无氧阈和高强度运动康复对慢性阻塞性肺疾病患者生活质量的影响

The Impact of Pulmonary Rehabilitation on Quality of Life in Patients with COPD:A Comparison of Exercises Intensity in a Maximum Level and a Anaerobic Threshold Level

目的比较无氧阈和高强度肺康复运动方案对中重度COPD患者生活质量的影响。方法采用随机、前瞻、对照的研究方法,将41例稳定期中重度COPD患者随机分为无氧阈组15例,高强度组17例,对照组9例。无氧阈组以无氧阈为运动强度,高强度组采用最大可耐受的运动强度,进行每周2次、共12周的踏车运动康复计划。康复治疗前后分别测定静态肺功能、心肺运动试验及圣.乔治呼吸疾病问卷(SGRQ)评分。结果高强度组的运动强度达到最大预计功率的(69±14)%,无氧阈组运动强度为最大功率的(52±7)%,差异有统计学意义(t=-3.850,P<0.01)。康复治疗后无氧阈组SGRQ总分由(44.1±20.7)分下降至(32.2±16.0)分,高强度组SGRQ总分由(40.9±16.1)分下降至(32.6±16.6)分,两组均获得显著改善(P均<0.05),其改善值分别为(11.9±15.5)U和(8.4±9.5)U,均达到临床显著意义(改善大于4U即为显著)。但两组的改善程度差异无统计学意义(Z=-0.540,P=0.589)。SGRQ各部分评分显示康复治疗后高强度组在症状、影响两方面有统计学显著意义的改善(P均<0.01),无氧阈组的症状在康复后有统计学显著意义的改善(P<0.05),而对照组康复前后四项评分差异均无统计学意义。运动能力的改善与SGRQ各项评分的改善无显著线性相关。结论无氧阈和高强度的肺康复运动方案均可显著改善COPD患者疾病相关生活质量,两种方案比较改善程度无显著差异。

Objective To evaluate the impacts of pulmonary rehabilitation at different levels of exercise intensity on health status of patients with moderate to severe COPD. Methods Thirty-two COPD patients treated with pulmonary rehabilitation by ergometry exercise were randomly assigned to exercise intensity level either by anaerobic threshold （AT group; n = 15 ） or by maximum tolerate [ high intensity group （ HI group ） ; n = 17 ]. Nine COPD patients without exercise training served as control. Bicycle exercise training was conducted in two separate days each week for 12 weeks. Spirometry,cardiopulmonary exercise testing, the St George＇ s Respiratory Questionnaire （ SGRQ ） were accessed before and after the rehabilitation program. Results Exercise intensity （ % Wmax） was significantly higher in HI group than AT group （69% ±14% vs 52% ±7% ,P 〈0. 01 ）. Significant improvement of SGRQ scores after rehabilitation were found both in AT group （ - 11.9± 15.5 U） and HI group （ -8.4 ±9. 5 U）. However,no significant difference was found between the two groups in the degree of improvement （ Z = - 0. 540, P = 0. 589 ）. Symptoms and impacts subscale scores of SGRQ were decreased significantly in HI group, but only symptoms scores decreased significantly in AT group. The control group did not show any significant improvement in SGRQ scores. No statistically significant correlation was found between improvement of peak oxygen consumption per predicted （Vo2peak% pre） and SGRQ scores. Conclusion Both pulmonary rehabilitation strategies by anaerobic threshold and by maximum tolerate can improve health status of COPD patients significantly with no significant difference between each other.