二十四式太极拳及呼吸功能训练辅助西药对慢性阻塞性肺疾病稳定期患者的影响

Effect of 24-style Tai Chi Combined with Respiratory Function Training and Western Medicine on Stable COPD

目的评估西药联合太极拳运动及呼吸功能训练对慢性阻塞性肺疾病(COPD)稳定期患者的影响。方法 72例COPD稳定期患者随机分为太极拳组、呼吸锻炼组、太极拳+呼吸锻炼组、西药对照组各18例。西药对照组患者根据病情给予吸氧、支气管舒张剂、糖皮质激素、祛痰药等对症治疗。太极拳组患者在对症治疗基础上加每日简化二十四式太极拳锻炼2次,每次练习2遍;呼吸锻炼组在对症治疗基础上加缩唇腹式呼吸,每天练习3次,每次15min;太极拳+呼吸锻炼组在对症治疗基础上加太极拳运动联合缩唇腹式呼吸,方法同以上两组。所有患者均在治疗前和治疗后1、3、6、12个月时观察肺功能[一秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%),一秒用力呼气容积/用力肺活量(FEV1/FVC)]、6分钟步行距离(6MWT)、慢阻肺评估测试(CAT评分)及急性加重情况。结果治疗前及治疗后各组患者的FEV1、FEV1%、FEV1/FVC比较差异均无统计学意义(P>0.05)。治疗后西药对照组各时段6MWT与治疗前比较差异无统计学意义(P>0.05),治疗后6个月、12个月,太极拳组、呼吸锻炼组、太极拳+呼吸锻炼组均较治疗前明显延长(P<0.05),且治疗后12个月,太极拳+呼吸锻炼组较太极拳组、呼吸锻炼组、西药对照组亦明显延长(P<0.05)。治疗后西药对照组各时段CAT评分与治疗前比较,差异均无统计学意义(P>0.05),治疗后6、12个月,太极拳组、呼吸锻炼组、太极拳+呼吸锻炼组患者的CAT评分较治疗前明显降低(P<0.05)。各组因急性加重住院次数差异无统计学意义(P>0.05),平均住院天数太极拳组、呼吸锻炼组、太极拳+呼吸锻炼组均较西药对照组明显减少(P<0.05)。结论太极拳与缩唇呼吸均能改善COPD稳定期患者活动能力及生活质量,减少住院天数,太极拳配合缩唇呼吸锻炼效果更明显。

Objective To evaluate the effect of Tai Chi combined with respiratory function training and western medicine on stable chronic obstructive pulmonary disease （COPD）. Methods Totally 72 stable COPD patients were randomized into Tai Chi group, respiratory training group, Tai Cbi and respiratory training group and western medicine control group, with 18 in each. All patients were given oxygen therapy, bronchodilator, glucocorticoid, ex- pectorant and other basic symptomatic treatment according to disease conditions. Patients in Tai Chi group practiced 24-style Tai Chi twice a day, two cycles each time. Patients in respiratory training group did pursed-lips breathing three times a day, 15rain each time. Patients in Tai Chi and respiratory training group practiced both Tai Chi andpursed-lips breathing. In western medicine control group, patients were only given medicine for treatment. Treatment course of each group was 12 months. The pulmonary function （including FEV1, FEVI%, and FEVI/FVC）, 6MWT, CAT score and aggravation situation were observed respectively 1 month, 3 months, 6 months and 12 months before and after treatment. Results There was no significant difference between groups in FEV1, FEV1% and FEV1/FVC betbre and after treatment （P 〉 0.05）. Before treatment, 6MWT of patients in each group had no statistically significant difference （P 〉 0.05）. After treatment, 6MWT at each time point of western medicine control group had no statistically significant difference as compared with before treatment （ P 〉 0.05 ）. Comparing with before treatment, 6MWT in Tai Chi group, respiratory training group, and Tai Chi and respiratory training group was significantly prolonged 6 months and 12 months after treatment （P 〈 0. 05 ）. 6MWT in Tai Chi and respiratory training group was also significantly prolonged 12 months after treatment comparing with that in the Tai Chi group, respiratory training group and western medicine control group （P 〈 0. 05 ）. As for CAT score at each time point in western medicine con- trol group, the difference between before and after treatment had no statistical significance （ P 〉 0. 05 ）. The CAT score in Tai Chi group, respiratory training group, and Tai Chi and respiratory training group was significantly de- creased 6 months and 12 months after the treatment （P 〈 0. 05 ）. In each group, difference among hospital stays due to acute exacerbation had no statistical significance （P 〉 0.05 ）. The average hospitalization days in Tai Chi group, respiratory training group, and Tai Chi and respiratory training group were dramatically shortened as compared with the western medicine control group （ P 〈 0.05 ）. Conclusion Tai Chi and pursed-lips breathing can both improve the activity and quality of life and reduce the hospital stays of stable COPD patients. The combination of Tai Chi and pursed-lips breathing has more significant effect.