上肢联合下肢运动训练对老年慢性阻塞性肺疾病稳定期患者运动心肺功能的影响

Effects of Upper-Limb and Lower-Limb Exercise Training in Elderly Patients with Chronic Obstructive Pulmonary Disease

目的探讨不同运动训练方式对老年COPD稳定期患者运动心肺功能的影响和症状改善情况。方法 54例稳定期老年COPD门诊患者随机分为对照组15例,下肢组20例,上肢+下肢组19例。运动训练组除常规内科治疗外进行相应的运动训练,持续16周。对照组15例,给予内科常规药物治疗。训练前后分别评价患者的静息肺功能、运动心肺试验、Borg呼吸困难评分。结果 COPD患者训练前后静息肺功能无明显差异(P>0.05);运动训练组在运动耐力、呼吸困难评分较自身康复前水平明显改善(P<0.05),较对照组明显改善(P<0.05);上肢+下肢组通气水平(VE@50%VO2max)得到明显的改善(4.81±0.70比2.49±1.15,P<0.001);运动训练组的呼吸储备较对照组明显提高(P<0.01),上肢+下肢组更为显著(9.79±1.57比-1.36±2.82,P<0.001);上下肢联合组康复前后的换气功能(VD/VT)略有改善(P<0.05);康复后Borg评分与康复后FEV1%pred、BR、VO2/kg相关[Borg=9.516-0.174×FEV1%pred-0.156×(VO2/kg)-0.023×BR]。结论上肢运动联合下肢运动能显著改善患者的有氧代谢能力和通气水平,从而提高患者的运动耐量。

Objective To evaluate the effects of different ways of exercise training on elderly patients with chronic obstructive pulmonary disease(COPD),which focuse on the changes of cardiopulmonary exercise function and COPD symptoms.Methods 54 cases of elderly patients with stable COPD were randomly allocated to a control(15 cases),a lower-limb(20 cases),or a upper-Limb and lower-Limb combined exercise group(19 cases).All patients received conventional medical therapy.Meanwhile,the exercise groups received training for 16 weeks.The improvements of resting spirometry,cardiopulmonary exercise test(CPET),and dyspnea(Borg scale rating) were evaluated before and after the training scheme.Results There was no significant difference in resting spirometry after exercise training(P>0.05).Exercise tolerance and Borg scale were improved in both exercise groups significantly than baseline(P>0.05) and the control group(P>0.05).VE@50%VO2max was improved significantly in the combined group(4.81±0.70 vs.2.49±1.15,P<0.001).Breathing reserve(BR) was elevated in both exercise groups than the control(P<0.01),and the improvement in the combined group was more significant(9.79±1.57 vs.-1.36±2.82,P<0.001).Gas exchange response(VD/VT) was slightly improved after rehabilitation in the combined group(P<0.05).Borg scale after rehabilitation was correlated with FEV1%pred,BR,and VO2/kg after rehabilitation[Borg=9.516-0.174×FEV1%pred-0.156×(VO2/kg)-0.023×BR].Conclusions Upper-limb combined with lower-limb exercise training can markedly improve the level of aerobic capacity and ventilation in elderly patients with stable COPD,and then improve the exercise tolerance.