呼吸训练联合膈肌起搏器治疗慢性阻塞性肺疾病的优化肺康复模式研究

Optimized pulmonary rehabilitation mode of breathing training combined with diaphragmatic pacemaker in treatment of chronic obstructive pulmonary diseases

目的:探讨呼吸训练联合膈肌起搏器治疗慢性阻塞性肺疾病(COPD)的优化肺康复模式效果。方法:前瞻性非随机收集2017年9月~2019年3月长沙市第四医院呼吸内科及康复医学科收治的中度至极重度稳定期COPD患者88例,按照患者意愿分为A、B、C、D组,A组采用常规内科治疗+呼吸训练,B组采用常规内科治疗+膈肌起搏器,C组采用常规内科治疗+呼吸训练+膈肌起搏器,D组采用单纯常规内科治疗。分析2个月后各组肺功能、6 min步行试验(6MWT)结果、呼吸困难量表(MRC)评分、圣乔治呼吸问卷(SGRQ)评分情况。结果:C组第1秒末用力呼气容量(FEV1)、FEV1/用力肺活量(FVC)及最大通气量(MVV)水平显著高于A、B、D组,FVC水平显著高于A组和D组(P<0.05);C组6MWT显著高于其他各组,Borg疲劳评分、Borg喘息评分均显著低于其他各组(P<0.05);C组MRC评分显著低于D组(P<0.05);C组症状、日常活动情况、疾病影响评分均显著高于其余3组(P<0.05)。结论:呼吸训练联合膈肌起搏器治疗COPD能够有效改善患者肺功能,缓解其呼吸困难情况,并提高其生活质量及运动耐力,取得最佳肺康复疗效。

Objective To investigate the therapeutic effects of an optimized pulmonary rehabilitation mode of breathing training combined with diaphragmatic pacemaker in the treatment of chronic obstructive pulmonary diseases(COPD).Methods A prospective analysis was performed on 88 patients with moderate to extremely severe stable-stage COPD who were admitted to Department of Respiratory Medicine and Department of Rehabilitation Medicine,the Fourth Hospital of Changsha from September 2017 to March 2019.The enrolled patients were divided into group A,B,C and D according to their wishes.Routine medical treatment combined with breathing training was adopted in group A,routine medical treatment combined with diaphragm pacemaker in group B,routine medical treatment combined with breathing training and diaphragm pacemaker in group C,and only routine medical treatment in group D.Two months later,the lung functions,6-minute walk test(6MWT)results,medical research council(MRC)scores and St.George's respiratory questionnaire(SGRQ)scores were analyzed.Results The levels of forced expiratory volume in 1 s(FEV1),FEV1/forced vital capacity(FVC)and maximal voluntary ventilation(MVV)in group C were significantly higher than those in groups A,B and D,and the FVC level in group C was significantly higher than that in groupsAand D(P<0.05).Compared with the other groups,group C had significantly higher 6MWT but obviously lower fatigue score and wheezing score which were evaluated with Borg scale(P<0.05).MRC score in group C was significantly lower than that in group D(P<0.05).Moreover,group C was superior to the other groups in the scores of symptoms,daily activities and disease effects(P<0.05).Conclusion Breathing training combined with diaphragmatic pacemaker in the treatment of COPD can effectively improve pulmonary functions,relieve dyspnea,improve the quality of life and exercise endurance,thereby achieving the optimal curative effect pulmonary rehabilitation.