Minimally supervised home rehabilitation improves exercise capacity and health status in patients with COPD

OBJECTIVE: The purpose of this study was to investigate the effects on exercise tolerance and quality of life of an outpatient rehabilitation program implemented at home without a physiotherapist's direct supervision in patients with chronic obstructive lung disease. DESIGN: Patients with moderate chronic obstructive pulmonary disease were studied. The rehabilitation program included lower limb exercise on a stationary bicycle and upper limb exercise and stretching, together with education, and it lasted for 12 wks. Every 2 wks, a physiotherapist contacted patients by phone to evaluate their compliance with the rehabilitation program and any adverse effects. The main measures of outcome were the Health Status Index, cycle ergometer test, forced expiratory volume in 1 sec, and forced vital capacity. Patients were evaluated at the baseline and at 12 wks. RESULTS: A total of 32 patients were recruited and 28 (mean age, 70.4 yrs) completed the trial. After pulmonary rehabilitation, a significant improvement was found in seven of the nine Health Status Index quality-of-life subscales. Exercise tolerance also improved significantly, whereas no variation was observed in pulmonary function tests. There was no correlation between the improvement in quality of life and the improvement in exercise tolerance. The improvements in the Health Status Index physical function and general health subscales correlated negatively with forced expiratory volume in 1 sec (percentage of predicted value) and positively with residual volume/total lung capacity ratio. The improvement in exercise tolerance (expressed in watts or as maximum oxygen uptake), but not in quality-of-life indexes, was associated negatively with age and positively with weight, cognitive function, and forced expiratory volume in 1 sec/forced vital capacity ratio. CONCLUSIONS: We conclude that an inexpensive home rehabilitation program can improve quality of life and exercise tolerance in patients with moderate chronic obstructive pulmonary disease. Furthermore, our results indicate that exercise tolerance evaluated by cycloergometry and quality of life evaluated by the mean of the Health Status Index questionnaire are independent outcome measures of pulmonary rehabilitation.     

COPD患者肺康复护理干预现状

肺康复是慢性阻塞性肺疾病(COPD)非药物治疗的重要干预手段,提高肺康复的实施率对缓解COPD患者的疾病负担和经济负担具有重要意义。本文主要从肺康复概念和发展概况、COPD肺康复干预实施的时机、场所、评估评价和措施,以及COPD患者肺康复实施的影响因素等进行综述,以期了解肺康复干预的现状,为肺康复的临床护理实践和肺康复护理研究提供指导,以获得COPD肺康复干预的最优方案。     

Pulmonary rehabilitation for patients with COPD

In the UK pulmonary rehabilitation is not a well-recognised therapy for patients with COPD. However, there is evidence to support its effectiveness and therefore a review of literature was undertaken to explore its benefits and limitations in the treatment of this disabling disease. The results showed that an improved quality of life for patients is achievable.     

Relaxation to reduce dyspnea and anxiety in COPD patients.

The purpose of this study was to test the effectiveness of a taped relaxation message in reducing dyspnea and anxiety in chronic obstructive pulmonary disease (COPD) patients. Twenty-six adult COPD patients with dyspnea were randomly assigned to two groups. The treatment group was taught relaxation using a prerecorded tape while the control group was instructed to sit quietly. Skin temperature, heart rate, and respiratory rate were recorded for all subjects during a total of four weekly sessions. Anxiety, dyspnea, and airway obstruction were measured at the beginning and end of the study. The relaxation group achieved the preset relaxation criteria. Dyspnea, anxiety, and airway obstruction were reduced in the relaxation group while the control group remained the same or became worse.     

急诊非器质性呼吸困难患者焦虑抑郁状态分析

目的 探讨急诊非器质性呼吸困难患者焦虑抑郁状态及相关影响因素.方法 连续人选中国医科大学北京顺义区医院急诊科与首都医科大学附属北京朝阳医院急诊科2014年1月1日至2014年5月30日急诊就诊的主诉呼吸困难患者,经过诊疗以后最终诊断为非器质性呼吸困难患者80例,其中68例同意进行心理测评.采用综合医院焦虑抑郁评分量表对68例非器质性呼吸困难患者行心理测评,评价焦虑和抑郁的发生率,对性别、年龄、受教育程度、情绪波动等影响因素进行分析.结果 68例患者中,焦虑患者22例,占32.4％,抑郁患者14例,占20.6％.女性、中学以下学历、就诊前情绪波动以及非本地居民来源者焦虑抑郁发生率更高(P＜0.05).Logistic回归分析结果显示中学以下学历、就诊前情绪波动和非本地居民来源均是发生焦虑、抑郁的主要影响因素.结论 对于急诊非器质性呼吸困难患者,在进行急诊常规诊疗的同时,应重视患者心理因素,必要时应该建议患者求助心理干预.     

