噻托溴胺联合呼吸操训练治疗稳定期慢性阻塞性肺病患者的临床研究

Clinical study on Tiotropium bromide combined with respiratory exercise training for patients with stable chronic obstructive pulmonary disease

目的探讨噻托溴胺联合呼吸操训练对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,慢阻肺)稳定期患者的肺通气功能、生活质量以及运动耐力的影响。方法选择2014年10月至12月稳定期慢阻肺患者共73例,随机分为常规药物治疗组(A组,n=37)和呼吸操训练组(B组,n=36)。对A组患者常规吸入噻托溴胺,有氧疗指征者给予长期家庭氧疗。B组患者除应用噻托溴胺和(或)氧疗外,指导呼吸操训练,方法包括腹式呼吸、缩唇呼气及全身性呼吸体操。记录每例患者入组时及12周后的FEV1占预计值的百分比(FEV1%Pred)、圣乔治呼吸疾病问卷(SGRQ)评分及6 min步行距离(6MWD)。结果入组时两组患者的性别、平均年龄、肺功能分级、FEV1%Pred、SGRQ评分及6MWD均无显著差异(P>0.05)。干预12周后两组患者FEV1%Pred、SGRQ评分及6MWD均较治疗前有显著变化。其中B组患者的SGRQ评分显著低于A组,B组患者的6MWD显著长于A组(P<0.05)。结论在常规吸入长效抗胆碱能药物治疗外,配合呼吸操训练可更好的改善稳定期慢阻肺患者的生活质量及运动耐力。

Objective To investigate the effect of Tiotropium bromide combined with respiratory exercise training on pulmonary ventilation function, living quality and exercise tolerance in patients with stable chronic ob- structive pulmonary disease （COPD）. Methods 73 stable COPD patients were randomly divided into two groups, the group A （ n = 37） and the group B （ n = 36）. The group A was treated with inhaled Tiotropium bromide with or without oxygen therapy. For patients in the group B, besides Tiotropium bromide and （or） oxygen therapy, they were instructed to perform respiratory exercise training including abdominal respiration, pursed lips breathing and systematic respiratory exercise. The percent of Forced Expiratory Volume 1 （ FEVt ） of each patient in the predicted value （Pred） for each patient, at the beginning of the study and after twelve weeks therapy, lung function test, Saint Georgeg respiratory disease questionnaire （SGRQ） score and walking distance in six minutes （6MWD） were per- formed and recorded. Results After 12-week therapy, FEV1% Pred, SGRQ score and 6MWD in each group were significantly improved compared with those before treatment. SGRQ scores in the group B were obviously lower than those in the group A, and 6MWDs in the group B were longer than those in the group A （P 〈 0. 05 ）. Conclusion Besides inhalation of long-acting anti-cholinergic drugs, the combined respiratory exercise could preferably improve living quality and exercise tolerance of patients with stable chronic obstructive pulmonary disease.