肺康复训练对不同严重度稳定期慢性阻塞性肺疾病的影响

Effects of Pulmonary Rehabilitation on Patients with Stable COPD of Different Severity

目的探讨肺康复训练对不同严重度慢性阻塞性肺疾病(简称慢阻肺)患者肺功能、呼吸困难程度、生存质量和急性加重的影响。方法收集2010年1月至2013年1月在成都市第三人民医院医院住院及门诊随访的300例稳定期慢阻肺患者,按严重程度分为中度慢阻肺组(n=120)、重度慢阻肺组(n=100)和极重度慢阻肺组(n=80),每组患者再随机分为对照组和训练组。训练组在常规治疗基础上进行6个月的肺康复训练,对照组不进行肺康复训练。比较干预前后及各组间患者肺功能、6分钟步行距离(6MWD)、呼吸困难程度评分(mMRC)、生存质量及COPD急性加重次数的变化。结果经过6个月的肺康复训练后,训练组中度、重度、极重度COPD患者干预前后生命存量评分、6MWD比较差异有统计学意义(P<0.05)。重度COPD组康复训练后6MWD的增加值明显大于中度、极重度慢阻肺患者(P<0.05)。极重度患者康复训练后mMRC改善效果最好(P<0.05)。三组患者干预前后肺功能比较差异均无统计学意义(P>0.05)。重度慢阻肺患者在肺康复训练后急性加重次数明显减少(P<0.05),其他严重度训练组急性加重次数与对照组比较差异均无统计学意义(P>0.05)。结论肺康复训练能提高不同严重度慢阻肺患者活动耐量和生存质量,减少重度慢阻肺患者急性加重次数,减轻极重度患者呼吸困难程度,是一种经济高效的稳定期慢阻肺治疗措施。

Objective To investigate the effect of pulmonary rehabilitation on pulmonary function,perception of dyspnea and quality of life in stable COPD patients of different severity. Methods 300 patients with COPD in stable stage were divided into a moderate COPD group （ n = 120） , a severe COPD group （ n=100） and a very severe COPD group （ n = 80） . Each group was randomly subdivided into a control group and a treatment group. The treatment groups received pulmonary rehabilitation for 6 months in addition to usual care, and the control groups received usual care without pulmonary rehabilitation.Pulmonary function （ FEV1 ） , 6 minute walking distance （ 6MWD） , modified medical research council （ mMRC） scale, and acute exacerbation frequency of COPD were compared before and after intervention and among groups. Results After pulmonary rehabilitation for 6 months, the quality of life score and 6MWD were significantly improved in the treatment groups with moderate, severe, very severe COPD, and the increscent of 6MWD was greatest in the severe COPD patients. The mMRC of the patients with very severe COPD improved significantly after pulmonary rehabilitation（ P 〈0. 05） . Lung function before and after the intervention in three groups all showed no significant difference （ P 〉 0. 05） . The acute exacerbation frequency of the severe COPD patients was significantly reduced by pulmonary rehabilitation （ P 〈0. 05） , while there was no significant change in the moderate and very severe groups （ P 〉 0. 05） . Conclusions Pulmonary rehabilitation can improve exercise tolerance and quality of life of COPD patients with different severity, reduce acute exacerbation frequency in severe COPD, reduce the dyspnea degree in very severe COPD. Pulmonary rehabilitation is a cost-effective treatment for stable COPD.