A national survey: percussion, vibration, shaking and active cycle breathing techniques used in patients with acute exacerbations of chronic obstructive pulmonary disease

Objectives

Chronic obstructive pulmonary disease (COPD) is a frequent cause of hospital admission in older people. There is a perception that manual chest physiotherapy techniques are commonly used in the treatment of patients admitted with acute exacerbations of COPD (AECOPD). However, it is not clear which chest physiotherapy techniques benefit patients admitted with AECOPD, or even which techniques are currently being employed. The aim of this study was to investigate the use of percussion, vibration, shaking and active cycle breathing techniques (ACBT) by physiotherapists working in respiratory care and treating patients admitted with AECOPD.

Design

A postal questionnaire was used to survey physiotherapists working in respiratory care in 190 acute hospital trusts in the UK about chest clearance physiotherapy techniques used in the treatment of patients admitted with AECOPD.

Results

Of the 190 questionnaires mailed, 146 (77%) complete responses were received. One hundred and twenty-nine (88%) respondents reported that they always or often used ACBT, compared with 38 (26%), 16 (11%) and 12 (8%) respondents for vibration, shaking and percussion, respectively. The differences were statistically significant: ACBT used always/often versus vibration used always/often (χ² = 5.8, P = 0.01); ACBT used always/often versus percussion used always/often (χ² = 8.3, P < 0.0001); and ACBT used always/often versus shaking used always/often (χ² = 6.7, P < 0.001).

Conclusions

Manual chest physiotherapy techniques (vibration, percussion and shaking) were used infrequently for chest clearance in patients admitted with AECOPD, whereas ACBT was used always or often by 88% of responders.     

慢性阻塞性肺疾病急性加重期患者症状群及前哨症状的调查研究

目的 调查慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者症状群及前哨症状,分析前哨症状严重程度与炎症指标的相关性,为护理人员开展AECOPD患者症状群干预提供参考。方法 2021年10月—2022年3月,便利选取南宁市某三级甲等医院呼吸与危重症医学科住院的165例AECOPD患者,采用一般资料调查表、修订版记忆症状评估量表进行问卷调查,并收集患者入院后首次检测的炎症指标。采用主成分分析法提取症状群,基于Apriori算法关联分析结果,判定症状群的前哨症状,采用相关性分析探讨患者前哨症状与炎症指标的关系。结果 AECOPD患者存在3个症状群,包括呼吸道症状群、情感症状群和疲乏症状群。Apriori算法关联分析显示,精力缺乏是呼吸道症状群的前哨症状,感到悲伤是情感症状群的前哨症状,注意力不集中是疲乏症状群的前哨症状。相关性分析显示,中性粒细胞与淋巴细胞比值、降钙素原水平与精力缺乏严重程度呈正相关(r=0.179,P=0.022;r=0.246,P=0.001),前白蛋白水...     

两种评分系统对慢性阻塞性肺疾病急性加重期患者病情严重程度及预后评估的研究

目的探讨慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)及慢性阻塞性肺疾病和支气管哮喘生理评分(COPD and asthma physiology score,CAPS)与病情严重程度及预后的关系及评估价值。方法回顾性分析2013年1月至2018年11月于北京积水潭医院呼吸与危重症医学科住院治疗的AECOPD患者239例。根据住院期间有无机械通气分为无机械通气组和机械通气组;根据预后分为存活组和死亡组。住院后计算APACHEⅡ评分及CAPS评分。进行两种评分系统的不同组间比较;进行两种评分系统与住院期间需要行机械通气的可能性及疾病转归的相关性分析;评估入院时两种评分系统对住院期间需要行机械通气的可能性及死亡发生风险的预测价值。结果①AECOPD无机械通气组患者两种评分均明显低于机械通气组[APACHEⅡ分别为(12.09±3.48)分、(18.74±4.06)分,CAPS分别为(18.70±5.70)分、(26.35±7.87)分,P<0.05];②AECOPD存活组患者两种评分均明显低于死亡组[APACHEⅡ分别为(13.88±4.06)分、(20.86±4.43)分,CAPS分别为(19.66±5.37)分、(32.84±6.74)分,P<0.05];③Spearman相关分析显示,AECOPD患者APACHEⅡ评分、CAPS评分与住院期间需要行机械通气的可能性均呈显著相关(r值分别为0.694、0.525,P<0.05);④Spearman相关分析显示,AECOPD患者APACHEⅡ评分、CAPS评分与死亡发生风险均呈显著相关(r值分别为0.554、0.612,P<0.05)。结论AECOPD患者入院时APACHEⅡ评分及CAPS评分与病情严重程度及预后密切相关;对于评估患者病情严重程度、住院期间需要行机械通气的可能性,APACHEⅡ评分优于CAPS评分;两者对于AECOPD患者预后的预测价值基本相当,均具有较高的预测价值。     

