慢性阻塞性肺疾病患者运动耐力下降的生理学研究

Physiology study on reduced exercise endurance of patients with chronic obstructive pulmonary disease

目的研究平板踏车联合无创正压通气（NIPPV）运动锻炼对COPD患者呼吸生理学的影响，探讨与运动耐力改善相关的生理学机制，期望为COPD患者呼吸康复提供新的更为有效的方法。方法按2011年修订版GOLD标准选择稳定期重度至极重度COPD患者为研究对象，分为3组：即平板踏车联合NIPPV运动锻炼组（A组）、平板踏车运动锻炼组（B组）、既无NIPPV又无平板踏车运动锻炼组（C组），每组观测20例。在运动锻炼前后分别测定6MWD、MRC评分、MEP、MIP及肺通气功能。结果经平板踏车联合NIPPV运动锻炼后COPD患者6MWD、MEP、MIP明显增加（P〈0．01），MRC评分明显降低（P〈0．01），肺功能FEV1％pred、FEV1／FVC、MVV、PEF等指标稍有改善，但锻炼前后差异无统计学意义（P〉0．05）；而MVV则有明显改善（P〈0．01），差异具有统计学意义。结论重度至极重度稳定期COPD患者在平板踏车上进行面罩NIPPV运动锻炼有助于改善其运动耐力和吸气肌力，缓解呼吸困难，是一种较好的适合于重度至极重度稳定期cOPD患者的呼吸康复锻炼方法。

Objective The paper studies the respiratory physiology impact of the exercise combined flat treadmill with non-invasive positive pressure ventilation （NIPPV） on patients with chronic obstructive pulmonary disease （COPD）, explores the physiological mechanism associated with improved exercise endurance,and expects to provide a more effective new method for pulmonary rehabilitation of COPD patients. Methods Select severe to very severe stable patients according to GOLD standard （2011 revision） as the object of study and divide these patients into three groups：flat treadmill combined with NIPPV exercise group （Group A）, flat treadmill exercise group （Group B）, no NIPPV or flat treadmill exercise group （Group C）,with 20 observations each. Measure and determine 6MWD, MRC score, MEP, MIP and pulmonary function separately before and after exercise. Results With exercise combined flat treadmill with NIPPV, COPD patients present significantly improved 6MWD, MEP, MIP （ P〈 0.01） and significantly lowered MRC score （ P〈0.01）. The pulmonary function FEV1% pred, FEV1/FVC, MVV, PEF and other indicators are slightly improved,showing no significant difference before and after exercise （ P 〉0.05）, while MVV is obviously improved （ P 〈0.01） with statistical significance. Conclusions Severe to very severe stable COPD patients taking mask NIPPV exercise on flat treadmill helps to improve their exercise endurance and inspiratory muscle strength, relieve dyspnea, proved to be a better respiratory rehabilitation exercise method to severe to very severe stable COPD patients.