离心运动与空中踏车加腹式呼吸训练对稳定期COPD患者运动能力和心肺耐力影响的比较研究

Comparative study of effects of centrifugal exercise and air treadmill combined with abdominal breathing training on exercise ability and cardiopulmonary endurance in stable COPD patients

目的比较离心运动与空中踏车加腹式呼吸训练对稳定期慢性阻塞性肺疾病(COPD)患者运动能力、心肺耐力的影响,为稳定期COPD患者的康复提供更适宜的训练技术。方法选择2019年3月—2022年3月本院收治的92例稳定期COPD患者,随机分为观察组、对照组,剔除脱落病例后,最终2组各43例纳入研究。观察组进行离心运动训练,对照组进行空中踏车+腹式呼吸训练。分别于训练前、训练后4周检测2组一秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、一秒率(FEV_(1)/FVC)、FEV_(1)占预计值百分比(FEV_(1)%pred)、最大自主通气量(MVV)、最大摄氧量(VO_(2)_(max))、最大公斤摄氧量(VO_(2)_(max)/kg)、最大分钟通气量(VE_(max))、最大心率(HR_(max))、氧脉搏(O_(2)/HR)、无氧阈(AT)、心脏指数(CI)、射血分数(EF)、心输出量(CO)、肺动脉压(PAP)水平;记录训练前、训练后2周和训练后4周2组膝关节活动度、步行速度、肌酸激酶(CK)水平;比较训练前、训练后4周2组圣乔治呼吸问卷(SGRQ)评分。结果训练后观察组FVC、MVV水平分别为(2.92±0.51)L、(56.81±9.06)L,对照组分别为(2.68±0.53)L、(52.75±9.33)L,差异均有统计学意义(t分别为2.140、2.047,P均<0.05);训练后观察组VO_(2)_(max)、VO_(2)_(max)/kg、VE_(max)、AT分别为(1.71±0.42)L、(23.62±4.85)mL/kg、(49.66±9.13)L、(13.86±3.28)mL/(kg·min),对照组分别为(1.53±0.36)L、(21.46±3.52)mL/kg、(45.58±9.25)L、(15.65±3.89)mL/(kg·min),差异均有统计学意义(t分别为2.134、2.364、2.059、2.307,P均<0.05);训练后2组的CI、EF、CO、PAP比较,差异均有统计学意义(P<0.05);训练后4周观察组膝关节活动度、步行速度、CK水平分别为(71.48±6.22)°、(0.75±0.09)m/s、(206.37±34.45)IU/L,对照组分别为(68.59±5.39)°、(0.62±0.22)m/s、(181.06±39.74)IU/L,差异均有统计学意义(t分别为2.303、3.586、3.156,P均<0.05);2组呼吸症状、活动能力、疾病影响评分和总分比较,差异均有统计学意义(P<0.05)。结论离心运动训练用于COPD稳定期患者有利于改善患者的运动能力和心肺耐力,加速其康复,提高其生活质量。

Objective To compare the effects of centrifugal exercise and air treadmill combined with abdominal breathing training on the exercise ability and cardiopulmonary endurance of patients with stable chronic obstructive pulmonary disease(COPD),and provide more suitable training techniques for the rehabilitation of patients with stable COPD.Methods Ninety-two patients with stable COPD admitted to our hospital from March 2019 to March 2022 were divided into an observation group and a control group by double-blind method.After removing shedding cases,43 cases in each group were finally included in the study.The observation group received centrifugal exercise training,and the control group received air treadmill+abdominal breathing training.Forced expiratory volume(FEV_(1))in one second,forced vital capacity(FVC),one-second rate(FEV_(1)/FVC),FEV_(1)percentage of the expected value(FEV_(1)%pred),maximum autonomous ventilation volume(MVV),maximum oxygen uptake(VO_(2)_(max)),and maximum oxygen uptake in kilograms(VO_(2)_(max)),maximum minute ventilation(VE_(max)),maximum heart rate(HR_(max)),oxygen pulse(O_(2)/HR),anaerobic threshold(AT),cardiac index(CI),ejection fraction(EF),cardiac output(CO),pulmonary artery pressure(PAP)level were detected in both groups before and 4 weeks after training,respectively.Knee joint motion,walking speed,and creatine kinase(CK)level were recorded before training,2 weeks after training,and 4 weeks after training.St.George’s Breathing Questionnaire(SGRQ)scores were recorded for both groups before and 4 weeks after training.Results After training,the levels of FVC and MVV were(2.92±0.51)L and(56.81±9.06)L in the observation group,and(2.68±0.53)L and(52.75±9.33)L in the control group,respectively,with statistical significance(t=2.140、2.047,both P<0.05).After training,the VO_(2)_(max),VO_(2)_(max)/kg,VE_(max),and AT of the observation group were(1.71±0.42)L,(23.62±4.85)mL/kg,(49.66±9.13)L,and(13.86±3.28)mL/(kg·min),respectively,and those of the control group were(1.53±0.36)L,(21.46±3.52)mL/kg,(45.58±9.25)L,and(15.65±3.89)mL/(kg·min)respectively,with statistical significance(t=2.134,2.364,2.059,2.307,all P<0.05).After training,there were significant differences in CI,EF,CO,and PAP between the two groups(P<0.05).Knee joint motion,walking speed,and CK level in the observation group were(71.48±6.22),(0.75±0.09)m/s,and(206.37±34.45)IU/L,respectively,4 weeks after training,and those in the control group were(68.59±5.39)°,(0.62±0.22)m/s,and(181.06±39.74)IU/L,respectively,and the differences were statistically significant(t=2.303,3.586,3.156,all P<0.05).There were significant differences in respiratory symptoms,mobility,disease impact scores,and total scores between the two groups(all P<0.05).Conclusion Centrifugal exercise training for patients with stable COPD is beneficial to improve their exercise ability and cardiopulmonary endurance,accelerate rehabilitation,and improve their quality of life.