甩手运动配合缩唇腹式呼吸锻炼对COPD稳定期患者肺功能及生活质量的影响

目的探讨甩手运动配合缩唇腹式呼吸锻炼对慢性阻塞性肺疾病(COPD)稳定期患者肺功能及生活质量的影响,为COPD稳定期患者肺康复锻炼提供科学依据。方法选取COPD稳定期患者120例为研究对象,随机分为两组,每组60例。两组患者均按呼吸内科常规对症治疗如抗感染、化痰、支气管解痉等,在此基础上,对照组给予常规护理,患者自主进行呼吸锻炼8周。观察组患者在常规对症治疗、护理的基础上,在专业人员指导下进行甩手运动配合缩唇腹式呼吸锻炼8 d,出院后继续进行康复锻炼8周。比较两组患者Borg呼吸困难评分、6分钟步行测定(6MWT)结果及圣乔治评分等的变化。结果锻炼后两组患者的Borg呼吸困难评分及6分钟步行试验(6MWT)结果均较干预前改善(P0.05),与对照组比较观察组患者改善更加显著,两组比较差异有统计学意义(P0.05);观察组患者的日常活动量、社交活动、精神状况评分明显低于对照组,差异有统计学意义(P0.05)。结论甩手运动配合缩唇腹式呼吸锻炼可增强膈肌、腹肌、下胸部肌肉的活动,减少呼吸肌疲劳的发生,从而改善COPD患者肺的通气功能,提高患者的生活质量。     

COPD患者的上下肢及呼吸肌锻炼的疗效评价

目的 探讨以上下肢及呼吸肌锻炼为主的呼吸康复锻炼对COPD稳定期患者的疗效.方法 随机选择处于稳定期的COPD患者80例,随机的分为肺康复组（n=40）与对照组（n=40）.对照组患者门诊行取药治疗,肺康复组在对照组治疗基础上采取上、下肢及呼吸肌锻炼.治疗8周后对两组肺功能进行评价.结果 治疗后,肺康复组肺功能和血气较对照组明显改善（P〈0.05）.结论 上、下肢及呼吸肌的康复锻炼可以明显改善COPD患者的肺功能,提高患者的生存质量,且不需要任何经济费用.     

长期家庭无创正压通气治疗稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床效果研究

目的 探讨家庭无创正压通气（NPPV）治疗稳定期慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的临床效果.方法 将2009年5月-2010年5月我院治疗的50例处于稳定期的COPD合并Ⅱ型呼吸衰竭患者随机分为治疗组和对照组,各25例.治疗组患者接受常规治疗＋ 家庭NPPV治疗,对照组患者接受常规治疗＋家庭氧疗治疗.出院后随访2年,比较两组出院时、出院2年后6 min行走距离、动脉血气分析、肺功能、辅助呼吸肌评分、生活质量、2年内再次住院次数及不良反应.结果 两组患者出院时6 min行走距离、用力肺活量（FVC）、1秒用力呼气末容积（FEV1）、PaCO2、PaO2、辅助呼吸肌评分及圣·乔治呼吸问卷（SGRQ）评分比较,差异均无统计学意义（P＞0.05）;出院2年后治疗组6 min行走距离、FVC、FEV1及PaO2高于对照组（P＜0.05）,PaCO2、辅助呼吸肌评分、SGRQ评分及再次住院次数低于对照组（P＜0.05）.结论 长期家庭NPPV治疗稳定期COPD合并Ⅱ型呼吸衰竭疗效肯定,能改善患者呼吸肌力恢复和收缩功能、纠正缺氧和高碳酸血症、延缓肺功能衰竭、提高患者生活质量.     

新型呼吸锻炼器康复锻炼对COPD患者的影响

目的了解新型呼吸锻炼器对COPD患者的影响;方法对46例中重度COPD患者应用FG－01型呼吸锻炼器进行呼吸锻炼12个月,进行呼吸困难评分、6min行走试验及肺功能评价;结果46例中重度COPD患者呼吸困难评分及6min步行试验及肺功能统计学有显著性差异;结论新型呼吸锻炼器可以改善COPD患者的肺功能及运动耐力,值得推广。     

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。     

布地奈德联合小剂量氨茶碱治疗稳定期慢性阻塞性肺疾病疗效观察

目的观察小剂量氨茶碱联合布地奈德治疗中重度COPD稳定期患者的疗效。方法将106例中重度稳定期COPD患者随机分为四组：布地奈德（B）组、布地奈德/氨茶碱（B/A）组、布地奈德/福莫特罗（B/F）组和对照组。比较四组治疗前后6 min行走距离（6-MWD）、肺通气功能、圣乔治呼吸问卷（SGRQ）评分。结果B组、B/A组、B/F组SGRQ评分均明显下降,肺功能、6-MWD均有不同程度改善,与对照组比较有统计学差异（P均〈0.05）;B/F组肺功能、6-MWD、SGRQ评分与B/A组比较无统计学差异（P〉0.05）。结论B/A可明显改善COPD患者的肺功能指标,提高其生活质量,降低治疗费用。     