无创通气在慢性阻塞性肺疾病急性发作期伴呼吸衰竭治疗中的应用

目的　探讨无创通气在慢性阻塞性肺疾病 (COPD)急性加重期 (AE)的应用价值。方法　急性加重期COPD患者 91例 ,分为无创通气组和有创通气组 ,观察患者上机前、上机后 30min、上机后 2d血气分析变化、机械通气天数、住院天数、花费与并发感染等指标。结果　有创通气 30min后PaO2 的升高、PaCO2 下降、pH的恢复明显快于无创通气组 (P <0 0 1)。但 2d后两组PaO2 、PaCO2 、pH差异无显著性 (P>0 0 5 )。无创通气组机械通气天数、住院天数、费用、以及院内感染的发病率明显低于有创通气组 (P <0 0 1)。无创通气组明显嗜睡者 12例 ,占 2 7 3% ,10例经无创通气治疗后清醒 ,无需气管插管有创通气。结论　无创通气治疗急性加重期COPD患者的呼吸衰竭是经济有效的方法     

Value of refined care in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUNDUnder physiological conditions, sputum produced during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can move passively with the cilia in the airway; the sputum is gradually excreted from the depth of the airways through the stimulation of the coughing reflex on the sensory nerve on the surface of the airway. However, when the sputum is thick, the cough is weak, or the tracheal cilia are abnormal, sputum accumulation may occur and affect the exchange of oxygen and carbon dioxide in the lung. Furthermore, the presence of pathogenic microorganisms in sputum may cause or aggravate the symptoms of pulmonary infection in patients, which is the main factor leading to AECOPD. Therefore, promoting effective drainage of sputum and maintaining airway opening are key points requiring clinical attention.AIMTo explore the effect of refined nursing strategies in patients with AECOPD and dysphagia.METHODSWe selected 126 patients with AECOPD and difficulty of expectoration at our hospital, and divided them into a refined care group and a routine care group, with 63 cases each, using a random number table. The two groups of patients were treated with expectorant, anti-infection, oxygen inhalation, and other basic treatment measures; patients in the refined care group were given refined nursing intervention during hospitalization, and the routine care group received conventional nursing intervention. The differences in sputum expectoration, negative pressure suction rate, blood gas parameters, dyspnea score measured through the tool developed by the Medical Research Council (MRC), and quality of life were compared between the two groups. RESULTSAfter 7 d of intervention, the sputum expectoration effect of the refined care group was 62.30%, the effective rate was 31.15%, and the inefficiency rate was 6.56%. The sputum expectoration effect of the routine care group was 44.07%, the effective rate was 42.37%, and the inefficiency rate was 13.56%. The refined care group had better sputum expectoration than the routine care group (P < 0.05). The negative pressure suction rate in the refined care group was significantly lower than that of the routine care group during the treatment (22.95% vs 44.07%, P < 0.05). Before the intervention, the arterial oxygen saturation (PaO₂) and arterial carbon dioxide saturation (PaCO₂) values were not significantly different between the two groups (P > 0.05); the PaO₂ and PaCO₂ values in the refined care group were comparable to those in the routine care group after 7 d of intervention (P > 0.05). Before the intervention, there was no significant difference in the MRC score between the two groups (P > 0.05); the MRC score of the refined care group was lower than that of the routine care group after 7 d of intervention, but the difference was not statistically significant (P > 0.05). Before intervention, there was no significant difference in the symptoms, activities, disease impact, or St. George’s Respiratory questionnaire (SGRQ) total scores between the two groups (P > 0.05). After 7 days of intervention, the symptoms, activities, and total score of SGRQ of the refined care group were higher than those of the routine care group, but the difference was not statistically significant (P > 0.05).CONCLUSIONAECOPD with thick sputum, weak coughing reflex, and abnormal tracheal cilia function will lead to sputum accumulation and affect the exchange of oxygen and carbon dioxide in the lung. Patients with AECOPD who have difficulty expectorating sputum may undergo refined nursing strategies that will promote expectoration, alleviate clinical symptoms, and improve the quality of life.     

