深呼吸训练器大负荷吸气肌训练对稳定期慢性阻塞性肺病患者运动耐力及呼吸困难程度的影响研究

Study on the effect of inspiratory muscle training of heavy load of deep breathing trainer for exercise tolerance and breathing difficulty level of patient with COPD in stable stage

目的:探讨采用深呼吸训练器大负荷吸气肌训练对稳定期慢性阻塞性肺病(COPD)患者运动耐力及呼吸困难程度的影响。方法:选取108例稳定期COPD患者,按照随机数表法将其分为观察组和对照组,每组54例。对照组采用深呼吸训练器低负荷(9 cmH_2O)吸气肌阻力训练;观察组采用深呼吸训练器大负荷(最大吸气压60%)吸气肌训练,每日早晚各15 min,每周6 d,训练6个月。比较两组患者的运动耐力6 min步行距离(6 MWD)和计步器步数、改良版英国医学研究会(mMRC)呼吸困难量表评分及肺功能。结果:观察组训练后1个月、3个月和6个月的运动耐力(6 MWD和计步器步数)明显高于对照组,两组比较差异有统计学意义(t=12.365,t=13.254,t=12.845;P<0.05);观察组训练后1个月、3个月和6个月的mMRC呼吸困难评分明显优于训练前,且明显优于对照组,两组比较差异有统计学意义(t=4.365,t=4.021,t=4.325;P<0.05);观察组训练后1个月、3个月和6个月的肺功能第1秒用力呼气容积(FEV1)、FEV1%及FEV1与用力肺活量%(FVC%)之比(FEV1/FVC%)明显优于训练前(F=3.265,F=2.985,F=2.963;P<0.05),与对照组比较其差异有统计学意义(F=3.474,F=3.146,F=3.271;P<0.05)。结论:对稳定期COPD患者采用深呼吸训练器大负荷吸气肌训练可以提高患者的运动耐力和减轻呼吸困难症状,改善患者的肺功能。

Objective： To explore the effect of adopting inspiratory muscle training of heavy load of deep breathing trainer for exercise tolerance and breathing difficulty level of patient with chronic obstructive pulmonary disease COPD in stable stage. Methods： 108 patients with COPD in stable stage were divided into observation group（54 cases） and control group（54 cases）. Patients of control group received resistance training of inspiratory muscle of low load（9 cmH_2O） of deep breathing trainer. And that of observation group received inspiratory muscle training of heavy load（the maximum inspiratory pressure was 60%） of deep breathing trainer, and this training was arranged at morning and evening（the time of each training was 15 min） of every day, and the training included 6 times in each week, and the total training time was 6 months. And then the exercise tolerance（6 min walk distance, 6 MWD）, the step number of pedometer, the score of breathing scale of modified medical British research council（m MRC） and lung function were compared. Results： The 6 MWD and step number of pedometer of observation group of 1 month, 3 months and 6 months post training were significantly higher than that of control group（t=12.365, t=13.254, t=12.845, P〈0.05）, respectively. And the score of dyspnea of m MRC of observation group of 1 month, 3 months and 6 months post training were significantly better than that of control group（t=4.365, t=4.021, t=4.325, P〈0.05）, respectively. And the forced expiratory volume in one second（FEV1）, FEV1% and the ratio of FEV1 and FVC% of lung function of 1 month, 3 months and 6 months post training were significantly better than that pre training（F=3.265, F=2.985, F=2.963, P〈0.05）. And the differences of the three indicators between observation group and control group were significant（F=3.474, F=3.146, F=3.271, P〈0.05）. Conclusion： For patients with COPD in stable stage, the inspiratory muscle training of heavy load of deep breathing trainer can enhance exercise tolerance of patient, and relieve their symptom of dyspnea and improve lung function of patients.