者的肺功能及血气分析结果较对照组明显改善,差异有显著性意义(P<0.01)。结论老年COPD患者进行长期、有效、个体化的呼吸康复训练可改善病人的肺功能,可提高患者的生活质量。     

布地奈德／福莫特罗联合治疗对中重度的COPD患者细胞因子、肺功能及生活质量的影响

目的观察应用布地奈德／福莫特罗粉吸人剂对cOPD患者的白介素-17（interleukin17,IL-17）、肿瘤坏死因子受体75（tumornecrosisfactorreceptor75,TNF-R75）、基质金属蛋白酶（matrixmetalloproteinase-9,MMP-9）和肺功能及生活质量的影响。方法2011年6月至2012年6月入住我科,符合中华医学会呼吸病学分会COPD诊断标准且肺功能分级为中重度的患者40例,在导人治疗第7天后用布地奈德／福莫特罗粉吸入剂160／4．5μg,每次2吸,每日2次。于用药前及用药第7、60、90天采用圣乔治评分、6分钟步行试验,酶联免疫吸附法测定外周血细胞因子：TNF1R75、IL-17、MMP-9。结果COPD患者使用布地奈德／福莫特罗粉吸入剂第60天时,FEV1％pred明显升高,圣乔治呼吸问卷评分、6分钟步行试验距离明显改善,与治疗前比较差异有统计学意义（P〈0．05）。治疗第90天时FEV,％pred继续改善（与治疗前比P〈0．01）,FEV1／FVC仅在治疗第90天时与治疗前比较有明显改善。COPD患者使用布地奈德／福莫特罗粉吸入剂后第7、60、90天患者MMP-9与治疗前相比差异无统计学意义（P〉0．05）。治疗后第90天TNF-R75、IL-17与治疗前比较差异有统计学意义（P值均〈0．05）。结论COPD患者长期规律使用布地奈德联合福莫特罗治疗可以改善患者生活质量评分及肺功能。     

健康教育在COPD稳定期治疗中的作用

目的研究健康教育对慢性阻塞性肺疾病(COPD)稳定期患者治疗效果的影响及作用。方法选择25例COPD稳定期患者,测定其肺功能(FEV1%pred)、6分钟步行试验(6MWT)、慢性阻塞性肺病评估测试(CAT),进行健康教育,要求患者每月定期随访,6个月后重复测定上述指标。结果经过系统的健康教育后,25例COPD稳定期患者吸入制剂、康复运动依从性显著提高(P<0.01),肺功能(FEV1%pred)改善不明显(P>0.05),但6MWT、CAT评分显著改善(P<0.05,P<0.01)。6MWT、CAT评分与肺功能指标具有高度相关性(P<0.01)。结论对COPD稳定期患者进行健康教育管理,可以提高患者对疾病的认识,增加治疗信心,提高长期治疗的依从性,从而有望达到改善肺功能、减少急性发作次数,降低病死率。     

舒利迭粉剂对COPD稳定期患者生存质量及肺功能的影响

目的观察长期吸入舒利迭对COPD(慢性阻塞性肺疾病)稳定期生存质量及肺功能的影响。方法对80例确诊为COPD稳定期患者随机分为两组,对照组为常规治疗,治疗组给予常规治疗加用长期吸入舒利迭,对两组的生存质量及肺功能进行观察对比,评价舒利迭对COPD稳定期患者的影响。结果舒利迭明显提高生存质量及肺功能,较对照组有明显的差异性。结论长期吸入舒利迭能缓解患者生存质量及肺功能。     

呼吸功能训练对稳定期COPD患者肺功能的影响

目的探讨呼吸功能训练对稳定期慢性阻塞性肺疾病（COPD）患者肺功能的影响及对生活质量的改善效果。方法将36例稳定期COPD患者随机分为2组,实验组在常规治疗同时进行呼吸功能训练（共6周）。观察训练前后肺功能相关指标变化,同时进行呼吸困难（MRC）评分和日常生活活动能力（ADL）评分。结果实验组肺功能及生活质量各指标明显好于对照组（P〈0.05）。结论呼吸功能训练能改善稳定期COPD患者的肺功能,提高患者的生活质量。     