降钙素原在慢性阻塞性肺疾病急性加重期中指导抗生素使用的价值

目的：评价降钙素原（PCT）对于慢性阻塞性肺疾病急性加重期（AECOPD）患者使用抗生素的指导价值。方法：本研究纳入74例AECOPD患者,随机分成PCT组和对照治疗组。其中PCT组根据PCT策略决定抗生素的使用;对照组根据患者临床症状进行经验性抗生素使用。主要观察指标包括抗生素的使用时间、住院时间、加重例数和死亡例数等。结果：两组数据结果对比显示,在死亡率和病情加重例数无显著差异的情况下,PCT组患者抗生素使用时间、住院时间明显减少,与对照治疗组具有显著差异。结论：PCT指导AECOPD抗感染治疗在不影响病情的情况下能够有效减少抗生素使用并且缩短患者的住院时间。     

Different gastoroesophageal reflux symptoms of middle-aged to elderly asthma and chronic obstructive pulmonary disease (COPD) patients

Symptomatic differences and the impact of gastroesophageal reflux disease (GERD) have not been clarified in patients with asthma and chronic obstructive pulmonary disease (COPD). The purpose of this study is to assess the differences of GERD symptoms among asthma, COPD, and disease control patients, and determine the impact of GERD symptoms on exacerbation of asthma or COPD by using a new questionnaire for GERD. A total of 120 subjects underwent assessment with the frequency scale for the symptoms of GERD (FSSG) questionnaire, including 40 age-matched patients in each of the asthma, COPD, and disease control groups. Asthma and control patients had more regurgitation-related symptoms than COPD patients (p<0.05), while COPD patients had more dysmotility-related symptoms than asthma patients (p<0.01) or disease control patients (p<0.01). The most distinctive symptom of asthma patients with GERD was an unusual sensation in the throat, while bloated stomach was the chief symptom of COPD patients with GERD, and these symptoms were associated with disease exacerbations. The presence of GERD diagnosed by the total score of FSSG influences the exacerbation of COPD. GERD symptoms differed between asthma and COPD patients, and the presence of GERD diagnosed by the FSSG influences the exacerbation of COPD.     

慢性阻塞性肺疾病急性加重并发糖尿病的危险因素分析

目的探讨慢性阻塞性肺疾病急性加重并发糖尿病（AECOPD-DM）的临床特点及危险因素,寻找潜在的AECOPD-DM的预测指标,为干预AECOPD病情进展及合并症管理提供参考。 方法收集盘锦市中心医院2019年9月1日至2021年5月1日因AECOPD住院的患者,根据是否合并糖尿病分为单纯AECOPD组为对照组（n=150）和AECOPD-DM组为试验组（n=131）,比较2组患者的一般资料、血糖水平、炎症指标、凝血指标、血气指标、血脂指标、合并疾病。应用Logistic回归分析AECOPD-DM的危险因素,绘制受试者工作特征（ROC）曲线分析各指标对AECOPD-DM的诊断效能。 结果试验组白细胞、C-反应蛋白（CRP）、D二聚体（D-Dimer）、纤维蛋白原（FIB）、二氧化碳分压（PaCO₂）低密度脂蛋白胆固醇（LDL-C）均高于对照组（P＜0.05）;凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）、氧分压（PaO₂）、动脉血氧饱和度（SaO₂）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）均低于对照组（P＜0.05）。高血压、LDL-C是AECOPD并发DM的危险因素,PaO₂、APTT、TC是AECOPD并发DM的保护因素。这5个因素联合指标ROC曲线下面积0.976（95%CI：0.964~0.989,P＜0.001）高于糖化血红蛋白（HbA1C）的ROC曲线下面积为0.895（95%CI：0.854~0.935,P＜0.001）,敏感度为98.5%,特异度为83.3%。 结论AECOPD-DM发病机制及危险因素复杂,预后较差,早期预测指标能够指导临床早期识别与管理AECOPD-DM患者,对改善患者预后,加强慢病管理、减轻社会经济负担起到积极作用。     

Impact of care pathways for in-hospital management of COPD exacerbation: a systematic review

Background

In-hospital management of COPD exacerbation is suboptimal, and outcomes are poor. Care pathways are a possible strategy for optimizing care processes and outcomes.

