强化“六字诀”肺康复操对稳定期COPD疗效影响的多中心临床随机对照研究

A multi-center randomized controlled clinical study on the clinical efficacy of strengthened “Liu Zi Jue” on COPD in stable phrase

目的观察强化"六字诀"肺康复操联合常规西医疗法治疗稳定期慢性阻塞性肺疾病(COPD)的临床疗效并探寻优化整合后的中医肺康复方案。方法将150例COPD稳定期患者随机分为对照组30例(予常规西医疗法)、康复1组30例(予常规西医疗法加"六字诀"操)、康复2组30例(予常规西医疗法加"六字诀"操,强化呬字诀)、康复3组30例(予常规西医疗法加"六字诀"操,强化摩腹)、康复4组30例(予常规西医疗法加"六字诀"操,强化呬字诀及摩腹)。各组疗程均为1年,观察中医证候积分、汉密尔顿心理问卷(HAMA与HAMD)积分变化情况,并对可能影响疗效的多因素进行Logistic回归分析。结果 1治疗前后组内比较,5组的中医证候积分差异均有统计学意义(P<0.05)。组间治疗后比较,康复各组与对照组中医证候积分差异均有统计学意义(P<0.05);康复4组分别与康复3组、康复1组比较,差异有统计学意义(P<0.05);康复2组分别与康复3组、康复1组比较,差异有统计学意义(P<0.05);康复4组与康复2组比较,差异无统计学意义(P>0.05)。2治疗前后组内比较,5组的HAMA及HAMD积分差异均有统计学意义(P<0.05)。组间治疗后比较,康复各组与对照组HAMA及HAMD差异均有统计学意义(P<0.05);康复4组分别与康复2组、康复1组比较,差异有统计学意义(P<0.05);康复3组分别与康复2组、康复1组比较,差异有统计学意义(P<0.05);康复4组与康复3组比较,差异无统计学意义(P>0.05)。3回归分析后得出,与综合疗效相关的因素为分组(P<0.05)与病程(P<0.05),提示较好的临床疗效与进行以"六字诀"操为基础的功法锻炼及较短的病程相关。结论强化"六字诀"(强化呬字诀及摩腹)肺康复操联合西医常规疗法治疗稳定期COPD,可显著改善患者的临床症状及焦虑、抑郁状态。

Objective To observe the clinical efficacy of strengthened ＂Liu Zi Jue＂ and conventional western therapy for the pulmonary rehabilitation rehabilitation program in patients with stable COPD. Methods One hundred and fifty cases with stable COPD were randomly divided into control group （ n = 29, conventional western therapy） , rehabilitation group 1 （ n = 30, conventional westem therapy and ＂Liu Zi Jue＂ ） , rehabilitation group 2 （ n = 28, conventional western therapy and ＂Liu Zi Jue＂, strengthen ＂Si Zi Jue＂ ） , rehabilitation group 3 （ n = 30, conventional western therapy and ＂Liu Zi Jue＂, strengthen abdominal rubbing exercise） , group four （n = 30, conventional western therapy and ＂Liu Zi Jue＂, strengthen ＂Si Zi Jue＂ and abdominal rubbing exercise） , with the course of 1 year. The TCM clinical symptoms, Hamilton psychological questionnaire were analyzed and a logistic regression analysis was conducted. Results （1）TCM symptom score in all 5 groups improved significantly （ P 〈 0.05 ）, and with significant difference between the rehabilitation groups and the control group （ P 〈 0.05 ） ; there were significant difference between the group 4 and group 3 as well as between the group 4 and group 1 （ P 〈 0.05 ） ; there were significant difference between the group 2 and group 3 as well as between the group 2 and group 1 （ P 〈 0.05 ） ; no significant difference was found between the group 2 and group 4 （ P 〉 0.05 ）.（2） HANA and HAND score among the 5 groups declined more significantly after treatment （ P 〈 0.05 ） ; HANA and HAND score in each rehabilitation group compared with the control group improved more significantly after treatment （ P 〈 0.05 ） ; the rehabilitation group4 was significantly better than rehabilitation groupl and group2 （P 〈 0.05 ） while the rehabilitation group3 was also significantly better than rehabilitation groupl and group2 （P 〈 0.05 ） ; there was no statistically difference between rehabilitation group3 and rehabilitation group4 （ P 〉 0.05 ）. （3） The Logistic regression analysis showed the possible factors related to the clinical efficacy were the sectionalization （ P = 0. 001, P 〈 0.05 ） and the course of disease （ P = 0. 036, P 〈 0.05 ）. These results suggested that the clinical efficacy was related to good conduct to ＂Liu Zi Jue＂ exercises and a shorter course of disease. Conclusion Combined conventional western therapy and strengthened ＂Liu Zi Jue＂ can improve the clinical symptom and the anxiety and depression statement of patients with stable COPD.