-＋营养支持治疗对AECOPD患者血气及肺功能的影响

目的评价慢性阻塞性肺疾病（COPD）急性加重期进行营养支持治疗后,患者血气分析和肺功能指标的变化。方法选择COPD急性加重期患者共55例,随机分为营养组（28例）与对照组（27例）,两组均接受相同的抗感染和对症治疗,营养组除标准饮食外,每日静滴10%脂肪乳500 mL,复方氨基酸250 mL。结果 2周后营养组与对照组的比较,两组PaO2均升高,PaCO2均降低,但营养组变化较明显（P〈0.01）,两组肺功能指标（FEV1、FEV1/FVC）均升高,但营养组变化较明显（P〈0.05）。结论 COPD急性加重期患者提供合理的营养支持可显著改善其血气和肺功能指标,提高临床疗效。     

Gender differences in pulmonary function,physical activity,and quality of life of patients with COPD based on data from the Korea National Health and Nutrition Examination Survey 2015 to 2019 from the Perspective of Pulmonary Rehabilitation

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide, with the fourth highest mortality rate. This study aims to analyze pulmonary function, physical activity, and quality of life (QoL) between genders from the perspective of pulmonary rehabilitation in Korean patients with COPD. This study investigated raw data from the Korea National Health and Nutrition Examination Survey from 2015 to 2019 and included 151 COPD patients (men: 66.55 ± 10.07 years, women: 65.21 ± 11.73) out of 39,759 participants. Pulmonary function, such as forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), and frequency of physical activities (e.g., physical activity for work and leisure, strengthening exercise, and sitting time a day) and QoL by using EQ-5D-3L, were compared between genders in patients with COPD. Smoking status differed in health-related characteristics between genders (P < .001). In pulmonary function, the FVC (men: 3.48 ± 0.98ℓ, women: 2.53 ± 0.56ℓ, P < .05), FEV1 (men: 2.13 ± 0.93 ℓ, women: 1.88 ± 0.53 ℓ, P < .001), FEV6 (men: 3.16 ± 1.00ℓ, women: 2.46 ± 1.56ℓ, P < .001) and peak expiratory flow (men: 5.61 ± 2.44ℓ/s, women: 4.68 ± 1.53ℓ/s, P < .05) was higher in men, however, predicted FEV1 (men: 66.03% ± 23.13%, women: 79.95% ± 18.45%, P < .05) and predicted FEV1/FVC ratio (men: 59.67% ± 15.02%, women: 74.10% ± 10.49%, P < .001) in women. The frequency of strengthening exercise was higher in men (P < .05). QoL of patients with COPD was not significantly different between genders. To provide correct interventions and pulmonary rehabilitation to patients with COPD, gender differences, including physiological and psychological differences, must be considered.     

Emphysema on imaging is associated with quality of life in elderly patients with chronic obstructive pulmonary disease

Background:   Limited data are available on the association between the severity of emphysema or airway narrowing, and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD), which has been seen to be more prevalent among elderly subjects. The aim of this study was to examine the association between HRQOL, physical parameters and structural alterations in lung of COPD patients.
Methods:   Stable COPD patients ( n  = 125; mean age 71.0) were studied. Both the severity of emphysema, which was expressed as the extent of the low-attenuation area (LAA%), and percentage of the large airway wall area (WA%) on high-resolution computed tomography (HRCT) were compared with various parameters of the generic and HRQOL, respectively, together with pulmonary function tests and exercise capacity.
Results:   The predicted value of forced expiratory volume in 1 s was significantly associated with both LAA% and WA%, but the diffusion capacity was strongly correlated with LAA% alone. Parameters of the generic and HRQOL, and almost all other parameters appeared to be significantly associated with LAA% alone, whereas no association was observed between WA% and QOL.
Conclusion:   We concluded that the severity of emphysema, but not that of large airway narrowing on HRCT, is associated with both generic and health-related QOL and reduced diffusion capacity. This notion might provide useful information in practice among elderly subjects who are unable to perform a spirometry.     

