肺康复对慢性阻塞性肺疾病患者运动能力和生活质量的影响

Effects of Pulmonary Rehabilitation on Exercise Capacity and Quality of Life in Patients with Stable Chronic Obstructive Pulmonary Disease

目的根据COPD综合评估方法分组,探讨肺康复在稳定期慢性阻塞性肺疾病(简称慢阻肺)患者中的作用,寻找最佳肺康复策略。方法将106例稳定期慢阻肺患者根据2011年GOLD指南中慢阻肺综合评估方法分为B组(n=37)、C组(n=36)和D组(n=33),每组再随机分为对照组(常规治疗);肺康复策略1组(呼吸训练);肺康复策略2组(呼吸训练+运动训练)。随访24周,比较肺康复前后及各组间肺功能指标FEV1%pred、慢阻肺评估测试(CAT)、改良英国MRC呼吸困难指数(mMRC)、BODE指数及6分钟步行距离(6MWD)的变化情况。结果经过24周的肺康复干预,在B组和C组患者中,肺康复策略2组的疗效最好,CAT评分、mMRC评分、BODE指数、6MWD在肺康复干预前后的差值改变差异有统计学意义(P<0.05)。在D组患者中,肺康复策略1组和肺康复策略2组各指标在干预前后的差值改变差异无统计学意义(P>0.05),但均比对照组好。相关分析显示CAT评分与FEV1%pred、mMRC评分、BODE指数、6MWD显著相关。结论基于慢阻肺综合评估方法分组选择不同的肺康复策略可以取得最佳的肺康复疗效。

Objective To investigate the effects of pulmonary rehabilitation on the exercise capacity and quality of life in patients with stable chronic obstructive pulmonary disease（ COPD） for a optimal strategy for pulmonary rehabilitation. Methods One hundred and six patients with COPD in stable stage were divided into group B（ n = 37）,group C（ n = 36）,and group D（ n = 33） based on GOLD 2011. Each group of patients were randomly subdivided into a control group（ usual care）,a pulmonary rehabilitation strategy group 1（ breathing training）,and a pulmonary rehabilitation strategy group 2（ breathing training and exercise training）,and they were intervened for 24 weeks. Pulmonary function（ FEV1% pred）,COPD Assessment Test（ CAT）,modified British Medical Research Council dyspnea scale（ mMRC）,BODE index and 6-minute walking distance（ 6MWD） were compared before and after intervention. Results After pulmonary rehabilitation intervening for 24 weeks,in group B and group C,pulmonary rehabilitation strategy group 2 showed the best effect,CAT,mMRC,BODE index,and 6MWD were proved significantly different before and after pulmonary rehabilitation（ P 〈 0. 05）. In group D,all indexes had no significant difference between pulmonary rehabilitation strategy group 1 and group 2 before and after pulmonary rehabilitation（ P 〉0. 05）,but they were better than those of the control group. Correlation analysis showed that CAT score had significant correlation with FEV1% pred,mMRC,BODE index and 6MWD（ P 〈 0. 01）. Conclusion Patients with different subgroup of COPD based on GOLD 2011 may take different pulmonary rehabilitation strategies to achieve the optimal effect.