慢性阻塞性肺疾病患者肺康复体验的质性研究的Meta整合

目的 系统评价慢性阻塞性肺疾病（COPD）患者及医务人员的肺康复体验。方法　计算机检索Pub Med、Cochrane、Library、Embase、Web of Science、Science Direct中国知网、中国生物医学文献数据库、维普、万方等中英文数据中关于COPD患者肺康复体验的质性研究,对文献质量进行评价,通过Meta整合方法对提炼结果进行整合。结果　共纳入5项研究,提炼29个主题,分析归纳为6个新类别,合成３个方面的整合结果：COPD患者从肺康复项目获益明显,但积极性及依从性有待提高;影响COPD患者参与肺康复的主要因素;有效肺康复的应对策略。 结论　肺康复项目受益明显,但尚存在诸多阻滞因素,积极识别肺康复的影响因素并针对性的提出应对策略,有利于提高COPD患者肺康复的参与度及依从性,使COPD患者真正受益于肺康复。     

焦虑和抑郁障碍共病患者与抑郁症及焦虑症患者心理健康状况对比

目的：探讨焦虑和抑郁障碍共病患者与抑郁症和焦虑症患者心理健康状况下降的差异性。方法：选取2003-06／2004-08广州市脑科医院精神科门诊首次就诊的焦虑和抑郁障碍共病患者27例、抑郁症24例和焦虑症患者29例。采用症状自评量表（问卷共90项，每个项目按5级评分，参照全国成人常模标准：因子分〈1．8分为正常；1．8-2．0分为轻度异常；2．1-3．0分为中度异常；〉3．0分为重度异常），对3组患者分别进行测评，记录总分和9个因子分（包括：躯体化、强迫状态、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性），比较各组间评分的差异。结果：有24例抑郁症患者、29例焦虑症患者和27例焦虑和抑郁障碍共病患者的测评结果纳入分析。①3组患者症状自评量表总分评定结果比较：焦虑和抑郁障碍共病患者明显高于单纯抑郁症患者和焦虑症患者（2.60&;#177;0.52，1.86&;#177;0.41和1.16&;#177;0.35；t=5.76，7．91，P〈0．01）。②3组患者症状自评量表各因子分评定结果比较：焦虑和抑郁障碍共病患者躯体化、强迫、人际、抑郁、焦虑、敌对、恐怖、偏执、精神病性等因子得分均显著高于焦虑组（P〈0．01）；焦虑和抑郁障碍共病患者除敌对外，躯体化、强迫、人际、抑郁、焦虑、恐怖、偏执、精神病性等因子得分和总分均显著高于抑郁组（P〈0．01）。结论：焦虑和抑郁障碍共病患者心理健康水平较单纯抑郁症和焦虑症患者下降程度更明显。     

