以呼吸生理为导向呼吸运动锻炼对慢性阻塞性肺疾病呼吸肌功能及运动耐力的影响

Effects of respiratory training in relation to respiratory pathophysiology on respiratory muscle function and exercise tolerance in chronic obstructive pulmonary disease patients

背景:以往报道证实缩唇呼吸可以改善慢性阻塞性肺疾病患者气促症状和运动耐力的非药物治疗方法。目的:试验以缩唇呼吸为对照,拟观察呼吸生理为导向呼吸运动训练对慢性阻塞性肺疾病患者呼吸肌功能及运动耐力的影响。设计、时间及地点:随机对照分组设计,于2006-10/2007-12在湖南省怀化市第二人民医院完成。参试者:按2006年慢性阻塞性肺疾病全球倡议标准选择60例慢性阻塞性肺疾病急性加重期患者,男51例,女9例。方法:采用前瞻、随机、对照的方法将60例患者分为3组,实验组患者给予以呼吸生理为导向的呼吸运动训练8周,3次/d,15min/次;阳性对照组患者给予缩唇呼吸运动训练8周,3次/d,15min/次;阴性对照组患者不给予呼吸运动训练,每组20例。主要观察指标:呼吸困难MRC评分、日常生活活动能力、生存质量、6min步行距离、最大呼气口腔压和最大吸气口腔压。结果:实验组、阳性对照组和阴性对照组在呼吸运动训练过程中退出试验的分别有3,5,5例。①实验组和阳性对照组呼吸运动训练后的MRC评分均比各自呼吸运动训练前下降(P<0.01);日常生活活动能力评分、6min步行距离、最大呼气口腔压和最大吸气口腔压均比各自呼吸运动训练前增加(P<0.01,P<0.05),其中实验组呼吸运动训练后的日常生活活动能力评分、6min步行距离、最大呼气口腔压和最大吸气口腔压比阳性对照组增加(P<0.05)。②实验组和阳性对照组呼吸运动训练前、后各项生存质量评分差异均有非常显著性意义(P<0.01,P<0.05)。结论:以呼吸生理为导向的呼吸运动训练能明显改善重度至极重度慢性阻塞性肺疾病患者的呼吸困难、提高生活活动能力和生存质量、增加运动耐力和呼吸肌功能。

BACKGROUND： Shrinkage lip respiration can improve breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease （COPD）. OBJECTIVE： Shrinkage lip respiration is considered as control. This study serves to investigate the respiratory training in relation to respiratory pathophysiology effects on respiratory muscle function and exercise tolerance in COPD patients. DESIGN, TIME AND SETTING： The randomized control grouping experiment was performed at the Second People＇s Hospital from October 2006 to December 2007. PARTICIPANTS： The acute and severe 60 patients with COPD on the basis of Global Initiative for Chronic Obstructive Lung Disease （2006） were selected in this study, including 51 males and 9 females. METHODS： A total of 60 patients were divided into three groups by randomized control trial. Patients in the experimental group were subjected to respiratory training on the basis of respiratory pathophysiology, three times a day, once 15 minutes, for 8 weeks. Patients in the positive control group were given respiratory training with shrinkage lip respiration, three times a day, once 15 minutes, for 8 weeks. Patients in the negative control group did not receive respiratory training. Each group consisted of 20 individuals. MAIN OUTCOME MEASURES： Medical research council scale, activities of daily living, quality of life, 6-minute walking distance, maximal expiratory pressure and maximal inspiratory pressure. RESULTS： A total of 3, 5 and 5 patients dropped out this study respectively in the experimental, positive control and negative control groups. Medical research council scale grade after respiratory training was lower than that before respiratory training in the experimental group and the positive control group （P 〈 0.01）. Activities of daily living, 6-minute walking distance, maximal expiratory pressure and maximal inspiratory pressure increased compared with that before respiratory training （P 〈 0.01, P 〈 0.05）. After respiratory training, activities of daily living, 6-rninute walking distance, maximal expiratory pressure and maximal inspiratory pressure increased in the experimental group compared with the positive control group （P 〈 0.05）. Compared with that before respiratory training, significant differences in each index were detected after respiratory training in the experimental and the positive control groups （P 〈 0.01, P 〈 0.05）. CONCLUSION： Respiratory training in relation to respiratory pathophysiology can ameliorate significantly dyspnea, improve activities of daily living, quality of life, exercise tolerance, respiratory muscle function of the severe and very severe patients with COPD.