慢性阻塞性肺疾病稳定期患者综合康复治疗疗效观察

目的观察慢性阻塞性肺疾病（COPD）患者康复治疗前、后症状评分、6分钟步行试验（6MWT）及肺功能的变化。方法采用前瞻性随机对照研究,将60例COPD稳定期患者分为治疗组和对照组各30例;其中治疗组进行综合康复治疗（包括心理康复治疗、呼吸肌康复治疗、长期家庭氧疗）,康复治疗前和48周后分别测定第1秒用力肺活量（FEV1）、第1秒用力肺活量／用力肺活量（FEV1／FVC）和FEV,占正常预计值的百分比（FEV1％）及6MWT运动距离;并通过问卷调查的形式进行症状评价。结果治疗组咳嗽、咯痰及呼吸困难等症状明显改善,6MWT运动距离明显提高,与对照组比较有显著差异（P〈0．05）,但肺功能指标的改变无统计学意义（P〉0．05）。结论对COPD稳定期患者进行长期、综合程序康复治疗可以显著提高运动耐力,减轻临床症状。     

肺康复治疗对稳定期COPD患者肺功能及血气分析的影响

目的探讨肺康复治疗对稳定期慢性阻塞性肺疾病（COPD）患者肺功能及血气分析的影响。方法将80例稳定期COPD患者随机分为肺康复组（n=40）与对照组（n=40）,肺康复组给予体能锻炼、呼吸肌锻炼、氧疗、心理与行为干预等肺康复治疗措施,治疗6～8周,治疗前后测定肺功能及血气分析,比较两组患者肺功能及血气分析的变化。结果观察组治疗后肺功能、血气分析较治疗前及对照组治疗后均显著改善（P〈0．01）。结论肺康复治疗可提高稳定期COPD患者肺功能及血气分析,从而提高患者的生存质量。     

呼吸操对慢阻肺患者肺功能影响的探讨

目的观察呼吸操对慢性阻塞性肺病（COPD）患者恢复期血气以及对肺功能和缺氧耐受性的影响。方法对符合慢性肺心病及缓解期诊断标准的患者50例，随机分成锻炼组25例和对照组25例，锻炼组进行呼吸操锻炼，对照组口服安慰剂。两组于开始前和1个月后分别进行血气，肺功能、行走距离和生存质量测定。结果锻炼组结束后各项指标的改善与锻炼前比较差异有显著性。而对照组各项指标服安慰剂前后无明显变化。结论呼吸操对缓解期慢性阻塞性肺病（COPD）患者动脉血气、肺功能、运动能力及生存质量等均有重要影响。     

肺康复训练对稳定期ILD患者生活质量的影响

目的探讨肺康复训练对稳定期间质性肺疾病(ILD)患者生活质量的影响。方法 60例ILD稳定期患者,在常规药物治疗的基础上,进行肺康复训练,定期随访及指导,疗程6个月。6个月后评价患者生活质量改善情况,包括6 min步行试验(6MWT),圣乔治呼吸问卷得分(SGRQ)以及肺功能情况。结果 6个月后患者6 min行走距离、圣乔治呼吸问卷得分明显改善(P<0.05),具有统计学意义,肺功能改善不明显(P>0.05)。结论肺康复训练可减轻稳定期ILD患者呼吸困难程度、提高活动耐力及生活质量,对患者具有重要的临床意义。     

营养支持与呼吸操提高COPD患者生存质量的探讨

目的观察营养支持与呼吸操对慢性阻塞性肺疾病(COPD)患者缓解期呼吸肌和生存质量的影响。方法将40例COPD缓解期患者随机分为两组,对照组和观察组,给予营养支持同时行呼吸操训练,3个月后分别进行肺功能及生存质量评估。结果观察组较对照组在肺功能及活动耐力、心理状态、社会适应能力等方面均明显改善(P<0.01)。结论营养支持与呼吸操训练能提高老年COPD患者呼吸功能和生存质量     

