运动训练在慢性阻塞性肺疾病肺康复中的应用

肺康复在慢性阻塞性肺疾病治疗中发挥重要作用,运动训练作为肺康复计划的基本组成部分,可提高患者运动能力和改善日常生活能力。本文将对肺康复中运动训练的病理生理学、方式及处方进行综述,为临床COPD患者的运动训练治疗提供新思路。     

间质性肺疾病患者肺康复护理的研究进展

肺康复对改善间质性肺疾病患者的活动耐力、自我管理能力有重要意义。对间质性肺疾病患者肺康复护理中运动训练、康复教育的研究现状进行综述,分析目前肺康复护理在间质性肺疾病患者中存在的问题并提出建议,旨为临床医护人员开展间质性肺疾病患者的肺康复提供指导。     

慢性阻塞性肺疾病患者肺康复下肢运动处方的制订

慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）是目前最常见的高患病率、高死亡率、高致残率的主要疾病之一，占据了相当大的社会医疗资源。其自然病程较难逆转，大部分中重度患者劳动和生活活动能力受限，出现心理障碍及社会适应力降低。长期以来，COPD的治疗以急性发作期药物治疗为主。近年来，在北美和欧洲部分地区．肺康复计划广泛应用于COPD患者。肺康复治疗在慢性肺疾病治疗中的效果和科学性已经被证实，它可改善患者的呼吸困难，提高运动耐力及生存质量、改善患者心理障碍及社会适应能力。     

慢性阻塞性肺疾病患者参与肺康复体验的Meta整合

目的 ：系统整合慢性阻塞性肺疾病患者参与肺康复的体验,为改善其肺康复参与度及治疗依从性提供循证依据。方法 ：计算机检索中文和英文数据库中关于慢性阻塞性肺疾病患者肺康复体验相关的质性研究,检索时间为建库至2022年6月30日。由研究者根据纳入和排除标准独立筛选文献、提取资料后,采用JBI循证卫生保健中心质性研究质量评价标准进行文献质量评价,运用汇集性整合的方法对结果进行整合。结果 ：共纳入13篇文献,提炼出47个完整的研究结果,归纳成6个新的类别,最终整合为肺康复给患者带来的积极作用和患者参与肺康复的影响因素2个主题。结论：医护人员应重视慢性阻塞性肺疾病患者参与肺康复的影响因素,结合患者的期望,优化肺康复方案,提升患者治疗参与度及依从性。     

慢性阻塞性肺疾病稳定期的中西医肺康复研究进展

综述了慢性阻塞性肺疾病稳定期患者实施中西医肺康复疗法的研究进展,包括运动治疗、穴位敷贴、饮食药膳康复等,阐明中西医康复护理能明显地减轻患者临床症状,延缓肺功能下降,改善患者的生活质量。     

无创正压通气在稳定期重度慢性阻塞性肺疾病患者肺康复中的应用进展

长期无创正压通气应用于稳定期重度慢性阻塞性肺疾病患者,可有效提高肺康复效果,持续改善患者的呼吸困难症状和运动耐力,稳定患者的肺功能,提高患者的生活质量,还可能改善患者的预后。本文对无创正压通气在稳定期重度慢性阻塞性肺疾病肺康复治疗中的应用进行综述。     

肺康复治疗在慢性阻塞性肺疾病中的临床对照研究

目的采用对照研究的方法观察总结肺康复治疗在慢性阻塞性肺疾病(COPD)中的临床疗效。方法将58例COPD患者随机分为治疗组和对照组各29例,两组患者均给予COPD常规治疗,如祛痰、平喘等药物治疗,治疗组在此基础上配合肺康复治疗。主要包括有氧运动、胸部物理治疗、氧气治疗等。规律治疗6个月,进行相关指标检测。结果两组患者在治疗前及治疗后的肺功能检测第1秒用力呼气率(FEV1/FVC)、第1秒用力呼气量(FEV1%)、动脉血气分析、6 min步行实验进行对比,统计资料显示治疗组、对照组指标均有改善,且治疗组改善幅度明显高于对照组,差异均具有显著性(P<0.05)。结论肺康复治疗在COPD治疗中起到了改善患者肺功能、提高生活质量及运动耐力的作用。     

超短波配合肺康复治疗慢性阻塞性肺疾病的疗效观察及护理

目的观察超短波配合肺康复治疗慢性阻塞性肺疾病(COPD)的效果及总结护理要点。方法将70例患者随机分为超短波配合肺康复36例(治疗组)和单纯肺康复34例(对照组),观察两组治疗总有效率,6 m in行走距离、FEV1(1 s用力呼气量)/FVC(用力肺活量)的改善程度。结果总治疗有效率、6 m in行走距离、FEV1/FVC治疗组和对照组比较,差异有统计学意义(均P<0.05)。结论超短波配合肺康复可提高COPD治疗疗效,改善患者的临床症状、6 m in行走距离及FEV1/FVC,提高患者肺功能。     

以肺康复指南为指导的肺移植术后康复研究现状

肺移植是临床治疗终末期肺部疾病唯一有效手段,患者术后康复是关系到手术治疗效果的关键[1],研究[1-2]证明术后早期多学科综合干预肺康复锻炼有助于提高患者活动耐力,改善患者肺功能状态,有效降低肺移植术后并发症对患者造     

