呼吸训练对稳定期慢性阻塞性肺疾病患者呼吸功能的影响

The effect of instrumented respiratory training on the respiration of patients with stable chronic obstructive pulmonary disease

目的 探讨呼吸训练对稳定期慢性阻塞性肺疾病（COPD）患者肺功能及呼吸肌表面肌电图（RMS）的影响。 方法 将67例稳定期COPD患者按随机数字表法分为治疗组（36例）和对照组（31例）。对照组采用常规呼吸康复治疗，如缩唇呼吸、腹式呼吸、上肢上举训练等，治疗组在常规呼吸康复治疗基础上，使用肺功能训练仪进行呼吸训练，每周治疗5次，每次30min，共治疗6个月。分别于治疗前、治疗6个月后采用6分钟步行测试、COPD评估测试（CAT）、BODE指数评分、用力肺活量和1秒用力呼气流量及表面肌电图评定2组患者的运动能力、生活质量、肺功能及呼吸肌表面肌电信号的RMS。 结果 治疗前，2组患者的各项评定指标比较，差异无统计学意义（P〉0.05）。治疗6个月后，两组患者的6分钟步行测试、CAT评分、BODE指数评分、呼吸肌表面肌电图的RMS较组内治疗前均有所改善（P〈0.05）。与对照组比较，治疗组的6分钟步行测试、CAT评分、BODE指数评分、呼吸肌表面肌电信号的RMS改善程度更显著（P〈0.05）；两组患者治疗6个月后，FVC和FEV1较治疗前改善，但无统计学意义（P〉0.05），两组患者治疗6个月后FVC和FEV1比较，差异亦无统计学意义（P〉0.05）。 结论 呼吸训练可改善稳定期COPD患者的运动能力、生活质量、呼吸肌表面肌电图的RMS。

Objective To explore the effectiveness of a respiratory function training instrument with stable chronic obstructive pulmonary disease （COPD） patients. Methods Sixty-seven COPD patients in the stable period were randomly divided into a treatment group of 36 and a control group of 31 using a random number table. Both groups were given conventional pulmonary rehabilitation, including half-closed lip respiration, abdominal respiration and upper limb training. The treatment group was additionally provided with 30 minutes of respiratory training using a respiration function training instrument 5 times per week for 6 months. Both groups were assessed for their mobility, life quality and pulmonary function using the 6-minute walk test （6 MWT）, a COPD assessment test （CAT）, the BODE index, forced vital capacity （FVC）, forced expiratory volume in one second （FEV1） and surface electromyography （SEMG） of the respiratory muscles before and after the 6-month intervention. Results Before the treatment there were no significant differences between the two groups in terms of any of the measurements. After the treatment, significant improvement was observed in the average 6 MWT, CAT, BODE index and SEMG results in both groups, but with significantly greater improvement in the treatment group. The average FVC and FEV1 results did not improve significantly, so after the intervention there was still no significant difference between the groups. Conclusions Respiratory training using the pulmonary function training instrument can improve the mobility, life quality and the functioning of the respiratory muscles of COPD patients in the stable period.