不同方式呼吸肌阈值负荷锻炼对稳定期慢性阻塞性肺疾病患者呼吸生理学指标的影响

Effect of different respiratory muscle threshold load training on the respiratory physiological indexes in patients with stable chronic obstructive pulmonary disease

目的不同方式呼吸肌阈值负荷锻炼对稳定期慢性阻塞性肺疾病(COPD)患者呼吸生理学指标的影响。方法将160例稳定期COPD患者随机分为单一吸气肌锻炼(IMT)组、完整呼吸相联合锻炼(CRMT)组、分解呼吸相锻炼(SRMT)组和对照组(不接受呼吸肌锻炼),每组各40例,IMT组、CRMT组和SRMT组患者均完成8周肺康复锻炼。比较4组患者锻炼前后呼吸生理学指标的变化。结果锻炼后,(1)IMT组、CRMT组和SRMT组患者肺功能均改善,其中CRMT组患者FEV/FVC改善最明显(P<O.05)。(2)IMT组、CRMT组和SRMT组患者吸气肌功能[最大吸气压力(MIP)、呼吸周期(Ttot)、吸气时间(Ti)、平均吸气流速(VTi/Ti)、吸气时间分数(Ti/Ttot)、胃内压和食道压差峰值(Pdi)、膈肌张力时间指数(TTdi)、膈肌肌电(RMSdi)]均较锻炼前改善(PvO.05)。CRMT和SRMT组患者呼气肌功能[呼气时间(Te)、平均呼气流速(VTe/Te)、呼气时间分数(Te/Ttot)]均较锻炼前改善(PV0.05),但IMT组患者呼气肌功能改善不明显(P>0.05)。CRMT组患者MEP、Ttot、Te/Ttot的改善优于SRMT组,SRMT组患者TTdi的改善优于CRMT组(P<0.05)。(3) IMT组.CRMT组和SRMT组患者mMRC和CAT评分较锻炼前均降低(P<0.05),其中CRMT组下降幅度最大(P<0.05)。结论IMT、CRMT和SRMT均可改善稳定期COPD患者的呼吸困难症状,CRMT可改善其呼吸肌耐力,但IMT对呼气肌功能几乎无影响。

Objective To explore the effect of different respiratory muscle threshold load training on the respiratory physiological indexes in patients with stable chronic obstructive pulmonary disease (COPD). Methods A total of 160 patients with stable COPD were randomly divided into inspiratory muscle training( IMT) group,complete breathing training( CRMT) group,decomposition breathing training (SRMT) group and control group( no breathing muscle training),40 cases in each group. Patients in IMT group, CRMT group and SRMT group completed 8 weeks of lung rehabilitation training. The changes of respiratory physiological indexes before and after training were compared among 4 groups. Results After training ,(1)IMT group, CRMT group and SRMT group showed significant improvement of lung function, and CRMT group had the most significant improvement in FEV1/FVC(P <0. 05).( 2) Inspiratory muscle function(MIP,Ttot,Ti,VTi/Ti,Ti/Ttot,Pdi,TTdi,RMSdi) in IMT group,CRMT group and SRMT group were significantly improved compared with before training ( P < 0. 05 ). Exhaled muscle function ( Te, VTe/Te, Te/Ttot) in the CRMT and SRMT groups were significantly improved compared with before training(P < 0. 05), but improvement of expiratory muscle function in IMT group was not significant (P > 0. 05). Improvement of MEP, Ttot and Te/Ttot in CRMT group were better than those in SRMT group,and improvement of TTdi in SRMT group was better than that in CRMT group(P <0.05).(3)mMRC and CAT scores of IMT group, CRMT group and SRMT group were lower than those before training (P <0.05),and CRMT group decreased the most(P < 0. 05). Conclusion IMT, CRMT and SRMT can improve dyspnea symptoms in stable COPD patients. CRMT can improve their respiratory muscle endurance, but IMT has almost no effect on it.