COPD急性加重期行呼吸康复的可行性及效果研究

Feasibility and Effect of Pulmonary Rehabilitation on Patients with Acute Exacerbation of COPD

背景呼吸康复对COPD稳定期患者的治疗有重要作用,但呼吸康复在COPD急性加重期患者的治疗中应用较少。目的建立COPD急性加重期患者呼吸康复的规范化操作流程,并对呼吸康复的可行性及效果进行评价。方法选取2011年12月—2013年11月在同济大学附属同济医院呼吸科住院的COPD急性加重期患者85例,呼吸康复前对其进行初期评价,入院后设计呼吸康复计划并实施,出院时行再评价。结果 85例COPD急性加重期患者中2例发现肿瘤、3例出现心功能衰竭、2例因高血压退出研究,最终78例COPD急性加重期患者完成呼吸康复。呼吸康复实施过程中78例患者均未出现不良事件。呼吸康复后,COPD急性加重期患者6分钟步行测试(6MWD)〔(291.1±14.6)、(241.9±15.0)m〕、日常生活活动呼吸困难量表(ADL-D)评分〔(60.7±2.3)、(40.3±2.2)分〕、生活质量指数(QOL)评分〔慢性呼吸系统疾病标准自测问卷(CRQ-SAS)评分为(126.7±11.8)、(104.7±2.2)分;COPD评估测试问卷(CAT)评分为(13.2±0.8)、(24.6±0.7)分〕较呼吸康复前均得到改善(P<0.05)。满意度调查发现呼吸康复的满意度评分为(90.7±1.7)分。结论对COPD急性加重期患者入院后实行呼吸康复是安全和可行的。本研究为临床医生对COPD急性加重期患者甚至重症患者及时实施康复计划提供了依据。

Background and Objective Exacerbation of chronic obstructive pulmonary disease（ COPD） is characterized by increased dyspnea and reduced quality of life. Pulmonary rehabilitation（ PR） can alleviate dyspnea, and improve endurance capacity and health- related quality of life in COPD patients. However, PR has rarely been applied in patients with acute COPD exacerbation in China. The purpose of this study is to establish a standard operation procedure of PR for patients with acute COPD exacerbation,and evaluate its feasibility and effect. Methods 85 patients were enrolled with acute COPD exacerbation who received hospitalized treatment in Department of Respiratory Medicine, Tongji Hospital Affiliated to Tongji University from December,2011 to November,2013. PR program was designed and performed on patients. Assessment was made before and after PR. Results Among 85 patients,78 patients completed the whole PR program without adverse events. Two cases of cancer and three cases of heart failure occurred,and two cases discontinued PR for hypertension. 6-minute walking distance（ 6MWD） test before and after PR were 〔（ 291. 1 ± 14. 6） vs.（ 241. 9 ± 15. 0） m〕respectively;scores of Activity of Daily Living Dyspnea scale（ ADL- D） were（ 60. 7 ± 2. 3） vs.（ 40. 3 ± 2. 2）; for Qality of Life（ QOL）,scores were（ 126. 7 ± 11. 8） vs.（ 104. 7 ± 2. 2） in CRQ- SAS,and（ 13. 2 ± 0. 8） vs.（ 24. 6 ± 0. 7） in CAT,the scores all improved after PR（ P 0. 05）. Patients＇satisfaction score with PR was（ 90. 7 ± 1. 7）. Conclusion PR is safe and feasible for patients with acute COPD exacerbation after admission into hospital. We suggest that clinicians apply PR in patients with acute COPD exacerbation or even patients in critical condition.