焦虑和抑郁障碍共病患者与抑郁症及焦虑症患者心理健康状况对比

目的:探讨焦虑和抑郁障碍共病患者与抑郁症和焦虑症患者心理健康状况下降的差异性。方法:选取2003-06/2004-08广州市脑科医院精神科门诊首次就诊的焦虑和抑郁障碍共病患者27例、抑郁症24例和焦虑症患者29例。采用症状自评量表(问卷共90项,每个项目按5级评分,参照全国成人常模标准:因子分<1.8分为正常;1.8～2.0分为轻度异常;2.1～3.0分为中度异常;>3.0分为重度异常),对3组患者分别进行测评,记录总分和9个因子分(包括:躯体化、强迫状态、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性),比较各组间评分的差异。结果:有24例抑郁症患者、29例焦虑症患者和27例焦虑和抑郁障碍共病患者的测评结果纳入分析。①3组患者症状自评量表总分评定结果比较:焦虑和抑郁障碍共病患者明显高于单纯抑郁症患者和焦虑症患者(2.60±0.52,1.86±0.41和1.16±0.35;t=5.76,7.91,P<0.01)。②3组患者症状自评量表各因子分评定结果比较:焦虑和抑郁障碍共病患者躯体化、强迫、人际、抑郁、焦虑、敌对、恐怖、偏执、精神病性等因子得分均显著高于焦虑组(P<0.01);焦虑和抑郁障碍共病患者除敌对外,躯体化、强迫、人际、抑郁、焦虑、恐怖、偏执、精神病性等因子得分和总分均显著高于抑郁组(P<0.01)。结论:焦虑和抑郁障碍共病患者心理健康水平较单纯抑郁症和焦虑症患者下降程度更明显。     

肝硬化患者睡眠状况与焦虑抑郁发生情况的调查

目的调查分析肝炎后肝硬化患者睡眠状况与焦虑、抑郁发生情况,为采取针对性干预措施提供依据。方法采用睡眠状况自评量表（SRSS）、焦虑自评量表（SAS）、抑郁自评量表（SDS）对72例住院的肝硬化患者进行问卷调查。结果肝硬化患者与全国常模SRSS评分中,睡眠质量、睡眠不稳因子、失眠后反应得分及总分比较差异有统计学意义（P〈0．01或P〈0．05）;不同病程患者失眠情况的比较差异有统计学意义（P〈0．01）;不同性别患者SDS、SAS评定结果的比较差异均有统计学意义（P〈0．05）。70．8％的患者存在不同程度的失眠,高于全国常模45．6％,差异有统计学意义（x2=18．366,P〈0．01）。不同性别肝硬化患者中,有69．44％的患者存在焦虑,女性高于男性;有62．50％的患者存在抑郁,男性高于女性,差异均有统计学意义（P〈0．05）。结论肝炎后肝硬化患者失眠、焦虑、抑郁的存在具有普遍性、特殊性,应引起医护人员的足够重视。     

医院焦虑抑郁量表对慢性阻塞性肺疾病患者焦虑抑郁情绪筛查价值的研究

目的：探讨医院焦虑抑郁量表在慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者焦虑、抑郁情绪筛查中的应用价值,并评估其信度和效度。方法：应用横断面研究方法,选择COPD住院患者200例,对其进行问卷调查。结果：获得有效问卷189份。医院焦虑抑郁量表（HADS）中焦虑、抑郁亚量表得分分别与焦虑自评量表、抑郁自评量表得分呈正相关（P<0.01）;以焦虑自评量表和抑郁自评量表作为诊断“金标准”分别绘制焦虑亚量表和抑郁亚量表的ROC曲线,其曲线下面积分别为0.823（95%CI：0.752~0.881）和0.906（95%CI：0.847~0.948）;医院焦虑抑郁量表总表、焦虑亚量表及抑郁亚量表的内部一致性系数的Cronbach's α分别为0.89, 0.76, 0.83;HADS得分水平与生活质量指数量表呈负相关,证明了其构念效度（P<0.05）。结论：医院焦虑抑郁量表可以可靠、有效地筛查COPD患者的焦虑、抑郁情绪,可以提高临床医务人员对患者不良情绪的筛查效能。     

COPD患者焦虑抑郁情绪非药物治疗的研究进展

焦虑抑郁是COPD患者最常见的负性情绪,与患者疾病预后、生活质量及不良事件的发生关系密切。本文就COPD患者焦虑抑郁的肺康复治疗、认知行为疗法、音乐疗法、中医疗法等非药物治疗方法的研究进展进行综述,并结合临床实际找出目前存在的问题,旨在为COPD患者焦虑抑郁非药物治疗的临床实施提供参考。     

