经皮穴位电刺激联合下肢运动训练在COPD患者肺康复中的应用

The application of transcutaneous electrical acupoint stimulation combined with lower limb exercise training in pulmonary rehabilitation of COPD patients

目的探究经皮穴位电刺激(TEAS)联合下肢运动训练在慢性阻塞性肺疾病(COPD)患者肺康复中的应用效果。方法随机数表法将湖南省人民医院2022年6月-2023年1月就诊的60例COPD稳定期患者分为实验组(n=30)与对照组(n=30),分别接受TEAS+下肢运动训练、单一下肢运动训练干预,均干预4周。比较2组干预前后呼吸功能[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、最大吸气压(MIP)、最大呼气压(MEP)]、相关症状评分[改良英国医学研究学会呼吸困难指数(mMRC)、COPD自我评估测试(CAT)、主观体力感等级量表(Brog)、肺康复评定指数(BODE)]、运动耐力[通过6 min步行距离(6MWD)]、炎症因子[白细胞介素-6(IL-6)、IL-8、高敏C反应蛋白(hs-CRP)]。结果干预前,2组FEV1、FVC、FEV1/FVC、MIP、MEP、mMRC、CAT、Brog、BODE、6MWD、IL-6、IL-8、hs-CRP水平比较差异均无统计学意义(P均>0.05)。干预4周后,2组FEV1、FVC、FEV1/FVC、MIP、MEP、6MWD比干预前明显升高,mMRC、CAT、Brog、BODE评分以及IL-6、IL-8、hs-CRP水平比干预前明显降低,差异均有统计学意义(P均<0.05);且实验组FEV1、FVC、FEV1/FVC、MIP、MEP、6MWD[(2.00±0.29)L、(2.75±0.38)L、(72.88±6.13)%、(8.50±0.99)Pa、(9.69±1.06)Pa、(482.52±29.98)m]高于对照组[(1.67±0.26)L、(2.37±0.39)L、(69.06±4.21)%、(7.44±0.60)Pa、(8.55±0.88)Pa、(416.14±26.15)m],mMRC、CAT、Brog、BODE评分以及IL-6、IL-8、hs-CRP水平[(1.27±0.52)分、(15.40±3.23)分、(2.10±0.76)分、(2.30±0.65)分、(2.04±0.48)μg/L、(3.03±0.55)μg/L、(2.70±0.53)mg/L]低于对照组[(1.70±0.47)分、(19.13±3.56)分、(2.67±0.71)分、(3.00±0.74)分、(2.46±0.43)μg/L、(3.89±0.83)μg/L、(3.68±0.19)mg/L],差异均有统计学意义(t=4.656、3.885、2.810、5.042、4.544、9.139、-3.396、-4.252、-2.984、-3.881、-3.564、-4.685、-4.661,P均<0.05)。结论TEAS联合下肢运动训练用于COPD稳定期患者肺康复,能明显减轻其临床症状及炎症反应,改善肺功能,提高运动耐力。

Objective To explore the effect of transcutaneous electrical acupoint stimulation(TEAS)combined with lower limb exercise training in pulmonary rehabilitation of patients with chronic obstructive pulmonary disease(COPD).Methods A total of 60 cases of stable COPD patients treated in the Hunan Provincial People's Hospital from June 2022 to January 2023 were divided into experimental group(n=30)and control group(n=30)by the random number table method.They were intervened by TEAS+lower limb exercise training and lower limb exercise training alone,respectively,and were both intervened for 4 weeks.Respiratory function[forced expiratory volume one second(FEV1),forced vital capcacity(FVC),FEV1/FVC,maximum inspiratory pressure(MIP),maximal expiratory pressure(MEP)],scores of associated symptoms[modified medical research council(mMRC)],COPD assessment test(CAT),subjective physical sensation rating scale(Brog),body mass index,airflow obstruction,dyspnea,exercise capacity(BODE)],exercise endurance[6-minutes walk distance(6MWD)],inflammatory factor[interleukin-6(IL-6),IL-8,high-sensitive C-reactive protein(hs-CRP)]were evaluated before and after intervention.Results Before intervention,there were no significant differences in FEV1,FVC,FEV1/FVC,MIP,MEP,mMRC,CAT,Brog,BODE,6MWD,IL-6,IL-8,hs-CRP levels between the two groups(all P>0.05).After 4 weeks of intervention,the levels of FEV1,FVC,FEV1/FVC,MIP,MEP,6MWD were significantly increased;the scores of mMRC,CAT,Brog,BODE and the levels of IL-6,IL-8,hs-CRP were significantly decreased in both groups,with statistically significant differences(all P<0.05);the levels of FEV1,FVC,FEV1/FVC,MIP,MEP,6MWD in the experimental group[(2.00±0.29)L,(2.75±0.38)L,(72.88±6.13)%,(8.50±0.99)Pa,(9.69±1.06)Pa,(482.52±29.98)m]were higher than those in the control group[(1.67±0.26)L,(2.37±0.39)L,(69.06±4.21)%,(7.44±0.60)Pa,(8.55±0.88)Pa,(416.14±26.15)m];the scores of mMRC,CAT,Brog,BODE and the levels of IL-6,IL-8,hs-CRP in the experimental group[(1.27±0.52)score,(15.40±3.23)score,(2.10±0.76)score,(2.30±0.65)score,(2.04±0.48)μg/L,(3.03±0.55)μg/L,(2.70±0.53)mg/L]were lower than those in the control group[(1.70±0.47)score,(19.13±3.56)score,(2.67±0.71)score,(3.00±0.74)score,(2.46±0.43)μg/L,(3.89±0.83)μg/L,(3.68±0.19)mg/L],with statistically significant differences(t=4.656,3.885,2.810,5.042,4.544,9.139,-3.396,-4.252,-2.984,-3.881,-3.564,-4.685,-4.661,all P<0.05).Conclusion TEAS combined with lower limb exercise training could significantly reduce clinical symptoms and inflammatory reactions,improve lung function and exercise endurance in stable COPD patients.