影响慢性阻塞性肺疾病患者呼吸康复训练疗效的因素

Influential factors of pulmonary rehabilitation efficiency in patients with COPD

目的探讨影响慢性阻塞性肺疾病(COPD)患者呼吸康复训练疗效的因素。方法采用回顾性队列分析研究,选取2013年5月-2015年5月在上海市同仁医院呼吸科病房及门诊接受PR训练的216例COPD患者。患者在基线水平的人口学资料包括营养状况评估、肺功能测试、运动能力测试,生活质量指数(QOL)以及COPD疾病自我认知评估。采用标准的PR训练流程,每周进行两次,一共持续8周,患者至少连续完成12次才能被归为完成组,否则为中途退出组。使用6 min步行距离(6MWD)和St.George’s呼吸问卷(SGRQ)评估问卷来评价运动能力和QOL的改善。结果在所有完成问卷的COPD患者中,患者的自我疾病认知与医院焦虑和抑郁量表(HADS)焦虑和抑郁评分呈负相关,即慢性气道疾病认知问卷总分越高,患者的HADS焦虑评分(r=-0.61,P<0.01)和抑郁评分越低(r=-0.34,P<0.05)。在完成组患者中,有73例(42.9%)患者在6MWD上有临床最小显著改善,有78例(45.9%)患者在SGRQ呼吸问卷得分上有最小显著改善。患者的肺功能在PR训练前(50.6±21.8)和训练后(67.8±18.5)有显著改善(P<0.05)。此外,使用6MWD的最小改善作为评估指标,两组患者基线水平的体重指数(BMI),焦虑评分和SGRQ总分均有显著差异(Ps<0.01)。多因素Logistic回归分析表明,BMI是影响COPD患者PR训练疗效的独立因素(OR∧=1.035,95%CI:0.996,1.013,P<0.01)。结论焦虑症状和BMI会影响COPD患者PR训练的疗效,而患者的年龄则无影响,应该采取综合的治疗措施,如健康教育、心理辅导、营养支持来提高PR训练的疗效。

Objective To investigate the influential factors of the efficacy of pulmonary rehabilitation （PR） in patients with COPD. Methods A retrospective cohort study of 216 patients with COPD attended an outpatient PR program in Department of Respiratory of the Tongren Hospital from May 2013 to May 2015. Baselines of patients＇ demographic data, including the assessment of nutritional status, the lung function testing, the exercise capacity testing, the quality of life （QOL） index and the awareness of COPD disease questionnaire were collected. A standard PR training was carried out twice a week, and lasted for eight weeks, and patients who completed at least 12 times continuously were included as the completes, otherwise, it was included as the drop out group. 6-minute walk distance （6MWD） and St. George＇s Respiratory Questionnaire were used to evaluate the improvement of exercise capacity and the QOL separately. Results In all COPD patients who completed the questionnaires, the total scores of self-awareness of COPD disease were negative correlated with the scores of HADS anxiety and depression, namely the higher cognitive questionnaire scores, the lower HADS anxiety scores （r = 0.61, P 〈 0.01） and the HADS depression score （r = 0.34, P 〈 0.05）. In the completed group, a total number of 73 patients （42.9%） improved significantly by the 6MWD, and 78 patients （45.9%） had a significant improvement by the St. George＇s Respiratory Questionnaire score. The lung function was significantly improved after PR training （50.6 ±21.8） vs （67.8 ± 18.5）, P 〈 0.05. The PR training efficacy had no significant difference between the younger patients and older patients. In addition, when using the minimum improvement of 6MWD as the evaluation index, there were significant differences of baseline body mass index （BMI）, hospital anxiety and depression scores, and St. George＇s score in both groups （P 〈 0.01）. Multivariate logistic regression analysis showed that BMI is an independent factor affecting the efficacy of PR training in patients with COPD （OR = 1.035, 95% CI ： 0.996, 1.013, P 〈 0.01）. Conclusion The hospital anxiety score and BMI affects the efficacy of PR training in patients with COPD, but the factor of age does not affect the efficacy of PR training. Comprehensive intervention measures, such as health education, psychological counseling, nutritional support should be taken to improve the PR training efficacy.