热-磁-振疗法和噻托溴铵联合应用在重度稳定期慢性阻塞性肺疾病患者康复治疗中的价值

The value of pulmonary rehabilitation combined with heat, magnetic vibration and tiotropium in treating stable but severe chronic obstructive pulmonary disease

目的探讨热-磁-振疗法和噻托溴铵联合应用在重度稳定期慢性阻塞性肺疾病（COPD）患者康复治疗中的价值。方法采取平行、对照、随机研究。将37例COPD患者随机分为噻托溴铵组（T组）和噻托溴铵加热-磁-振疗法组（T＋HMV组），研究周期为4周。在治疗前1天、治疗第2周末和第4周末分别进行血气分析、肺功能检查，并通过Borg评分、6rain步行试验（6MWT）、圣·乔治呼吸问卷（SGRQ）对患者总体健康状况进行评价。结果治疗前、后比较，T组吸气容量（IC）明显增高（P〈0．05），第1秒末用力呼气量（FEV1.0）、FEV1.0占预计值百分比、第1秒末用力呼气量／用力肺活量（FEV1.0／FVC）无明显增高；而T＋HMV组FEV1.0、FEV1.0占预计值百分比、FEV1.0／FVC和IC均增高（P〈0．05）；2组间比较，T＋HMV组FEV1.0、FEV1.0占预计值百分比、FEV1.0／FVC均高于T组（P〈0．05）；T组、T＋HMV组PaO2均明显增高（P〈0．05），而PaCO2均无明显变化（P〉0．05）；2组间PaO，和PaCO2差异无统计学意义（P〉0．05）；T组、T＋HMV组6MWD均明显提高，而Borg评分均明显下降（P〈0．05），2组间6MWD和Borg评分差异无统计学意义（P〉0．05）。2组SGRQ下降均超过4分，T＋HMV组SGRQ明显低于T组（P〈0．05）。结论噻托溴铵在重度稳定期COPD患者康复治疗中具有重要的价值；热-磁-振疗法和噻托溴铵联合应用优于单一应用噻托溴铵。

Objective To explore the value of combining pulmonary rehabilitation with heat and magnetic vibration （HMV） therapy and tiotropium for patients with stable but severe chronic obstructive pulmonary disease （COPD）. Methods This was a paralleled, controlled, randomized study. Thirty-seven patients with stable se- vere COPD were enrolled and divided into two groups at random. One was the tiotropium group （T group） , while the other combined tiotropium therapy with HMV （the T ＋ HMV group）. The time span was 4 weeks. The examinations were performed at week 0, week 2 and week 4. The examinations included pulmonary function tests, arterial blood gas analysis, the 6 minute walking test （6MWT） , Borg＇s score and St George＇s Respiratory Questionaire （SGRQ）. Results Inspiratory capacity （IC） increased in both groups. Forced expiratory volume in one second （FEV^0 ） , percent predicted FEV1.0 and FEV~.0/forced vital capacity （FVC） increased significantly only in the T ＋ HMV group. The average parameters of the pulmonary function test in the T ＋ HMV group were significantly higher than in the T group. In both groups, alveolar PO2 （PaO2） improved but alveolar PCO2 （PaCO2 ） did not change and in this there was no significant difference between the groups. The 6 minute walking distance increased and the average Borg score decreased in both groups, and there was no difference between the groups. SGRQ dropped more than 4 scores in both groups, but the decrease in the T ＋ HMV group was significantly greater. Conclusions Tiotropium can play an important role in the rehabilitation of patients with stable severe COPD. The combination of tiotropium with HMV therapy is superior to tiotropium alone in pulmonary rehabilitation for stable but severe COPD patients.