慢性阻塞性肺疾病不同肺康复训练方法比较研究

Comparative study on different lung rehabilitation training methods for chronic obstructive pulmonary disease

目的比较不同肺康复训练方法对慢性阻塞性肺疾病(COPD)患者肺功能及运动能力的影响。方法采取动态随机化法将2016年6月至2017年6月海南医学院第一附属医院呼吸内科收治的120例COPD患者分为A、B、C、D组,每组30例。A组患者进行缩唇-腹式呼吸、吹气球等呼吸功能锻炼;B组患者进行缩唇-腹式呼吸、吹气球、呼吸操训练等呼吸功能锻炼;C组患者进行缩唇-腹式呼吸、吹气球、呼吸操、呼吸练习器训练等呼吸功能锻炼;D组患者进行缩唇-腹式呼吸、吹气球、呼吸操、呼吸练习器等呼吸功能锻炼及运动训练。比较四组患者训练完成15 d,3、6个月后肺功能[肺活量(VC)、用力1秒呼气量(FEV1)]、呼吸困难指数及运动能力(6 min步行距离)的差异。结果 120例患者中失访13例,其中A组失访3例(入院2 d后转院2例,病情加重转入重症监护病房治疗1例),B组失访2例(在练习过程中出现呼吸困难而不愿再参与本研究1例,因受该例患者影响感觉害怕而放弃1例),C组失访3例(转入心内科1例,转入内分泌科1例,病情加重1例),D组失访5例(认为每天训练项目较多、花费时间较长、感觉厌烦而放弃参与本研究4例,死亡1例)。D组患者训练完成15 d,3个月后VC、FEV1均明显高于A、B、C组,差异均有统计学意义(P<0.05)。四组患者训练完成6个月后VC、FEV1比较,差异均无统计学意义(P>0.05)。四组患者训练完成15 d、3个月后呼吸困难症状均有所改善,D组患者改善程度最明显,差异均有统计学意义(P<0.05)。四组患者训练完成6个月后呼吸困难得分比较,差异均无统计学意义(P>0.05)。四组患者训练完成15 d,3、6个月后6 min步行距离均有所改善,D组患者改善最明显,差异均有统计学意义(P<0.05)。结论肺康复训练方法中,呼吸功能锻炼联合运动训练的方法能明显改善COPD患者的肺功能及运动能力。

Objective To compare the effects of different lung rehabilitation training method on the pulmonary function and motor function in the patients with chronic obstructive pulmonary disease(COPD).Methods One hundred and twenty patients with COPD in the respiration department of the First Affiliated Hospital of Hainan Medical College from June 2016 to June 2017 were divided into the group A,B,C and D by adopting the dynamic randomization method,30 cases in each group.The patients in the group A conducted the respiration function exercise of lip girdle-abdominal respiration and blowing balloon;the patients in the group B conducted the respiration function exercise of lip girdle-abdominal respiration,blowing balloon and respiratory exercise training;the patients in the group C conducted the respiration function exercise of lip girdle-abdominal respiration,blowing balloon,respiratory exercise training and breathing apparatus training;the patients in the group D conducted the respiration function exercise and exercise training of lip girdle-abdominal respiration,blowing balloon,respiratory exercise training and breathing apparatus training and sports training.The differences in the lung function [vital capacity(VC),forced expiratory volume in one second(FEV1),dyspnea index and athletic ability(6 min walking distance)] on 15 d,in 3,6 months after training finish were compared among 4 groups.Results Among 120 cases,13 cases were lost to follow up,in which the group A had 3 cases(2 cases were transferred to another hospital and 1 case was converted to ICU due to the disease aggravation),the group B had 2 cases(1 case was unwilling to participate in this study due to appear dyspnea during training process and 1 case felt fear due to been affected by this case),the group C had 3 cases(1 case of converting to the cardiology department,1 case of converting to endocrinology department and 1 case of aggravation)and the group D had 5 cases(4 cases considered that there were many training items every day,which spent longer time and got bored with training,thus gave up this study,1 case of death).VC and EFV on 15 d and in 3 months after training finish in the group D were significantly higher than those in the group A,B and C,the differences were statistically significant(P<0.05).VC and FEV1 in 6 months after training finish had no statistical difference among 4 groups(P>0.05).The dyspnea symptom on 15 d and in 3 months after training finish in 4 groups was improved,while the improvement degree in the group D was most obvious,the differences were statistically significant(P<0.05).The dyspnea score in 6 months after training finish had no statistically significant among 4 groups(P>0.05).The 6 min walking distance on 15 d and in 3,6 months after training finish in 4 groups was improved,while the improvement in the group D was most obvious,the differences all were statistically significant(P<0.05).Conclusion In the lung rehabilitation training methods,the method of respiratory function exercise combined with sports training can significantly improve the pulmonary function and athletic function in the patients with COPD.