极重度慢性阻塞性肺疾病患者家庭肺康复的效果

EFFECTS OF HOME-BASED PULMONARY REHABILITATION IN VERY SEVERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

目的评估长期氧疗的极重度慢性阻塞性肺疾病(chronicobstructive pulmonary disease,COPD)患者进行家庭肺康复的安全性和有效性。方法将2010年7月—2011年12月门诊的44例长期氧疗极重度COPD患者随机分成控制组和肺康复组;肺康复组除了常规药物治疗外,在家进行每周5d、每天2～3次、每次10～15min无创正压通气下运动锻炼,时间6个月。对比2组患者肺康复开始时和6个月后的运动耐力、运动后呼吸困难程度和健康相关生活质量。结果有35例患者完成该研究,其中控制组18例,肺康复组17例。2组患者的初始特征差异无统计学意义。肺康复组没有出现因运动锻炼而造成的不良并发症。6个月后肺康复组的6min步行距离(six-minute walk distance,6MWD)增加82.1m,大于有临床意义的最小显著差异值(54m)(P<0.05);6MWD后Brog评分下降了3.7分,大于有临床意义的最小显著差异值(1分)(P<0.05);圣乔治呼吸问卷评分的总分明显下降,总分的变化值是8.3分,大于有临床意义的最小显著差异值(4分)(P<0.05);而控制组各项评估值的变化无临床意义。结论家庭肺康复对于长期家庭氧疗的极重度COPD患者是安全且有效的,它可以提高患者的运动耐力,减轻其劳力性呼吸困难,提高其生活质量。

Objective To determine the safety and usefulness of a home-based pulmonary rehabilitation （PR） program for patients with very severe chronic obstructive pulmonary disease （COPD） who received long-term treatment with oxygen. Methods Forty-four outpatients from July 2010 to December 2011 ,with very severe（ GOLD stage IV ） COPD undergoing long-term treatment with oxygen were randomly distributed into two groups, the control group and the PR group. In addition to conventional pharmacotherapy, the patients of the PR group executed simultaneously exercise training and noninvasive positive pressure ventilation （NPPV） for 10 - 15 min every time, twice-thrice per day,5 days per week for six months at home. The six-minute walk distance （ 6MWD ） , Brog score at the end of 6MWD and St. George respiratory questionnaire （SGRQ） score at the start, of the program and after six months were evaluated. Results Thirty-five patients completed the study （ 17 in the rehabilitation group and 18 in the control group）. There were no initial differences between two groups. No complications arising from the performance of the exercises were observed. The PR group showed a clinically significant increase in the 6MWD and a clinically significant reduction in the Brog score at the end of 6MWD and the SGRQ score. After six months, the 6MWD in the PR group increased 82.1 m, which was significantly higher than the minimum clinically significant difference （54 m） （P 〈 0.05 ） and the Brog score at the end of 6MWD decreased 3.7 marks, which was significantly higher than the minimum clinically significant difference （1 mark） （ P 〈 0.05 ）. The total score of the SGRQ score in the PR group declined and the differences （ 8.3 marks） in the total scale were significantly higher than the minimum clinically significant difference （4 marks） （P 〈 0.05 ）. No significant changes were found in any of the parameters in the control group. Conclusion A home-based PR program for patients with very severe COPD under long-term oxygen treatment is safe and useful, as it achieves improvement in exercise tolerance, reduces dyspnea after effort, and improves quality of life.