噻托溴胺联合呼吸操训练治疗稳定期慢性阻塞性肺病患者的临床研究

目的探讨噻托溴胺联合呼吸操训练对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,慢阻肺)稳定期患者的肺通气功能、生活质量以及运动耐力的影响。方法选择2014年10月至12月稳定期慢阻肺患者共73例,随机分为常规药物治疗组(A组,n=37)和呼吸操训练组(B组,n=36)。对A组患者常规吸入噻托溴胺,有氧疗指征者给予长期家庭氧疗。B组患者除应用噻托溴胺和(或)氧疗外,指导呼吸操训练,方法包括腹式呼吸、缩唇呼气及全身性呼吸体操。记录每例患者入组时及12周后的FEV1占预计值的百分比(FEV1%Pred)、圣乔治呼吸疾病问卷(SGRQ)评分及6 min步行距离(6MWD)。结果入组时两组患者的性别、平均年龄、肺功能分级、FEV1%Pred、SGRQ评分及6MWD均无显著差异(P0.05)。干预12周后两组患者FEV1%Pred、SGRQ评分及6MWD均较治疗前有显著变化。其中B组患者的SGRQ评分显著低于A组,B组患者的6MWD显著长于A组(P0.05)。结论在常规吸入长效抗胆碱能药物治疗外,配合呼吸操训练可更好的改善稳定期慢阻肺患者的生活质量及运动耐力。     

Systematic review of noninvasive positive pressure ventilation in severe stable COPD.

The present systematic review examined the effectiveness of bilevel noninvasive positive pressure ventilation (NIPPV) in the management of chronic respiratory failure (CRF) due to severe stable chronic obstructive pulmonary disease (COPD). Randomised controlled trials (RCTs) and non-RCTs (crossover design) of adults with severe stable COPD and CRF receiving bilevel NIPPV via nasal, oronasal or total face mask were identified from electronic databases and manual screening of journals and reference lists. Respiratory function (gas exchange, lung function, ventilatory/breathing pattern, respiratory muscle function and work of breathing) and health-related outcomes (dyspnoea, functional status, exercise tolerance, health-related quality of life (HRQOL), morbidity and mortality) were assessed. In total, 15 studies met the inclusion criteria: six RCTs and nine non-RCTs. RCTs did not find improved gas exchange with bilevel NIPPV, while non-RCTs did. Lung hyperinflation and diaphragmatic work of breathing were reduced in a nonrandomised subset. HRQOL and dyspnoea, the least studied outcomes, showed improvement with bilevel NIPPV. In a subset of individuals on maximal medical treatment regimes for severe stable chronic obstructive pulmonary disease, bilevel noninvasive positive pressure ventilation may have an adjunctive role in the management of chronic respiratory failure through attenuation of compromised respiratory function and improvement in health-related outcomes.     

Is there any treatment other than drugs to alleviate dyspnea in COPD patients?

Patients with chronic obstructive pulmonary disease (COPD) are often limited in their activities by breathlessness. In these patients, exercise training may result in significant improvements in dyspnea, exercise tolerance, and health related quality of life (HRQoL). Further possibilities are to reduce ventilatory demand by decreasing the central respiratory drive or to lessen the perceived breathing effort by increasing respiratory muscle strength through specific respiratory muscle training. Upper limb training may also improve exercise capacity and symptoms in these patients through the modulation of dynamic hyperinflation. Ventilatory assistance during exercise reduces dyspnea and work of breathing and enhances exercise tolerance, although further studies should be required to define their applicability in the routine pulmonary rehabilitation programs. Lung volume resection surgery and lung transplantation in selected patients may control symptoms and improve HRQoL.     

无创正压通气治疗稳定期慢性阻塞性肺疾病的疗效

无创正压通气(noninvasive positive pressure ventilation,NPPV)在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期和稳定期患者中都有广泛应用.对于急性加重期患者,NPPV可显著降低气管插管率、病死率、住重症监护病房(ICU)时间及住院时间等.对于稳定期患者,NPPV能显著改善呼吸困难症状及部分肺功能指标、提高PaO2水平、缓解呼吸肌疲劳、增强活动耐力以及改善睡眠和生活质量,但对于NPPV能否显著降低PaCO2水平,降低住院率、病死率、住ICU时间以及住院时间等,尚存在较大争议.充分了解NPPV在稳定期COPD患者中的疗效,对于提高NPPV的临床应用水平具有重要意义.     

Failure of resistive breathing training to improve pulmonary function tests in patients with chronic obstructive pulmonary disease

The effects on pulmonary function tests and exercise tolerance of resistive breathing training (RBT) were assessed in 16 subjects with stable chronic obstructive pulmonary disease (COPD) who had received no benefit from previous programs of breathing retraining (BR) and medical therapy (MT). 16 male patients with mild degree stable COPD underwent detailed evaluation of pulmonary function tests, blood gas analysis and exercise tolerance test before and after a monthly program of RBT. The patients had received no physiological effects from previous monthly programs of BR and MT. No change in pulmonary function tests, blood gas analysis and exercise tolerance test was observed after RBT. Only maximal static expiratory pressure increased significantly after RBT. We conclude that RBT does not improve pulmonary function tests in subjects who received no physiological benefit from BR.     