慢性阻塞性肺疾病患者焦虑状况调查及护理干预

目的:探讨慢性阻塞性肺疾病(COPD)患者的焦虑状况及护理干预方法。方法:将60例COPD患者采用随机配对的方法分为观察组和对照组各30例,观察组给予个性化听-唱结合的音乐护理干预,对照组给予常规护理,比较两组患者护理前后焦虑状况、生命体征及住院时间、住院费用。结果:护理干预前两组患者焦虑状况、生命体征比较差异无统计学意义(P>0.05),护理干预后两组患者焦虑状况、生命体征及住院时间、住院费用比较差异均有统计学意义(P<0.05,P<0.01)。结论:个性化听-唱结合的音乐护理干预对COPD患者具有减轻焦虑程度、改善和稳定生命体征、缩短住院时间,减少住院费用的作用,方法简便易行,值得临床借鉴。     

肺康复疗法改善慢性阻塞性肺疾病运动和呼吸功能的临床研究

目的:观察肺康复疗法改善慢性阻塞性肺疾病(COPD)患者运动能力和呼吸困难的临床效果。方法:选取2014年至2018年收治的COPD患者100例,采用随机数字表法将其随机分为对照组( n＝50)和观察组( n＝50)。对照组患者给予常规药物治疗,观察组患者在此基础上增加包含健康指导、氧疗、呼吸生...     

Daily functioning of dyspnea, self-esteem and physical self in patients with moderate COPD before, during and after a first inpatient rehabilitation program

PURPOSE: Inpatient rehabilitation improves dyspnea and increases self-esteem between admission and discharge in patients with moderate chronic obstructive pulmonary disease (COPD). Some researchers nevertheless argue that the changes may be due to nursing effects and thus that scores will decrease quickly at home after discharge. This study assessed the change in dyspnea, self-esteem and physical self mean scores and stability in patients with moderate COPD during three consecutive four-week periods: at home, during an inpatient rehabilitation program, and again at home post-discharge. METHODS: Twenty-three consecutive patients [63.9 years (SD 6.6)] with moderate COPD [FEV1 = 55.8% (SD 13.2)] were included. The participants responded to the Physical Self Inventory and rated dyspnea using a visual analogue scale twice a day. Exercise tolerance was assessed with the six-minute walk test (6MWT) at admission and discharge. RESULTS: 6MWT performance improved between admission and discharge [452.3 m. (SD 74.0) vs. 503.3 m. (SD 80.4), p < 0.001]. Dyspnea ratings improved (p < 0.001), as did the self-esteem and physical self scores between the two home periods (p < 0.001). The group showed less instability (SD and range) in their assessments of physical self-worth at home post-discharge compared to pre-admission (p < 0.01). Before rehabilitation, the correlation coefficients between dyspnea, and self-esteem, the perceptions of physical condition and attractive body were all significant. After rehabilitation, the coefficients between dyspnea, and perceived physical condition, physical strength and sport competence were significant (p < 0.05). CONCLUSIONS: The results suggest that a first rehabilitation program increases the mean physical self scores in patients with moderate COPD and decreases their instability; the program also improves dyspnea. However, the impact of rehabilitation was greater on specific perceptions of physical abilities than on the global self-esteem. Randomized controlled trials are needed to confirm these changes, which were probably due to rehabilitation program.     

Daily functioning of dyspnea,self-esteem and physical self in patients with moderate COPD before,during and after a first inpatient rehabilitation program

Purpose. Inpatient rehabilitation improves dyspnea and increases self-esteem between admission and discharge in patients with moderate chronic obstructive pulmonary disease (COPD). Some researchers nevertheless argue that the changes may be due to nursing effects and thus that scores will decrease quickly at home after discharge. This study assessed the change in dyspnea, self-esteem and physical self mean scores and stability in patients with moderate COPD during three consecutive four-week periods: at home, during an inpatient rehabilitation program, and again at home post-discharge.

Methods. Twenty-three consecutive patients [63.9 years (SD 6.6)] with moderate COPD [FEV₁ = 55.8% (SD 13.2)] were included. The participants responded to the Physical Self Inventory and rated dyspnea using a visual analogue scale twice a day. Exercise tolerance was assessed with the six-minute walk test (6MWT) at admission and discharge.

Results. 6MWT performance improved between admission and discharge [452.3 m. (SD 74.0) vs. 503.3 m. (SD 80.4), p < 0.001]. Dyspnea ratings improved (p < 0.001), as did the self-esteem and physical self scores between the two home periods (p < 0.001). The group showed less instability (SD and range) in their assessments of physical self-worth at home post-discharge compared to pre-admission (p < 0.01). Before rehabilitation, the correlation coefficients between dyspnea, and self-esteem, the perceptions of physical condition and attractive body were all significant. After rehabilitation, the coefficients between dyspnea, and perceived physical condition, physical strength and sport competence were significant (p < 0.05).

