郑氏卧位康复操联合呼吸排痰阀对重度慢性阻塞性肺疾病患者的疗效观察

  目的  探讨重度慢性阻塞性肺疾病(COPD)患者进行郑氏卧位康复操联合呼吸排痰阀训练的临床效果。  方法  收集2020年10月—2021年2月蚌埠市第三人民医院呼吸内科治疗的重度慢性阻塞性肺疾病急性加重期(AECOPD)患者62例，采用随机数字表法分为观察组(31例)和对照组(31例)，均给予抗感染、解痉祛痰、氧疗等基础治疗。对照组进行缩唇腹式康复治疗，观察组采用郑氏卧位康复操联合呼吸排痰阀治疗，研究周期为12周。观察2组患者干预前后第1秒用力呼气容积(FEV₁)、用力肺活量(FVC)、第1秒用力呼气容积与用力肺活量的比值(FEV₁/FVC)、CRP、IL-6、CD3+、CD4+、CD45+、慢性阻塞性肺疾病评估测试(CAT)及改良英国医学研究学会呼吸困难量表(mMRC)。  结果  干预后，观察组IL-66.11(0.82，10.83)pg/mL]和CRP9.15(2.15，18.91)mg/L]较对照组显著降低8.64(5.41，15.54)pg/mL、18.64(6.49，26.15)mg/L，均P < 0.05]，CD3+、CD4+及CD45+较对照组显著升高(均P < 0.05)，CAT评分(28.03±4.53)分]和mMRC分级(3.10±0.70)级]较对照组改善(28.77±4.31)分、(3.45±0.62)级，均P < 0.05]，干预前后2组FEV₁、FVC、FEV₁/FVC差异均无统计学意义(均P>0.05)。  结论  郑氏卧位康复操联合呼吸排痰阀能够有效减轻患者的炎症反应，增强机体免疫功能，改善患者的呼吸困难症状，使肺功能维持稳定。 

Clinical observation of Zheng's clinostatic rehabilitation exercise combined with respiratory expectoration valve on patients with severe chronic obstructive pulmonary disease

  Objective  To investigate the clinical effect of Zheng's clinostatic rehabilitation exercise combined with breathing and expelling valve training in patients with severe chronic obstructive pulmonary disease.  Methods  A total of 62 patients with acute exacerbation of severe chronic obstructive pulmonary disease (AECOPD) admitted to the Respiratory Department of Bengbu Third People's Hospital from October 2020 to February 2021 were divided into observation group (n=31) and control group (n=31) by random number table method. All patients were given basic treatment such as anti-infection, antispasmolysis and expectoration and oxygen therapy. The control group received lip-shrinking abdominal rehabilitation treatment, and the observation group received Zheng's clinostatic rehabilitation exercise combined with respiratory expectoration valve. The study period was 12 weeks. Forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC, CRP, IL-6, CD3+, CD4+, CD45+, COPD assessment test (CAT) and modified British medical research council (mMRC) were observed in the two groups before and after intervention.  Results  After intervention, the levels of IL-6 6.11(0.82, 10.83) pg/mL] and CRP 9.15(2.15, 18.91) mg/L] in the observation group were significantly lower than those in the control group 8.64(5.41, 15.54) pg/mL, 18.64(6.49, 26.15) mg/L, all P < 0.05]. The levels of CD3+, CD4+ and CD45+ in the observation group were significantly higher than those in control group (all P < 0.05). CAT (28.03±4.53) points] and mMRC (3.10±0.70) in the observation group was improved compared with that in the control group (28.77±4.31) points, 3.45±0.62, all P < 0.05]. No significant differences in FEV₁, FVC and FEV₁/FVC were found in the two groups before and after intervention (all P>0.05).  Conclusion  Zheng's clinostatic rehabilitation exercise combined with respiratory expectoration valve can effectively reduce inflammatory response, enhance immune function, improve dyspnoea and maintain stable lung function.