Pulmonary rehabilitation

Pulmonary rehabilitation programs use multidisciplinary teams to optimize physical and social functioning of patients with chronic respiratory impairment. These programs provide rehabilitation in inpatient, outpatient, or home settings, using at least three sessions weekly (one may be unsupervised) for at least 6 wk. The programs usually consist of exercise training, education, and psychosocial/behavioral components. Upper extremity exercises and instruction on breathing technique are included in most rehabilitation programs and reduce dyspnea, but the contribution of these to improved functional capacity remains unproven. Decreases in the sensation of dyspnea, increased functional exercise capacity, and enhanced quality of life of patients with chronic obstructive pulmonary disease (COPD) are established benefits of pulmonary rehabilitation. Evidence is lacking for the efficacy of rehabilitation for patients with non-COPD causes of pulmonary impairment, but many of these patients probably benefit. Despite the availability of strong evidence to support the efficacy of pulmonary rehabilitation programs in patients with severe COPD, third-party reimbursement policies have been inconsistent. Nonetheless, enrollment in a pulmonary rehabilitation program is encouraged for all appropriate candidates with chronic respiratory impairment, particularly for those with severe COPD.     

Quality of life in COPD

Measurement of health related quality of life (HRQL) is quantification of the impact of disease on daily life and well-being in a formal and standardized manner. Chronic obstructive pulmonary disease (COPD) is essentially incurable, the therapy is directed towards minimization of symptoms, reduction of exacerbations and prevention of the decline in pulmonary functions also improvement in patients' HRQL. In COPD patients, impaired pulmonary function and limited exercise capacity may result in quality of life. As the relationship between respiratory impairment and HRQL is generally weak; it's important to evaluate HRQL in patients with COPD. In this review, general and disease specific questionnaires and assessment of COPD patients is evaluated in the light of recent literatures.     

噻托溴铵联合沙美特罗替卡松对重度极重度慢性阻塞性肺疾病稳定期患者疗效分析

目的探讨联合吸人沙美特罗替卡松及噻托溴铵对重度极重度稳定期COPD患者肺通气功能指标、活动耐力及生活质量的疗效观察。方法选取2008年1月至2010年2月河间市人民医院门诊收治的102例稳定期重度极重度COPD患者,采用完全随机法分成A、B、C3组,A组给予噻托溴铵干粉剂,B组给予沙美特罗替卡松50／500μg,C组给予噻托溴铵干粉剂与沙美特罗替卡松联合吸人,共治疗6个月,在治疗3个月和6个月时分别进行肺通气功能评定、运动耐力评定、健康相关生活质量评价。结果3组患者治疗后肺通气功能评定、运动耐力评定、健康相关生活质量评价较治疗前均有改善,C组比A、B2组各指标改善明显,差异有统计学意义（P值均〈0．05）。结论联合使用噻托溴铵和沙美特罗替卡松可以更好地改善重度极重度稳定期COPD患者肺通气功能、提高运动耐力及生活质量,且不良反应发生率低,值得临床推广。     

Hypogonadism in men with chronic obstructive pulmonary disease: prevalence and quality of life

We recently reported that hypogonadism does not affect respiratory muscle performance and exercise capacity in men with chronic obstructive pulmonary disease (COPD). In COPD, however, the relationship between exercise capacity and quality of life is controversial, making it unreliable to extrapolate about quality of life from exercise data. Accordingly, we determined prevalence and impact of hypogonadism on health-related quality of life in men with COPD. We enrolled 101 stable outpatient men (FEV1 1.34 +/- 0.04 L) older than 54 years; 38 patients were hypogonadal-a prevalence similar to that reported in the general population. The degree of airflow limitation did not predict levels of free testosterone. Quality of life, as quantified by a disease-specific instrument (St. George's Respiratory Questionnaire) and a general-health instrument (Veterans Short Form-36) were equivalent in the hypogonadal and eugonadal groups. Both groups demonstrated large decrements in perceived physical health and smaller decrements in perceived emotional and mental health. No relationship was found between free testosterone level and physical activity, respiratory symptoms, or quality of life. In conclusion, hypogonadism, although common among men older than 54 years with COPD, does not worsen the severity of respiratory symptoms or quality of life.