Conclusions. The results suggest that a first rehabilitation program increases the mean physical self scores in patients with moderate COPD and decreases their instability; the program also improves dyspnea. However, the impact of rehabilitation was greater on specific perceptions of physical abilities than on the global self-esteem. Randomized controlled trials are needed to confirm these changes, which were probably due to rehabilitation program.     

肝移植患者的焦虑、抑郁状态评估

目的：对肝移植患者术前及术后不同时间的焦虑、抑郁状态进行评估。 方法：选择2002-03／2004-12在解放军兰州军区乌鲁木齐总医院普外科和解放军第四军医大学西京医院肝胆外科接受肝移植、并有完整的临床资料和术后随访资料的7例患者做为观察对象。应用焦虑自评量表和抑郁自评量表对患者术前1周和术后15d、1，2，6及12个月不同时间段的焦虑、抑郁状态进行评估。焦虑自评量表用于评定焦虑患者的主观感受，该量表有20个项目，主要的评定依据为项目所定义症状的出现频度，均按4级评分。抑郁自评量表用于衡量抑郁状态的轻重程度及其在治疗中的变化。由20个陈述句和相应问题条目组成。每一条目相当于一个有关症状，按1-4级评分。患者均在住院期间和出院后定期复查时自愿完成量表测评。评估标准：焦虑或抑郁分值〉71分为重度焦虑或抑郁；56～70分为中度焦虑或抑郁；41～55分为轻度焦虑或抑郁；≤40分为无焦虑或抑郁。对不同时间点的焦虑或抑郁的平均分数的比较采用One—WayANOVA过程。 结果：7例患者均完成全部测评进入结果分析。随访时间1年，随访率100％。在术前1周和术后15d、1，2，6及12个月，焦虑平均分数分别为：（45．57&;#177;5．94），（55．14&;#177;9．01），（68．14&;#177;7．52），（69．29&;#177;7．25），（57．43&;#177;4．76），（43．29&;#177;5．15）分；抑郁平均分数分别为：（41．14&;#177;6．69），（57．43&;#177;6．55），（63．14&;#177;5．49），（60．43&;#177;7．76），（55．86&;#177;4．88），（48．57&;#177;4．99）分。肝移植术后焦虑和抑郁逐渐增加，其中焦虑评分在术后2个月达最高，明显高于术前1周，差异具有显著性（t=-6．723，P〈0．01）；抑郁评分在术后1个月达最高，明显高于术前1周，差异具有显著性（t=-4．977，p〈0．01）。而后两者均逐渐下降，到术后12个月焦虑评分较术前1周有所下降，但差异无显著性意义（t=0．769，P〉0．05）；抑郁评分仍明显高于术前1周，差异有显著性意义（t=-2．353，P〈0．05）。 结论：肝移植患者在术后1，2个月内焦虑和抑郁症状最为明显，应加强此期间内的心理干预，促进患者的康复，提高患者的生活质量。     

