吸气肌训练在慢性阻塞性肺疾病中的康复效果评价

The value of inspiratory muscle training as a rehabilitation treatment in patients with chronic obstructive pulmonary disease

目的探讨吸气肌训练(IMT)对中重度慢性阻塞性肺疾病(COPD)患者的肺康复效果。方法选择2014年1月—2015年12月在苏州市吴江区第一人民医院就诊时处于稳定期的COPD患者50例,随机分为对照组和IMT组,每组25例。对照组吸入支气管扩张剂或糖皮质激素,IMT组在此基础上采取吸气肌训练。2组患者在入组时(0个月)及第12个月进行随访,检测最大吸气压力(PImax)、6min步行距离、COPD评分(CAT)及住院次数,分析对比2组间上述指标的变化。结果通过12个月的观察,对照组的PImax下降[(80.12±17.94)cmH2Ovs.(78.28±17.98)cmH2O,P<0.05],6min步行距离缩短[(283.96±22.67)mvs.(278.12±21.12)m,P<0.05],第1秒用力呼气容积(FEV1)减少[(1.32±0.25)Lvs(.1.27±0.24)L,P<0.05]。与对照组相比,IMT组PImax显著上升[(78.28±17.98)cmH2Ovs(.95.48±19.36)cmH2O,P<0.05],6min步行距离明显增加[(278.12±21.12)mvs.(320.32±28.71)m,P<0.05];通过训练,IMT组患者的CAT评分明显下降(15.36±5.20vs.11.76±2.79,P<0.05),而且因急性加重所致的住院次数明显减少[(1.40±0.91)次vs.(0.68±0.63)次,P<0.05];但2组FEV1及FEV1占预计值百分比(FEV1%)差异无统计学意义[(1.27±0.24)Lvs.(1.40±0.28)L;49.56%±9.93%vs.53.81%±13.66%,均P>0.05]。结论长期进行IMT可以改善COPD患者的活动耐量及生活质量,减少住院次数,为COPD患者生存带来益处。

Objective To investigate the effect of inspiratory muscle training (IMT) as a rehabilitation treatment for patients suffering from moderate to severe chronic obstructive pulmonary disease (COPD). Methods Fifty COPD patients in stable stage hospitalized in the First People’s Hospital of Wu Jiang District, Suzhou from January 2014 to December 2015 were included and randomly divided into control group and IMT group. Patients in the control group inhaled bronchodilators or glucocorticoids, whereas those in IMT group took inspiratory muscle training in addition to inhaling bronchodilators or glucocorticoids. All patients were followed up for 12 months. Values of maximum inspiratory pressure (PImax), 6-minute walking distance (6MWD), COPD Assessment Test (CAT) score were analyzed. The number of hospitalizations within twelve months was also recorded in two groups of patients. Results After 12-month fellow-up, it was found that PImax was decreased[(80.12±17.94) cmH2O vs.(78.28±17.98) cmH2O, P<0 .05)], 6MWD was shortened[(283.96±22.67) m vs.(278.12±21.12) m, P<0.05] and FEV1 was decreased[(1.32±0.25) L vs.(1.27±0.24) L, P<0 .05] in control group. Compared with control group, PImax increased significantly in IMT group[(78.28±17.98) cmH2O vs.(95.48±19.36) cmH2O, P<0 .05], 6MWD was also increased[(278.12 ± 21.12) m vs.(320.32 ± 28.71) m, P<0.05)]. While the CAT score was significantly reduced in patients of IMT group (15.36±5.20 vs. 11.76±2.79, P<0.05). The hospitalizations caused by acute exacerbation were significantly decreased (1.40±0.91 vs. 0.68±0.63, P<0 .05), but there was no significant improvement in pulmonary function (P>0 .05). Conclusion Long-term IMT can improve the activity tolerance and quality of life in COPD patients, and reduce hospitalizations, bring benefits to the survival of COPD patients.