肺康复治疗方案对急性期中重度COPD患者BODE指数的影响

Exploration of the pulmonary rehabilitation therapy on the BODE index of acute moderate and severe COPD patients

目的评估肺康复治疗方案对急性期中重度COPD患者BODE指数的影响。方法将在我院接受治疗的102例急性期中重度COPD患者，随机分为对照组和观察1组、观察2组，对照组接受常规治疗，观察1组在常规治疗的基础上给予患者有氧呼吸的训练，1次／d，20min／次；观察2组在观察1组治疗的基础上进行上下肢训练，1次／d，20min／次。5个疗程治疗结束后，测定3组患者在治疗后6分钟步行距离（6MWD）、FEVl％pred、体质量指数（BMI）、呼吸困难指数（MMRC），计算BODE指数。结果3组中度患者中观察1组、观察2组的6MWD差值分别为（30．1±5．0）m、（63．9±11．1）m，与对照组（10．1±1．1）m比较差异有统计学意义（P〈O．05）；观察1组、观察2组的FEVl％pred差值分别为7．9±3．0，11．6±1．5，与对照组2．4±0．5比较差异均有统计学意义（P〈0．05）；观察2组BMI差值为4．3±0．5，与对照组0．6±1．6比较差异有统计学意义（P〈O．05）；观察1组和观察2组BODE指数差值依次为0．8±0．2，1．2±0．4，与对照组0．3±0．1比较差异有统计学意义（P〈O．05）；3组重度患者中观察1组、观察2组的6MWD差值分别为（55．1±30．1）m，（87．0±22．6）m，与对照组（8．6±3．6）m比较差异有统计学意义（P〈O．05）；观察1组、观察2组的FEV，％pred差值分别为7．6±1．2，10．9±1．0，与对照组1．9±1．1比较差异有统计学意义（P〈O．05）；观察1组、观察2组BMI差值为2．9±1．2，5．3±1．4，与对照组1．0±0．6比较差异有统计学意义（P〈0．05）；观察2组MMRC差值为1．5±0．3，与对照组0．3±0．1比较差异有统计学意义（P〈0．05）；观察1组和观察2组BODE指数差值依次为0．9±0．1，1．4±0．6，与对照组0．4±0．1比较差异有统计学意义（P〈0．05）；3组极重度患者中观察1组6MWD差值为（42．2±4．4）m，与对照组（3．0±1．6）m比较差异有统计学意义（P〈O．05）；观察1组BMI差值为2．6±2．1，与对照组0．7±0．8比较差异有统计学意义（P〈O．05）；观察1组MMRC差值为1．1±0．2，与对照组0．3±0．1比较差异有统计学意义（P〈0．05）；观察1组BODE指数差值为1．3±1．0，与对照组0．3±0．5比较差异有统计学意义（P〈O．05）。结论对不同病变程度的COPD患者采用合理的最佳治疗方案，能有效改善患者的生活质量，对患者的积极康复有重要意义。

Objective To evaluate the effects of pulmonary rehabilitation therapy on the BODE index of patients with acute moderate and severe COPD. Methods One hundred and two acute moderate and severe COPD patients accepted treatment in our hospital were divided randomly into control group, observing group 1 and observing group 2. The control group was treated with conventional therapy, the observing group 1 was treated with aerobic respiration training （1 time per day, 20 minutes per time） combined with conventional therapy, and the observing group 2 was treated by upper and lower limb training （1 time per day,20 minutes per time） based on the the treatment method of the observing group 1. Data was collected among three groups after 5 courses of the treatment,including 6MWD, FEV1% pred, BMI,MMRC. Results Among moderate COPD patients in three groups, the difference value of the 6MWD between observing group 1 and observing group 2 was （30.1 ± 5.0） m, （63.9 ± 11.1） m respectively, which was statistical compared that in the control group （ P 〈0.05）. The difference value of the FEV1% pred between observing group 1 and observing group 2 was 7.9±3.0, 11.6 ±1.5 respectively,which was statistical to compare that in the control group （ P 〈0.05）. There was statistical meaning comparing the difference value of the BMI between observing group 2 （4.3± 0.5） and control group（0.6±1.6） （ P 〈0.05）. The difference value of the BODE index between observing group 1 and observing group 2 was 0.8±0.2,1.2±0.4 respectively, and the difference value in the control group is 0.3± 0.1, both of the difference between observing group 1 and control group as well as between tobserving group 2 and control group was statistical （ P 〈0.05）. Among severe COPD patients in three groups,the difference value of the 6MWD between observing group 1 and observing group 2 was （55.1±30.1） m,（87.0±22.6） m respectively,which was statistical to compare that in the control group （ P 〈0.05）. The difference value of the FEV1% pred between observing group 1 and observing group 2 was 7.6±1.2,10.9±1.0 respectively,which was statistical to compare that in the control group （ P 〈0.05）. There was statistical meaning comparing the difference value of the BMI between observing group 2 （5.3±1.4） and control group （1. 0±0.6） （ P d0.05）. Which applied to the observing group 1 （2.9± 1.2） and control group （ P 〈0.05）. The difference value of the MMRC between observing group 2 and control group was 1.5±0.3,0.3±0.1 respectively,the difference is obvious （ P d0.05）. The difference value of the BODE index between observing group 1 and observing group 2 was 0.9 ± 0.1,1.4 ± 0.6 respectively,which was statistical to compare that in the control group （ P 〈0.05）. Among extremely severe COPD patients in three groups,the difference value of the 6MWD between observing group 1 and control group was （42.2± 4.4） m, （3.0 ±1.6） m respectively, the difference between two groups is obvious （P 〈0.05）. The difference value of the BMI in observing group 1 was 2.6 ± 2.1, which was statistical to compare that in the control group （ P 〈0.05）. There was statistical meaning comparing the difference value of the MMRC between observing group 1 （5.3 ±1.4） and control group （ 1.0 ± 0.6） （ P〈 0.05）. Which applied to the observing group 1 （1.1±0.2） and control group （0.3±0.1） （ P 〈0.05）. The difference value of the MMRC between observing group 2 and control group was 1.5 ±0.3,0.3 ± 0.1 respectively,the difference is obvious （P 〈 0.05）. The difference value of the BODE index between observing group 1 and control group was 1.3 ± 1.0,0.3 ± 0.5 respectively, which was statistical （ P 〈0.05）. Conclusions Adopting reasonable optimal treatment program for different degrees of COPD patients can improve the patients life quality,which is of great significance to rehabilitation.