呼吸训练器辅助下呼吸康复对新型冠状病毒肺炎患者的疗效

Respiratory rehabilitation assisted by respiratory trainers in patients with coronavirus disease 2019:an analysis of efficacy

目的观察呼吸康复在新型冠状病毒肺炎(COVID-19)患者中的疗效,以及不同呼吸训练方法对疗效的影响。方法选择2020年2月4日至3月25日武汉市金银潭医院某病区集中收治的病情稳定、有主动康复意愿的普通型或重型COVID-19患者21例,随机分为3组,每组7例。除了针对COVID-19的常规药物及对症支持治疗外,3组患者分别予以瞬清呼吸训练器(A组)、Acapella呼吸训练器(B组)和Leventon Spiro-Ball呼吸训练器(C组)进行呼吸功能及排痰训练,每天2次,每次30 min,共7 d。另选4例无主动呼吸康复意愿、病情稳定的COVID-19患者作为对照组,仅给予COVID-19常规药物及对症支持治疗。分别于康复训练前、康复训练7 d后对患者进行改良呼吸自觉用力程度(RPE)量表评价、呼吸频率测量、无氧支持下指脉氧饱和度(SpO2)测定、痰液总量评定和日常生活活动能力(ADL)评定。结果训练前各组的年龄、性别等人口学特征及基线改良RPE量表评分、无氧支持下SpO2、痰液量分级、ADL评分的差异均无统计学意义(P均>0.05),呼吸频率差异有统计学意义(P=0.040)。训练后A、B、C组改良RPE量表评分、呼吸频率、无氧支持下SpO2和ADL评分均较训练前改善,各组训练前后比较差异均有统计学意义(P均<0.05)。训练后A、B组改良RPE量表评分、呼吸频率、无氧支持下SpO2和ADL评分与对照组相比差异均有统计学意义(P均<0.05),C组仅呼吸频率与对照组比较差异有统计学意义(P<0.05);A、B、C 3组之间上述4个指标两两比较差异均无统计学意义(P均>0.05)。训练后4组痰液总量较训练前均有所减少,其中A、B、C 3组痰液量分级构成比训练前后比较差异均有统计学意义(P<0.05),而对照组训练前后比较差异无统计学意义(P>0.05)。结论应用呼吸训练器辅助进行呼吸康复可有效改善普通型和重型COVID-19患者的呼吸困难症状,减少痰液分泌,改善呼吸功能,提高日常生活活动能力。不同呼吸训练器的辅助效果无差异,需要进一步开展大样本、多中心研究验证。

Objective To observe the efficacy of respiratory rehabilitation in patients with coronavirus disease 2019(COVID-19)and the effect of different respiratory training methods.Methods Twenty-one patients of common or severe COVID-19 with stable condition and positive rehabilitation willingness were selected from a ward of Wuhan JinyintanHospital during Feb.4 to Mar.25,2020.They were evenly randomized into 3 groups.In addition to the conventional drugs and symptomatic and supportive treatments,the 3 groups of patients were given Shunqing respiratory trainer(group A),Acapella respiratory trainer(group B)and Leventon Spiro-Ball respiratory trainer(group C),respectively,for respiratory function and expectoration trainings,twice a day,30 min each time,for 7 days.Four patients with stable condition but without positive respiratory rehabilitation willingness were selected as the control group,and they were only given conventional drugs and symptomatic and supportive treatments.Modified Borg’s rating of perceived exertion(RPE)score,respiratory rate,pulse oxygen saturation(Sp O2)without oxygen support,total sputum volume,and activities of daily living(ADL)score were assessed before and 7 days after rehabilitation training.Results No significant differences were observed in demographic characteristics(such as age,gender),baseline modified RPE score,Sp O2 value without oxygen support,constituent ratio of sputum volume or ADL score among the 4 groups before training(all P>0.05),but there was significant difference in respiratory rate(P=0.040).After training,the modified RPE scores,respiratory rates,Sp O2 values without oxygen support and ADL scores in groups A,B and C were significantly improved compared with those before training(all P<0.05);the modified RPE scores,respiratory rates,Sp O2 values without oxygen support and ADL scores in groups A and B were significantly different from those in the control group(all P<0.05),while only respiratory rate in group C was significantly different from that in the control group(P<0.05);there were no significant differences in the above 4 indexes between groups A,B and C(all P>0.05).The post-training sputum volume of the 4 groups were decreased compared with that pre-training,and there was significant difference in the constituent ratio of sputum volume of groups A,B and C before and after training(P<0.05),while there was no significant difference in the control group before and after training(P>0.05).Conclusion Respiratory rehabilitation assisted by respiratory trainers can effectively reduce sputum secretion,improve dyspnea symptoms,respiratory function and activities of daily living in patients with common or severe COVID-19.There are no significant differences in the effects of different respiratory trainers.Further large sample multicenter studies are needed.