无创呼吸机辅助运动训练对老年重度COPD稳定期的影响

Curative Effects of Exercises Training with Noninvasive Positive Pressure Ventilation Training on Senile Severe Stable COPD

目的探讨无创呼吸机辅助进行上下肢运动训练对重度慢性阻塞性肺疾病(COPD)稳定期老年患者的血压、心率、呼吸、血氧饱和度及症状评分等指标的变化。方法对照组15例患者进行常规内科治疗,运动组15例稳定期COPD患者除内科治疗外,在无创呼吸机辅助下进行上下肢肌力训练,4周后两组均评价血压、心率、呼吸等一般情况,以及非吸氧状态下血氧饱和度和上下肢周径的变化,并进行呼吸困难评分。结果①治疗前后,运动组和对照组的心率、呼吸频率均降低,差异有统计学意义。但两组间比较,运动组的收缩压、心率和呼吸较对照组降低明显,尤其心率和呼吸指标,P<0.01,差异有统计学意义;②运动组非吸氧状态下血氧饱和度提高,与运动前相比差异有统计学意义(P<0.05);③运动训练后呼吸困难有所改善;④下肢大腿周径有增加,但差异无统计学意义(P>0.05)。结论当运动耗氧增加,无创呼吸机辅助通气能保证运动时间和强度,达到肌力训练目的。4周的运动训练对心率、呼吸已有改善,运动耐力和无氧阈提高,症状减轻,改善了生活质量。下肢肌力提高有可能需要更高的运动强度和训练时间才能达到。

Objective To investigate the effects of exercises training with noninvasive positive pressure ventilation（NIPPV） on the blood pressure（ BP）, heart rate （HR）, respiratory rate（ RR）, oxyhemoglobin saturation and symptom score in elderly patients with severe stable chronic obstructive pulmonary disease （COPD）. Methods The control group and the exercises training group were both consisted of 15 cases. Two groups received medicine therapy, while the exercises training group received the training of upper and lower limbs with the help of NIPPV for 4 weeks. The improvements of BP, HR, RR, dyspnea ratings （MRC） and circumferences of upper and lower limbs were compared after 4 weeks prospectively. Assessments were performed before and after the training program. Results HR and RR of two groups reduced, which in the exercises training group were evident （ P 〈 0.01 ）. Index such as oxyhemoglobin saturation and dyspnea ratings were improved （P 〈 0.05 ）. Conclusion NIPPV can ensure safe training. Exercises training can markedly improve symptoms and endurance in elderly patients with stable severe COPD.