Objectives

The aim of the literature review was to explore characteristics of existing care pathways for in-hospital management of COPD exacerbations and to address their impact on performance of care processes, clinical outcomes, and team functioning.

Methods

A literature search was conducted for articles published between 1990 and 2010 in the electronic databases of Medline, CINAHL, EMBASE, and Cochrane Library. Main inclusion criteria were (I) patients hospitalized for a COPD exacerbation; (II) implementation and evaluation of a care pathway; (III) report of original research, including experimental and quasi experimental designs, variance analysis, and interviews of professionals and patients about their perception on pathway effectiveness.

Results

Four studies with a quasi experimental design were included. Three studies used a pre–post test design; the fourth study was a non randomized controlled trial comparing an experimental group where patients were treated according to a care pathway with a control group where usual care was provided. The four studied care pathways were multidisciplinary structured care plans, outlining time-specific clinical interventions and responsibilities by discipline. Statistic analyses were rarely performed, and the trials used very divergent indicators to evaluate the impact of the care pathways. The studies described positive effects on blood sampling, daily weight measurement, arterial blood gas measurement, referral to rehabilitation, feelings of anxiety, length of stay, readmission, and in-hospital mortality.

Conclusions

Research on COPD care pathways is very limited. The studies described few positive effects of the care pathways on diagnostic processes and on clinical outcomes. Though due to limited statistical analysis and weak design of the studies, the internal validity of results is limited. Therefore, based on these studies the impact of care pathways on COPD exacerbation is inconclusive. These findings indicate the need for properly designed research like a cluster randomized controlled trial to evaluate the impact of COPD care pathways on performance of care processes, clinical outcomes, and teamwork.     

Evidence for aerobic exercise training on the autonomic function in patients with chronic obstructive pulmonary disease (COPD): a systematic review

Objective

To assess evidence for the effectiveness of aerobic exercise training (AET) on the autonomic function (AF) outcomes in patients with chronic obstructive pulmonary disease (COPD).

C-反应蛋白在COPD急性加重期患者血清中的变化分析

目的观察慢性阻塞性肺疾病(COPD)患者的急性加重期时血清C-反应蛋白(CRP)中的水平及意义。方法检测160例COPD急性加重期的患者及160例正常成人的CRP、白细胞计数(WBC),并进行比较。同时对COPD急性加重期的患者给予抗生素治疗,比较治疗前后这些指标的变化情况。结果COPD急性加重期患者组CRP的异常率为95%,明显高于WBC的异常率。治疗后,CRP和WBC与治疗前相比已经明显下降,但与正常成人组比较差异具有显著性(P<0.05)。结论CRP是反映COPD患者存在感染的敏感指标,CRP升高可以提示COPD急性加重期患者疾病的严重程度,对COPD急性加重期的早期发现与治疗具有重要意义。     

氦氧混合气体治疗慢阻肺急性加重期的临床评价

目的评价氦氧混合气体(Heliox)治疗慢性阻塞性肺病急性加重期(AECOPD)患者的临床疗效。方法回顾分析2004-08～09急诊ICU收治的54例AECOPD患者的临床资料,按是否接受Heliox治疗将患者分为常规治疗组(28例)和Heliox治疗组(26例),前者给予常规治疗,后者在常规治疗基础上予吸入Heliox治疗,比较两组患者有创机械通气使用率、平均机械通气时间、平均ICU治疗时间、平均住院时间和预后等参数。结果Heliox治疗组患者有创机械通气使用率显著低于常规治疗组,而且平均有创机械通气时间、平均ICU治疗时间和平均住院时间均显著短于常规治疗组,但两组患者病死率比较差异无统计学意义。结论AECOPD患者吸入Heliox治疗具有较好的临床疗效。     

慢性阻塞性肺疾病急性加重患者的机械通气指南(2007)

慢性阻塞性肺疾病（COPD）是一种常见的慢性呼吸系统疾病，患病人数多，病死率高，严重影响患者的劳动能力和生活质量。2002年世界卫生组织（WHO）公布的资料显示，COPD是目前世界上死亡的第五位病因，预计到2020年，COPD将成为第三位死亡病因。COPD急性加重（AECOPD）合并呼吸衰竭（呼衰）是导致COPD患者住院最重要的原因，加强对AECOPD的防治，特别是提高机械通气技术的应用水平，对提高AECOPD合并呼衰的抢救成功率具有重要意义。     