Correlates of mortality in elderly COPD patients: Focus on health-related quality of life

Background and objective:   The Saint George Respiratory Questionnaire (SGRQ) is widely used as a measure of health-related quality of life (HRQL) in patients with COPD. This study tested whether the SGRQ predicts the survival of patients with COPD.
Methods:   The study recruited 238 patients with COPD who were participants in the multicentre Salute Respiratoria nell'Anziano (Sa.R.A.) study. Patients' sociodemographic, clinical and functional characteristics were assessed and the association between the SGRQ and mortality, corrected for potential confounders, was estimated.
Results:   The mean age of study participants was 72.6 years. Over the 5-year observation period there were 88 deaths. After adjustment for potential confounders, the SGRQ score was associated with an increased risk of dying (hazard ratio (HR): 1.22 for four-point increments; 95% confidence interval (CI): 1.02–1.45). There was no association between mortality and the Symptoms subscale (corrected HR: 1.13; 95% CI: 0.96–1.32), whereas each four-point increment of the Activity (HR: 1.20; 95% CI: 1.00–1.43) and Impact (HR: 1.38; 95% CI: 1.03–1.83) subscale scores were associated with increased mortality. Higher FEV₁ relative to predicted (HR: 0.73 for each 5% increment; 95% CI: 0.58–0.91) and better performance at the 6-min walking test relative to predicted (HR: 0.93 for each 5% increment; 95% CI: 0.89–0.97) were associated with lower mortality.
Conclusions:   In elderly COPD patients, the SGRQ can improve prognostic models based on classical indicators of disease severity.     

噻托溴胺粉吸入剂对稳定期COPD患者运动耐量及肺功能的疗效

目的探讨稳定期COPD患者予噻托溴胺粉吸入剂治疗后运动耐量及肺功能的改善作用。方法 60例稳定期COPD患者,随机分成治疗组、对照组以及空白对照组。观察三组治疗不同时期肺功能的变化和St Georges呼吸问卷(SGRQ)情况,进行6 min步行试验观察运动耐力的变化。结果用药6个月后治疗组患者咳嗽、咳痰、气促等症状明显好转,前后比较(P<0.05),用药6个月后治疗组FEV1、FVC、FEV1/FVC及FEV1占预计值(%)、运动耐力较对照组及空白对照组改善,三组比较差异有显著性(P<0.05)。治疗组运动耐力(6MWT)增加,SGRQ评分比较治疗组明显下降(P<0.05)。结论吸入噻托溴胺粉吸入剂对稳定期COPD患者运动耐量及肺功能有改善作用,并可以减少急性发作次数,改善患者生活质量,且副反应少。     

Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD

OBJECTIVE: The purpose of this study was to understand the outcomes for patients admitted to hospital for an acute exacerbation of COPD, and to determine the factors influencing quality of life and health service utilization of patients with COPD. METHODOLOGY: Hospital outcomes of 282 patients with moderate and severe COPD, for an acute exacerbation, were retrospectively evaluated. After 24 months of follow up, health-related quality of life (QoL) and health service utilization (emergency room (ER) visit and readmission) in 54 patients admitted previously, were surveyed by questionnaires. RESULTS: Of 282 COPD patients admitted for an acute exacerbation, 28 patients (9.9%) died during hospitalization, 241 patients (85.5%) were discharged home, and only 13 patients (4.6%) needed long-term care facilities. Although over 50% of the patients had survived over 2 years after discharge, their QoL was poor. Patients who frequently went to the ER or were admitted, were those with poor QoL, severe dyspnoea and frequent exacerbation. COPD exacerbation and dyspnoea were the main factors influencing QoL of the patients. Age, comorbidity, QoL, FEV1, frequency of COPD exacerbation, long-term oxygen therapy, and family doctor were the factors determining the likelihood of patients visiting the ER. Frequency of COPD exacerbation, family doctor and living alone were the factors determining which patients were likely to be admitted to hospital. CONCLUSION: The outcomes and QoL of patients admitted for an acute exacerbation of COPD were poor. The major factors influencing QoL were frequency of COPD exacerbation and severity of dyspnoea. Improvement of social and medical networks (e.g. reducing the number of patients living alone and providing family doctors for patients) may reduce health care service utilization.     

营养支持治疗对COPD合并呼吸衰竭的影响

目的研究COPD合并呼吸衰竭（呼衰）时,进行营养支持治疗对患者营养状况的影响。方法选择COPD急性期合并呼衰患者共55例,随机分为营养组（28例）与对照组（27例）,两组均接受相同的抗感染和对症治疗,营养组加用了管饲喂养肠内营养液-瑞高。结果2周后营养组氮平衡、血清白蛋白、总蛋白、血红蛋白等均明显优于对照组（P〈0.05）,营养组治疗前后各项指标差异也有显著性（P〈0.05）。结论合理的营养支持可显著改善COPD合并呼衰患者的营养状况,促进其康复。