重复肺康复训练改善慢性阻塞性肺病患者运动能力的效果观察

Effectiveness of repeated courses of pulmonary rehabilitation on functional exercise capacity in patients with COPD

目的观察重复肺康复训练对慢性阻塞性肺病(COPD)患者功能性运动能力的影响。方法回顾性分析在上海市杨浦区控江医院就诊且已完成肺康复训练的COPD患者,均进行6 min步行测试(6MWD),筛选37例已完成2个疗程肺康复训练的COPD患者为试验组,以及39例只完成1个疗程的患者为对照组进行分析。结果两组在第1次肺康复训练中的年龄、性别、肺功能指标、初始6MWD、△6MWD以及6MWD运动耐力最小改善程度(minimal important difference,MID)≥35 m等方面差异无统计学意义(P>0.05)。试验组第1次和第2次肺康复疗程间隔平均时间是(30.00±18.00)个月。试验组在第2次康复训练中△6MWD为(55.48±19.02)m,与对照组(21.34±17.56)m相比,差异有统计学意义(P<0.05)。在进行第2次康复且满足MID≥35 m的患者中分析第1次6MWD差值,发现数值明显高于未达标患者,两者相比差异具有统计学意义(P<0.05)。结论 COPD患者在第1次康复训练(30±18)个月后再次进行第2次康复,能更好地提高患者的运动能力,康复训练6MWD改变差值越大的患者康复预后效果越好。

Objective To determine whether an as-needed repeated pulmonary rehabilitation(PR)intervention produces a clinically important improvement in exercise capacity.Methods The study included a retrospective analysis of characteristics and 6-minute walk distance(6MWD)test in patients with chronic obstructive pulmonary disease(COPD)who completed PR.Data were abstracted from all patients with COPD completing 2 courses of rehabilitation and those of randomly sampled patients completing only 1 course of PR.Results We identified 37 repeaters and selected 39 non-repeaters for analysis.We observed no significant differences between 2 groups with respect to age,FEV1 percent predicted,gender,initial 6MWD,improvement in 6MWD,or the percentage of patients achieving the minimal important difference(MID)of≥35 m with the completion of the first rehabilitation.The time between the first and second PR interventions was a mean of 30.00±18.00 months.Repeating patients had a decrease of 55.48±19.02 m in the 6MWD at the beginning of the second rehabilitation course compared with the end of the first intervention(P<0.05).In total,64.86%of repeating patients achieved the MID in the 6MWD at the end of the second course of PR.Those who achieved the MID in the 6MWD during the second course of rehabilitation also tended to have attained greater improvement in this outcome during the first course(P<0.05).Conclusion Two-thirds of patients with COPD undergoing repeat PR experience significant improvement in exercise capacity.Offering PR to patients with COPD on an as-needed basis appears to be beneficial even after a prolonged period of time between the interventions.