呼吸训练器在稳定期慢性阻塞性肺疾病患者肺康复中的临床应用疗效分析

目的:探讨呼吸训练器对稳定期慢性阻塞性肺疾病(CPOD)患者的临床应用价值。方法:稳定期COPD患者40例,随机分为观察组和对照组各20例。2组均接受常规的药物治疗,观察组在此基础上利用呼吸训练器进行肺康复训练,分别收集使用前、使用至4和24周时的改良英国医学研究委员会呼吸困难量表(mMRC)、COPD评估测试(CAT)、6min步行试验(6MWT)、肺功能(FEV1%pred)、C反应蛋白(CRP)和白介素6(IL-6)等数据进行对比分析。结果:经肺康复训练后,观察组在治疗4周时mMRC、CAT、CRP和IL-6均较治疗前明显降低(均P<0.05),但持续使用到24周时,mMRC和CAT未观察到持续下降趋势,CRP和IL-6呈现持续下降;观察组治疗4和24周时的mMRC、CAT、CRP和IL-6均低于对照组(均P<0.05)。对照组在治疗4和24周时的mMRC、CAT、CRP和IL-6较治疗前呈持续增高趋势(均P<0.05);2组自身各时间点比较存在统计学差异(P<0.05)。进一步的重复测量设计方差分析中,分组和时间两个因素均对上述结果存在影响,即存在交互效应。观察组在治疗4周时6MWT及FEV1%pred均较治疗前明显提高(均P<0.05),但持续使用到24周时未进一步观察到持续增加趋势;观察组在治疗4和24周时的6MWT及FEV1%pred均高于对照组(均P<0.05)。对照组在治疗4和24周时6MWT及FEV1%pred均较治疗前呈现持续下降趋势(均P<0.05);2组自身各时间点比较存在统计学差异(P<0.05)。进一步的重复测量设计方差分析中,时间因素占据主效应,对上述结果存在影响。结论:临床上,利用呼吸训练器对稳定期COPD患者进行肺康复训练,能在短时间内改善患者的症状、实验室检查结果和肺功能,但长时间的效果较差。

Clinical effectiveness of breathing trainer in stable chronic obstructive pulmonary disease patients

Objectives: To explore the application value of breathing trainer for patients with chronic obstructive pulmonary disease (COPD) in stable period. Methods: Forty patients with stable COPD were randomly divided into observation group and control group with 20 cases in each group. The two groups received routine medication. The observation group was given breathing trainer for pulmonary rehabilitation training. Data of modified British Medical Research Council Dyspnea Scale (mMRC), COPD Assessment Test (CAT), 6 minute walking test (6MWT), lung function(FEV1%pred), C reactive protein (CRP) and interleukins 6 (IL 6) were collected and analyzed before and 4, 24 weeks after use of breathing trainer. Results: After pulmonary rehabilitation training, mMRC, CAT, CRP and IL 6 in the observation group were significantly lower than those before treatment (P<0.05) after use for 4 weeks. After use for 24 weeks, no further decrease was observed in mMRC and CAT, while CRP and IL 6 showed a continuous decline. The mMRC, CAT, CRP and IL 6 in the observation group after use for 4 and 24 weeks were significantly lower than those in the control group (P<0.05). In the control group, mMRC, CAT, CRP and IL 6 increased continuously after use for 4 and 24 weeks (P<0.05). There were statistically significant differences between the two groups at each time point (P<0.05). In the further analysis of variance of repeated measurement design, both grouping and time factors had an effect on the above results, that was, there was interaction effect. The 6MWT and FEV1%pred in the observation group were significantly higher than those in the control group after use for 4 (P<0.05), but no further increasing trend was observed after continuous use of 24 weeks. The 6MWT and FEV1%pred in the observation group at 4th and 24th week of treatment were significantly increased as compared with those in the control group (P<0.05). The 6MWT and FEV1%pred in the control group decreased continuously at 4th and 24th week after treatment (P<0.05). There were statistically significant differences between the two groups at each time point (P<0.05). In the further analysis of variance of repeated measurement design, the time factor was the main factor, which had an effect on the above results. Conclusion: Clinically, the pulmonary rehabilitation using breathing trainer for patients with COPD in stable period can improve the patient''s symptoms, laboratory examination results and lung function in the short term. But the effect is not good in long term.