体外膈肌起搏器在重度及极重度慢性阻塞性肺疾病患者肺康复中的运用

Application of External Diaphragm Pacemaker on Pulmonary Rehabilitation in Patients with Severe or Very Severe COPD

目的探讨重度及极重度慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD患者早期肺康复的有效方法,以加速急危重患者的康复,从而提高其生活质量。方法 2015年2-11月,便利抽样法选取因COPD急性加重住院治疗的重度及极重度患者32例为对照组;同法选择2015年12月至2016年9月的患者34名为观察组。两组患者均采取药物治疗,对照组患者在稳定期联合体外膈肌起搏,观察组患者在急性加重期开始联合体外膈肌起搏,即COPD急性加重期和稳定期都联合使用体外膈肌起搏。在入院及出院时采用COPD评估测试(COPD assessment test,CAT)评价两组患者的生活质量,并比较两组患者呼吸困难程度评分(modified medical research council scale,MMRC)。在出院时,采用线性视觉模拟评分标尺评定患者的舒适度,并比较两组患者的住院时间。结果两组患者平均住院时间、MMRC评分及CAT评分的差异均有统计学意义(均P<0.05),观察组患者均明显优于对照组。两组患者的舒适度差异无统计学意义(P>0.05)。结论重度及极重度COPD急性加重期患者的肺康复介入的时机可以从稳定期扩展到急性加重期,针对该类患者在无更好的肺康复护理方案的情况下,体外膈肌起搏不失为一种简便的提高患者生活质量的辅助治疗和呼吸肌康复方式。

Objective To investigate the effective method of early pulmonary rehabilitation in patients with severe or very severe chronic obstructive pulmonary disease(COPD),so as to improve their rehabilitation and quality of life.Methods By convenience sampling,32 patients with severe and very severe acute exacerbation of chronic obstructive pulmonary disease from February to November in 2015 were enrolled as control group;and 34 patients with severe and very severe acute exacerbation of chronic obstructive pulmonary disease from December 2015 to September 2016 were treated as observation group.All the patients were treated with medications.The control group was treated with external diaphragm pacing in stable phase,while the patients in the observation group were treated with external diaphragm pacing in the acute exacerbation stage.The COPD assessment test(CAT)and modified medical research council scale(MMRC)were used to evaluate patient’s quality of life and degree of dyspenea upon their admission and discharge.Besides,at the time of discharge,the patient’s comfort was evaluated by using visual analogue scale,and the length of stay in hospital was compared.Results The average length of stay in hospital,MMRC score and CAT score in the observation group were all significantly better than those in the control group(all P<0.05).However,no statistical significance of comfort level was found between two groups(P>0.05).Conclusion The timing of pulmonary rehabilitation can be extended from stable to acute exacerbation stage in patients with severe or very severe acute exacerbation of COPD.External diaphragm pacing is a simple and convenient alternative to improving pulmonary rehabilitaionand quality of life of patients.