呼吸训练器在社区慢性阻塞性稳定期肺病患者肺康复中的应用研究

Effect of respiratory exerciser tri-ball training in stable COPD patients during pulmonary rehabilitation

目的探讨利用三球式呼吸训练器进行肺康复对社区稳定期COPD患者肺功能和生活质量的影响。方法呼吸科医联体社区病房60例COPD稳定期患者分为训练器组和对照组各30例。两组均行常规药物治疗,对照组采用缩唇呼吸、腹式呼吸,训练器组利用三球式呼吸训练器联合缩唇腹式呼吸进行呼吸肌功能锻炼1年。两组分别于第3月、6月、1年测定BODE指标(FEV 1%预计值;6MWT;mMRC;BMI)、COPD患者生活质量评估问卷(CAT)评分。结果训练器组28人、对照组27人最终完成实验。训练器组和对照组FEV 1%预计值均随时间持续改善,两组间总体差异有统计学意义(P<0.01),第3月、6月两组间比较统计学无差异(P=0.875,0.172),12月时训练器组FEV 1%预计值较对照组差异有统计学意义(P=0.023),且两组内各时间点与实验前相比差异均有统计学意义(P<0.01);根据GOLD肺功能分级,1年后训练器组4级患者减少与对照组相比有显著差异(P=0.0297);mMRC两组均随时间降低,虽然总体比较无差异(P=0.609),但12月时组间比较出现差异有统计学意义(P=0.032),与观察前相比,训练器组各时间点差异均有统计学意义(P<0.05),而对照组组内比较在12月时出现差异有统计学意义(P=0.011);CAT评分、BODE评分出现随时间的下降趋势,组间及时间点间比较均差异无统计学意义(P>0.05)。结论COPD稳定期患者使用三球式呼吸训练器进行肺康复训练,能有效改善肺功能及呼吸困难评分,在社区医院有很好的推广应用价值。

Objective To observe the effect of respiratory exerciser tri-ball training(RE)on pulmonary function and quality of life of stable obstructive pulmonary disease(COPD)patients in community healthy center(CHC).Methods 60 COPD elderly patients at stable stage in Qinhong CHC were allocated to follow exerciser tri-ball training(RE)and half-closed lip abdominal respiration(AR)versus AR alone.The evaluations were performed at inclusion and 3,6 and 12 months after training.The primary outcome was the change in pulmonary functions such as forced expiratory volume in one second(FEV 1)/predicted value(FEV 1%pred),quality of life score(CAT),and BODE index(FEV 1%pred,mMRC,6MWT,BMI).Results FEV 1%pred was significantly higher in the study group than that in the control group(P<0.01).There was no significant difference between the two groups 3 and 6 months after training, while the data in the study group was higher than that in the control group 12 months after training ( P =0.023). At the same time, the ratio with GOLD 4 level decreased remarkably in the study group ( P =0.0297). The value of mMRC in study group was lower than that in the control group 12 months after training ( P =0.032). However, there was no significant different in BODE index and CAT between the two groups ( P> 0.05). Conclusion RE with AR can effectively improve FEV 1 % pred and dyspnoea in elderly patients with stable COPD in CHC.