肝移植患者的焦虑、抑郁状态评估

目的:对肝移植患者术前及术后不同时间的焦虑、抑郁状态进行评估。方法:选择2002-03/2004-12在解放军兰州军区乌鲁木齐总医院普外科和解放军第四军医大学西京医院肝胆外科接受肝移植、并有完整的临床资料和术后随访资料的7例患者做为观察对象。应用焦虑自评量表和抑郁自评量表对患者术前1周和术后15d、1,2,6及12个月不同时间段的焦虑、抑郁状态进行评估。焦虑自评量表用于评定焦虑患者的主观感受,该量表有20个项目,主要的评定依据为项目所定义症状的出现频度,均按4级评分。抑郁自评量表用于衡量抑郁状态的轻重程度及其在治疗中的变化。由20个陈述句和相应问题条目组成。每一条目相当于一个有关症状,按1～4级评分。患者均在住院期间和出院后定期复查时自愿完成量表测评。评估标准:焦虑或抑郁分值>71分为重度焦虑或抑郁;56～70分为中度焦虑或抑郁;41～55分为轻度焦虑或抑郁;≤40分为无焦虑或抑郁。对不同时间点的焦虑或抑郁的平均分数的比较采用One-WayANOVA过程。结果:7例患者均完成全部测评进入结果分析。随访时间1年,随访率100%。在术前1周和术后15d、1,2,6及12个月,焦虑平均分数分别为:(45.57±5.94),(55.14±9.01),(68.14±7.52),(69.29±7.25),(57.43±4.76),(43.29±5.15)分;抑郁平均分数分别为:(41.14±6.69),(57.43±6.55),(63.14±5.49),(60.43±7.76),(55.86±4.88),(48.57±4.99)分。肝移植术后焦虑和抑郁逐渐增加,其中焦虑评分在术后2个月达最高,明显高于术前1周,差异具有显著性(t=-6.723,P<0.01);抑郁评分在术后1个月达最高,明显高于术前1周,差异具有显著性(t=-4.977,P<0.01)。而后两者均逐渐下降,到术后12个月焦虑评分较术前1周有所下降,但差异无显著性意义(t=0.769,P>0.05);抑郁评分仍明显高于术前1周,差异有显著性意义(t=-2.353,P<0.05)。结论:肝移植患者在术后1,2个月内焦虑和抑郁症状最为明显,应加强此期间内的心理干预,促进患者的康复,提高患者的生活质量。     

Exercise therapy improves both mental and physical health in patients with major depression

Abstract

Purpose: to present clinical guidelines for exercise therapy in depressed patients derived from recent meta-analyses. Method: four meta-analyses on effects of physical exercise on mental and physical in depression were analysed. Results: For mild to moderate depression the effect of exercise may be comparable to antidepressant medication and psychotherapy; for severe depression exercise seems to be a valuable complementary therapy to the traditional treatments. Depression is associated with a high incidence of co-morbid somatic illnesses, especially cardiovascular diseases, type 2 diabetes and metabolic syndrome. Exercise is extremely powerful in preventing and treating these diseases. Physical exercise is an outstanding opportunity for the treatment of patients who have a mix of mental and physical health problems. Exercise therapy also improves body image, patient s coping strategies with stress, quality of life and independence in activities of daily living in older adults. Conclusions: Physical therapists should be aware, that several characteristics of major depression (e.g. loss of interest, motivation and energy, generalised fatigue, a low self-worth and self-confidence, fear to move, and psychosomatic complaints) and physical health problems interfere with participation in exercise. Therefore, motivational strategies should be incorporated in exercise interventions to enhance the patients' motivation and adherence in exercise programs.

• Implications for Rehabilitation

• For mild to moderate depression, the effect of exercise may be comparable with antidepressant medication and psychotherapy; for severe depression, exercise seems to be a valuable complementary therapy to the traditional treatments.

• Exercise therapy also improves physical health, body image, patient’s coping strategies with stress, quality of life, and independence in activities of daily living in older adults.

• Motivational strategies should be incorporated in exercise interventions to enhance the patients’ motivation.

     

终末期肾病行血液透析患者述情障碍及焦虑抑郁状态的影响和护理对策

【】 目的 探讨团体心理辅导对行血液透析患者发生述情障碍的影响效果以及对患者发生焦虑、抑郁状态的干预结果。方法 抽取四川大学华西医院血液透析中心,长期规律透析的终末期肾病患74名,按初次行透析治疗时间先后顺序分为观察组(39名)和对照组(35名)。观察组患者在知情同意前提下接受8次(1周/次)的团体心理辅导,对照组给予常规的心理护理及健康指导。在干预前后以及干预后第8周,使用多伦多述情障碍量表(Toronto Alexithymia Scale-20,TAS-20)、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)及汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)对两组患者进行调查。结果 两组患者的述情障碍得分、焦虑、抑郁状态的差异无统计学意义(P>0.05);干预后,观察组患者的述情障碍得分、焦虑、抑郁状态低于对照组,有统计学意义(P<0.05)。结论 行血液透析治疗的患者,在述情障碍、焦虑、抑郁水平均较高,通过团体心理辅导,可显著改善患者的述情障碍、焦虑和抑郁的状态,值得在护理流程设计中进行使用和优化。