慢性阻塞性肺疾病肺康复阶段效果评价

Evaluation of pulmonary rehabilitation phases in COPD

目的:观察肺康复(pulmonary rehabilitation,PR)对慢性阻塞性肺疾病患者肺功能、运动状态及生活质量等的影响,探索肺康复远期获益方案。方法:通过对符合条件的78名慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者进行前瞻性研究,分析资料完整的58例患者肺康复后7周、26周、52周、104周肺功能,观察患者的运动功能,吸气肌功能,生活质量等资料并与0周时的指标比较。结果:与0周相比,经7周肺康复训练,患者递增往返步行试验(incremental shuttle walk test,ISWT)增加(t=2.834,P=0.026),6 min步行试验(6-minute walk test,6MWT)增加(t=2.574,P=0.005),最大口腔吸气压(Pi Max)增加(t=1.868,P=0.032),同时呼吸困难得到明显改善,呼吸疲劳柏格(Borg)量表评分下降(t=3.668,P<0.001),改良英国医学研究学会呼吸困难指数(m MRC)下降(t=4.606,P<0.001),圣乔治呼吸问卷(The St George’s respiratory questionnaire,SGRQ)总评分下降(t=2.636,P=0.005),活动受限维度评分下降(t=3.360,P=0.001),经26周肺康复后,Pi Max较0周增加(t=2.542,P=0.006),52周与0周相比,各项指标差异均无统计学意义(P>0.05);104周与0周相比,各项指标差异均无统计学意义(P>0.05)。104周-52周-26周-7周-0周相比重复测量方差分析显示,Pi Max(F=2.451,P=0.046)、ISWT(F=2.413,P=0.049)、6MWT(F=3.627,P=0.007)、Borg(F=4.909,P<0.001)、m MRC(F=6.502,P<0.001)、SGRQ(F=2.727,P=0.030)、SGRQ A(F=4.000,P=0.004)差别具有统计学意义。结论:患者进行肺康复7周后,运动功能、吸气肌功能、生活质量得到改善,远期获益未能继续保持,因此仍需探索肺康复的手段以及对肺康复效果评价的方法。

Objectlve：To evaluate the effect of pulmonary rehabilitation （PR） on pulmonary function, exercise capacity and quality of life in patients with chronic obstructive pulmonary disease （ COPD）, and to explore PR programmes which could maintain long - term improvements. Methods：A prospective study of 78 COPD patients which were accorded with inclusion criteria was performed. 58 COPD patients with entire data including pulmonary function, exercise capacity and quality of life after PR （ at 7 weeks, 26 weeks, 52 weeks, 104 weeks） were analyzed and compared with baseline. Results：After 7 -week PR program, incremental shuttle walk test （ISWT） （37.6 ± 18.9）m, 6 -minute walk test （6MWT） （43.6 ±15.6）m, and PiMax （9.6 ±12.8） cmH2O increased（ P 〈0.05） , while Borg score （0.61 ±1.5） , mMRC score （0.73 ±0. 8 ）, the St George± respiratory questionnaire （SGRQ） score （ 8.7 ± 6.5 ） , and score of limited mobility （ 14.6 ± 4.9 ） reduced （ P 〈 0.05 ）. At 26 weeks, PiMax increased （ I0.2 ± 11.5 ） cmH2O （ P 〈 0.05 ） and the other indexes at 52 weeks and 104 weeks had no significant difference compared with baseline（ P 〉 0.05 ）. Each of the index values at 52 weeks and 104 weeks had no significant difference compared with baseline. Conclusion：After a 7 -week PR, exercise capacity, inspiratory muscle function, and quality of life are improved significantly, however, this benefit could not be maintained. Thus the methods of PR and the evaluation of the effects of PR are still needed.