针对COPD呼气流速受限的康复训练的效果研究

The clinical study of pulmonary rehabilitation toward expiratory airflow limitation of COPD

目的:观察针对COPD呼气流速受限的呼吸康复训练在改善重度至极重度COPD患者呼吸困难、日常生活活动能力、运动耐力、呼吸肌功能及肺功能等方面的效果。方法:按2006年GOLD标准来选择稳定期重度至极重度COPD患者为研究对象,分为A、B、C组,每组20例。在常规治疗的基础上,A组患者接受针对COPD呼气流速受限的呼吸康复训练8周;B组患者接受缩唇呼吸康复训练8周;C组患者无呼吸康复训练。A、B组患者在呼吸康复训练前后和C组患者在8周前后分别测定6MWD、MRC评分、ADL评分、MEP、MIP及肺功能。结果:①A、B组呼吸康复训练后的呼吸困难MRC评分均比其呼吸康复训练前的有非常显著性下降,但两者之间差异无显著性。②A、B组呼吸康复训练后的ADL评分均比其呼吸康复训练前的有显著增加且两者之差异也有显著性。③A、B组呼吸康复训练后的6MWD、MEP、MIP与MVV均比其呼吸康复训练前有非常显著性增加。④A、B两组训练前后的FEV1、FEV1(pred%)、FVC、FVC(pred%)、PEF的差异均无显著性。结论:①针对COPD呼气流速受限的呼吸康复训练能明显改善重度至极重度COPD患者的呼吸困难,提高ADL能力,增加运动耐力和呼吸肌功能。②缩唇呼吸训练是重度至极重度COPD患者进行呼吸康复训练的有效方法之一。③针对COPD呼气流速受限的呼吸康复训练在改善重度至极重度COPD患者的ADL能力、运动耐力、呼吸肌功能等方面不同程度地比缩唇呼吸康复训练更为显著,可认为是重度至极重度COPD患者更为有效的呼吸康复训练的方法。④针对COPD呼气流速受限的呼吸康复训练和缩唇呼吸康复训练除能提高每分钟最大通气量之外,不能明显改善重度至极重度COPD患者的肺功能。

Objective：To observe the clinical effects on dyspnea ,activity of daily living ,exercise tolerance ,respiratory muscle function and pulmonary function in severe and very severe patients with COPD by pulmonary rehabilitation toward expiratory airflow limitation （EAL） of COPD. Method：The severe and very severe patients with COPD by GOLD （2006） were chosen as objects of study in this clinical trial. All enrolled patients were divided into group A, group B and group C in randomized controlled trial. Group A were given pulmonary rehabilitation toward EAL of COPD, group B were given pulmonary rehabilitation with pursed lips breathing （PLB）, both for 8 weeks, thrice a day,15min per times. Group C were given no pulmonary rehabilitation.Every group had 20 patients. Group A and B before and after pulmonary rehabilitation, and group C before and after 8 weeks, were assessed with 6MWD, MRC,ADL,QOL,MEP,MIP and pulmonary function respectively. Result： ①MRC scores in group A and B after pulmonary rehabilitation were very lower than those before pulmonary rehabilitation respectively, but the difference between two groups wasn＇t marked.②ADL scores in group A and B after pulmonary rehabilitation were very higher than those before pulmonary rehabilitation respectively, but the difference between two groups was marked. ③The 6MWD, MEP, MIP and MVV in group A and B after pulmonary rehabilitation were very higher than those before pulmonary rehabilitation respectively, but the difference between two groups was remarkable. ④In group A and Gruop B, before and after pulmonary rehabilitation the difference of FEV1,FEV1 （pred%）,FVC,FVC （pred%）,PEF weren＇t marked, and the difference between two groups wasn＇t marked also.Conclusion： ①The pulmonary rehabilitation toward EAL of COPD could remarkably ameliorate dyspnea, improve ADL, exercises tolerance, respiratory muscle function of severe and very severe patients with COPD. ②The pulmonary rehabilitation with PLB was one of effective methods for severe and very severe patients with COPD. ③The effects of pulmonary rehabilitation toward EAL of COPD in improving ADL, exercises tolerance,respiratory muscle function were better than that with PLB, and it could be considered as a more effective pulmonary rehabilitation method for severe and very severe patients with COPD. ④Pulmonary rehabilitation toward EAL of COPD and pulmonary rehabilitation with PLB couldn＇t improve pulmonary function of severe and very severe patents with COPD remarkably, except MVV.