心肺康复运动训练对特发性肺间质纤维化患者心肺功能的影响研究

Effect of Cardiopulmonary Rehabilitation Exercise Training on Cardio-pulmonary Function in Patients with Idiopathic Pulmonary Fibrosis

背景特发性肺纤维化(IPF)是中老年人群常见的慢性炎症性肺病,仅依靠药物治疗难以有效控制病情进展。目前心肺康复运动训练虽已广泛应用于临床,但具体锻炼方法和运动强度仍缺少统一标准。目的探讨心肺康复运动训练对IPF患者心肺功能的影响,以期为临床应用提供参考。方法选取都江堰市医疗中心2017年8月至2020年8月收治的IPF患者82例,按照随机数字表法分为对照组和观察组,各41例。对照组患者采用常规药物治疗,观察组患者在此基础上接受心肺康复运动训练,均持续干预3个月。比较两组患者干预前后肺功能指标〔用力肺活量占预计值百分比(FVC%)、第1秒用力呼气容积占预计值百分比(FEV1%)、一氧化氮弥散量占预计值百分比(DLCO%)〕、6 min步行距离(6MWD)、Borg呼吸困难评分、动脉血气分析指标〔动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(OI)〕、呼吸力学指标〔吸气末跨肺压(Ptp-ei)、呼气末跨肺压(Ptp-ee)、跨肺驱动压(ΔPtp)〕。采用Pearson相关分析探讨IPF患者干预后呼吸力学指标与6MWD、Borg呼吸困难评分的相关性。结果两组患者干预前FVC%、FEV1%、DLCO%、6MWD、Borg呼吸困难评分、PaO2、PaCO2、OI、Ptp-ei、Ptp-ee、ΔPtp及干预后FEV1%、PaCO2、Ptp-ee比较,差异无统计学意义(P>0.05);观察组患者干预后FVC%、DLCO%、PaO2、OI高于对照组,6MWD长于对照组,Borg呼吸困难评分、Ptp-ei、ΔPtp低于对照组(P<0.05)。两组患者干预后FVC%、FEV1%、DLCO%、PaO2、OI分别高于本组干预前,6MWD长于本组干预前,Borg呼吸困难评分、Ptp-ei、ΔPtp分别低于本组干预前(P<0.05)。Pearson相关分析结果显示,IPF患者干预后Ptp-ei、ΔPtp与6MWD呈负相关,与Borg呼吸困难评分呈正相关(P<0.05);IPF患者干预后Ptp-ee与6MWD、Borg呼吸困难评分均无直线相关关系(P>0.05)。结论心肺康复运动训练可有效改善IPF患者的心肺功能,改善缺氧程度,减少呼吸肌做功,进而提高患者的运动耐量,减轻呼吸困难症状。

Background Idiopathic pulmonary fibrosis(IPF)is a common chronic inflammatory pulmonary disease in middle-aged and elderly people.It is difficult to effectively control the progress of disease only by relying on drug treatment.At present,although cardiopulmonary rehabilitation exercise training has been widely used in clinic,there is still lack of uniform standards for specific exercise methods and exercise intensity.Objective To analyze the effect of cardiopulmonary rehabilitation exercise training on cardio-pulmonary function in patients with IPF,in order to provide a reference for clinical application.Methods A total of 82 cases of patients with IPF treated in Dujiangyan Medical Center were selected from August 2017 and August 2020,and they were divided into control group and observation group according to random number table method,with 41 cases in each group.Patients in control group were given conventional drug treatment,patients in observation group were given cardiopulmonary rehabilitation exercise training on the basis of control group,both groups were continuously intervened for 3 months.Pulmonary function indexes[percentage of forced vital capacity to predicted value(FVC%),percentage of forced expiratory volume in the first second to predicted value(FEV1%),percentage of diffusion capacity for carbon monoxide to predicted value(DLCO%)],6 min walking distance(6MWD),Borg dyspnea score,arterial blood gas indexes[partial pressure of arterial oxygen(PaO2),partial pressure of arterial blood carbon dioxide(PaCO2),oxygenation index(OI)],respiratory mechanisms indexes[end-inspiratory transpulmonary pressure(Ptp-ei),end-expiratory transpulmonary pressure(Ptp-ee),ΔPtp]before and after intervention were compared between the two groups.Pearson correlation analysis was used to explore the correlation of respiratory mechanics indexes with 6MWD and Borg dyspnea score of IPF patients after intervention.Results There were no statistically significant differences in FVC%,FEV1%,DLCO%,6MWD,Borg dyspnea score,PaO2,PaCO2,OI,Ptp-ei,Ptp-ee,ΔPtp before intervention and FEV1%,PaCO2,Ptp-ee after intervention between the two groups(P>0.05);after intervention,FVC%,DLCO%,PaO2,OI in observation group were higher than those in control group,6MWD was longer than that in control group,Borg dyspnea score,Ptp-ei,ΔPtp were lower than those in control group(P<0.05).In the two groups,FVC%,FEV1%,DLCO%,PaO2,OI after intervention were higher than those before intervention,6MWD was longer than that before intervention,Borg dyspnea score,Ptp-ei,ΔPtp were lower than those before intervention,respectively(P<0.05).Pearson correlation analysis showed that,Ptp-ei,ΔPtpwere negatively correlated with 6MWD,respectively,and were positively correlated with Borg dyspnea score after intervention of IPF patients,respectively(P<0.05);there was no linear correlation between Ptp-ee and 6MWD and Borg dyspnea score after intervention in IPF patients(P>0.05).Conclusion Cardiopulmonary rehabilitation exercise training can effectively improve the cardio-pulmonary function of IPF patients,improve the degree of hypoxia,reduce respiratory muscle work,and then improve the exercise tolerance of patients and alleviate the dyspnea symptoms.