胸肺物理治疗的研究进展

肺康复治疗在慢性肺疾病治疗中的效果和科学性已被证实,它可改善患者的呼吸困难,提高运动耐力及生存质量,改善患者心理障碍及社会适应能力[1]。全面的肺康复治疗包括:运动训练、呼吸肌训练、健康教育、心理行为干预及其效果评价,其中运动训练是肺康复的核心,而更多的为胸肺物理治疗[2]。     

Ventilation-perfusion pulmonary scintigraphy for diagnosis of pulmonary thromboembolism

Ventilation-perfusion pulmonary scintigraphy with analysis ofventilation-perfusion ratio, apex-base ventilation and perfusion gradient, pulmonary perfusion, and the condition of alveolar permeability at the 10th and 30th min after inhalation of radiopharmaceutical was carried out in 16 patients with clinical and scintigraphic signs of thromboembolism of distal pulmonary artery branches and 10 controls. Thromboembolism of distal pulmonary artery branches was manifested by an increase in apex-base ventilation and perfusion gradient in both involved and intact lungs vs. the same parameters in healthy people. Patients with bilateral thromboembolism of distal pulmonary artery branches were characterized by an increase in ventilation-perfusion ratio and retardation of alveolar permeability.     

光谱CT肺动脉成像定性诊断肺动脉栓塞及定量评估肺组织灌注

目的 观察光谱CT肺动脉成像(SCTPA)定性诊断肺动脉栓塞(PE)和定量评估肺组织灌注的价值。方法 回顾性分析37例临床诊断PE患者的CTPA资料,观察常规CTPA及SCTPA后处理图像,后者包括40 keV虚拟单能量图(VMI_{40 keV})、碘密度图(IDI)与有效原子序数(Z-eff)图的融合图及电子密度图(EDI);记录2种图像中肺段动脉、肺亚段及以下动脉内的栓子数量和位置,对比其中相应肺灌注缺损区与对侧相应正常肺实质区常规CT值、碘密度(ID)、Z-eff及电子密度(ED)的差异;针对差异有统计学意义的sCTPA参数绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估其区分PE肺灌注缺损区与正常肺实质的效能。结果 37例中,仅以常规CTPA检出37个栓子,其中26个位于肺段动脉、11 个位于肺亚段及以下动脉;之后结合SCTPA后处理图像额外检出1个肺段动脉和2个肺亚段以下动脉内栓子。全部40个栓子对应肺灌注缺损区常规CT值高于、ID及Z-eff均低于对侧正常肺实质区(P均<0.01),而ED与正常肺实质区差异无统计学意义(P=0.54)。以常规CT值区分肺灌注缺损区与正常肺实质区的敏感度、特异度分别为42.50%及87.50%,以ID及Z-eff区分的敏感度分别为95.00%、97.50%,特异度均为100%。ID及Z-eff的AUC均为0.99,均高于常规CT值(0.65,Z=5.56、5.53,P均<0.01),而 ID与Z-eff的AUC差异无统计学意义(Z=0.71,P=0.48)。结论 利用SCTPA可提高PE检出率及定量评估肺组织灌注;根据ID及Z-eff可有效区分肺灌注缺损区与正常肺实质。     

Primary pulmonary carcinoma in patients with idiopathic pulmonary fibrosis

OBJECTIVE: To identify distinguishing characteristics between patients with idiopathic pulmonary fibrosis (IPF) and primary lung carcinoma and patients with either IPF or carcinoma alone. PATIENTS AND METHODS: The study group consisted of 24 patients with histologically proven usual interstitial pneumonia and lung carcinoma identified through a search of the Rochester Mayo Clinic database for 1990 to 1998. Medical records, radiographs, and histological slides were reviewed. Several variables including survival were compared in 2 control groups, IPF only and carcinoma only, by using various statistical methods. RESULTS: Our study group included 21 men and 3 women (mean age, 72.3 years). Twenty-two were past or current smokers. Approximately half of the lung carcinomas were incidental findings. Of the 14 patients with preoperative computed tomographic scans, 12 had peripheral tumors situated in areas of fibrosis. Squamous cell carcinoma was the most common histological type, accounting for 16 cases. Almost all patients underwent surgical treatment; nearly 40% developed postoperative complications, and 3 died within 30 days of surgery. The ratio of men to women in patients with IPF and carcinoma was 7:1 compared with 1:1 in patients with IPF only (P=.003). Patients with IPF and carcinoma were also older, with a mean age of 72.3 years compared with 64.4 years (P=.001), and were more often smokers (P=.002). Carcinomas involved the lower lobes in 42% of patients with IPF and carcinoma compared with 29% of patients with carcinoma only (P=.004) and were mainly composed of squamous cell carcinoma (P=.004). Mean survival in patients with IPF and lung carcinoma was 2.3 years after the diagnosis of IPF and 1.6 years after that of carcinoma. This finding did not differ significantly from survival of patients with either IPF or carcinoma alone. However, statistical power was limited. CONCLUSION: Carcinoma in patients with IPF arises in older male smokers and usually presents as peripheral squamous cell carcinoma. The prognosis is poor.