社区呼吸康复对稳定期慢性阻塞性肺疾病患者疗效的影响

Effects of pulmonary rehabilitation on patients with stable chronic obstructive pulmonary disease

目的观察社区呼吸康复对慢性阻塞性肺疾病（COPD）患者症状及生活质量的影响。方法选取我院门诊及社区COPD患者为研究对象并给予社区呼吸康复干预，治疗内容包括健康教育、用药及营养指导、呼吸训练、运动锻炼等；每4周电话随访1次。于入选时及干预1年后进行疗效评定，疗效观察指标包括肺功能第一秒用力呼气容积占预计值百分比（FEV1％）、第一秒用力呼气容积与用力肺活量比值（FEV．／FVC％）、圣乔治呼吸问卷（SGRQ）、医学研究会呼吸困难量表（MRC）及Borg量表、焦虑及抑郁测评、6min步行试验（6MWT）、营养状况等。结果共有85例患者纳入最终统计分析。入选COPD患者康复前FEV，％为（48．11±14．54）％，康复后为（47．82±14．94）％，康复前后差异无统计学意义（P〉0．05）；6min步行距离从康复前（416．10±99．84）m增加至（437．51±116．17）m，康复前后差异具有统计学意义（P〈0．05）；SGRQ评分较康复前平均降低4．8分；急性加重次数由康复前（1．07±1．27）次减至（0．39±0．69）次（P〈0．01）。根据疾病严重度分级，中度及重度以上COPD患者SGRQ评分均较康复前分别降低4．84分和5．73分。体重指数正常COPD患者6min步行距离改善幅度由（409．52±98．31）m增加至（433．53±118．46）m较低体重指数患者改善情况由（440．07±105．4）m增加至（452．0±110．32）m更显著；低体重指数患者SGRQ评分较康复前降低9．46分，体重指数正常患者SGRQ评分较康复前降低3．33分。抑郁及焦虑在本研究入选对象中较少见。结论社区呼吸康复可改善COPD患者运动耐力及生活质量，减少急性加重次数。不同严重程度COPD患者均可通过社区呼吸康复干预受益，且患者治疗依从性较高，值得全面推广、应用。

Objective To observe the effects of pulmonary rehabilitation on the symptoms and quality of life of persons with chronic obstructive pulmonary disease （ COPD）. Methods COPD patients were recruited from a hospital and community health centers and given pulmonary rehabilitation in the community. The rehabilita- tion program included health education and nutrition guidance, medication, breathing exercises, and physical exer- cise. Each patient was followed up every 4 weeks by telephone. The outcome measures included pulmonary function （FEV1%, FEV1/FVC%）, St George＇s questionnaire （SGRQ）, the Medical Research Council scale （MRC）, Borg scoring, evaluation of anxiety and depression, the six-minute walk test （6MWT） , and an evaluation of nutri- tional status. All of the patients were observed for one year. Results A total of 85 patients completed the pro- gram and were included in the final statistical analysis. There was no difference in FEV~ % before and after rehabil- itation. Six-minute walking distance improved significantly in statistical terms but the average increase was only from （416.1 ＋99.84）m to （437.51 ±116.17）m. The SGRQ scores decreased by an average of 4.8 points after a year of rehabilitation, with significant improvements among the moderately and severely impaired. Incidents of COPD exacerbation also decreased significantly. Patients with a low body mass index had the greatest SGRQ score improvments. Few patients showed depression or anxiety in this research population. Conclusions Pulmonary re- habilitation in the community can improve exercise tolerance and the quality of life for persons with COPD, reducing incidents of acute exacerbation. Patients may benefit from such pulmonary rehabilitation regardless of disease severity. The compliance was good despite the infrequent monitoring. Pulmonary rehabilitation in the community is worthy of more widespread use.