Determination of the relationship between cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study

Abstract

Background: Hand dexterity is important for daily living activities and can be related to cognitive functions in patients with chronic obstructive pulmonary disease (COPD). Objective: The aim of this study was to investigate the relationship between cognitive dysfunction and hand dexterity in patients with COPD. Methods: 35 COPD patients and 36 healthy individuals were assessed. The Minnesota Hand Dexterity Test and Mini Mental State Examination (MMSE) were used for assessment of cognitive function and hand dexterity. Results: Hand dexterity test scores and cognitive function of COPD patients’ were significantly lower than the healthy group (p?<?0.01). The MMSE scores were negatively correlated with hand dexterity scores in the COPD group (p?<?0.05). Conclusions: There was a relationship between cognitive function and hand dexterity in the patients with COPD; however, hand dexterity did not alter according to hypoxemia severity. Hand dexterity which is important in daily living activities should be evaluated in greater detail with further studies in COPD patients.     

认知行为护理干预对慢性阻塞性肺疾病患者急性加重风险的改善作用研究

目的 研究认知行为护理干预对慢性阻塞性肺疾病(COPD)患者急性加重风险的改善作用.方法 将2017年5月至2019年5月深圳市龙岗区第二人民医院收治的COPD患者108例纳入研究,按随机数字表分成研究组及对照组,每组各54例.对照组予以常规护理干预,研究组在常规护理基础上增用认知行为护理干预.比较两组患者急性加重次数...     

耐力联合抗阻训练在慢性阻塞性肺疾病急性加重后早期应用的Meta分析

目的:探讨慢性阻塞性肺疾病急性加重后早期耐力联合抗阻训练对病人运动能力和再入院率的影响。方法:计算机检索Medline、CINAHL、Cochrane Libary、Embase、CBM、中国知网、万方、维普数据库,检索时限均为建库至2019年8月,收集耐力联合抗阻训练在慢性阻塞性肺气肿急性加重后住院期间及出院后4周内应用的随机对照试验(RCT)。分别采用Cochrane手册5.1.0和RevMan 5.3软件进行质量评价和数据分析。结果:共纳入10篇RCT,包括540例病人。耐力联合抗阻训练持续3~12周,频率为每周2~5次、每次1~2 h。在改善病人6 min步行距离[MD=39.54,95%CI(8.41,70.67),P=0.01]、递增穿梭步行距离[MD=65.38,95%CI(11.88,118.89),P=0.02]方面,耐力联合抗阻训练组优于对照组,差异有统计学意义;但再入院率方面,两组之间差异无统计学意义(P>0.05)。敏感性分析显示:在剔除异质性较大的研究后,试验组在改善再入院率方面,优于对照组且有统计学意义(P<0.05)。结论:耐力联合抗阻训练,可以改善因急性加重住院病人的运动能力,且不增加再入院率,是一项有效的运动处方。在病人能耐受的情况下,可在住院期间或出院后4周内应用。     

脑钠肽在慢性阻塞性肺疾病患者中检测的临床意义

目的探讨脑钠肽(BNP)在慢性阻塞性肺疾病(COPD)患者中检测的临床意义。方法选择2012年8月至2013年8月收治的COPD患者80例,按病情分为急性加重期为40例,稳定期患者40例。同时选择健康患者40例作为对照组。所有参与研究的对象均空腹抽取2 ml静脉血,检测血浆BNP水平。观察COPD患者与对照组、COPD患者治疗前后BNP水平的差异。结果 COPD患者BNP水平明显高于对照组,而急性加重期患者又明显高于稳定期患者,三组比较差异具有统计学意义(P0.05)。COPD患者治疗1 d和治疗7 d后,血浆BNP水平较治疗前明显下降,治疗7 d后又比治疗1 d时明显下降,差异均有统计学意义(P0.05)。急性加重期患者治疗前血浆BNP平均值为176.5±28.7 pg/ml,有18例重度患者转入ICU行机械通气治疗,18例重度患者血浆BNP平均值为351.8±57.3 pg/ml,明显高于急性加重期患者的平均水平,差异具有统计学意义(P0.05)。结论血浆BNP水平在COPD患者急性加重期、稳定期均有不同程度的升高,其与COPD的严重程度具有密切相关性。