体外膈肌起搏对稳定期COPD患者心肺功能及生活质量的影响

Effects of diaphragmatic pacing on cardiopulmonary function and life quality of patients with stable chronic obstructive pulmonary disease

目的观察体外膈肌起搏对稳定期慢性阻塞性肺疾病(COPD)患者心肺功能及生活质量的影响。方法本研究为病例对照研究。采用单纯随机抽样法,选取2019年1月至2021年4月在昆山市康复医院心肺康复科及呼吸内科就诊的稳定期COPD患者68例,采用随机数字表法分成观察组和对照组,每组34例。2组患者均进行为期12周的COPD的常规治疗和心肺康复科特色康复治疗,包括下肢功率踏车训练和温针治疗。观察组在对照组治疗的基础上辅以体外膈肌起搏治疗。治疗前后进行第1秒用力呼气容积(FEV_(1))、FEV_(1)/用力肺活量(FVC)、第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)、峰值公斤摄氧量(Peak VO_(2)/kg)、无氧阈时公斤摄氧量(VO_(2)/kg@AT)、峰值负荷功率(Peak W)、慢性阻塞性肺疾病评估测试(CAT)评分、改良版英国医学研究委员会呼吸困难量表(mMRC)评分的测试。治疗前后比较采用配对t检验,组间比较采用成组设计的t检验;分类资料采用χ^(2)检验;等级资料采用非参数检验;非正态分布的计量资料采用Mann-WhitneyU检验、Wilcoxon符号秩检验进行组间和组内比较。结果治疗12周后,与对照组比较,观察组FEV_(1)[(1.82±0.56)L比(1.43±0.58)L]、FEV_(1)/FVC[(65.47±10.94)%比(59.79±6.68)%]、FEV_(1)%pred[(60.91±20.19)%比(51.97±16.28)%]、Peak VO_(2)/kg[(24.43±4.21)ml·kg^(-1)·min^(-1)比(17.33±2.62)ml·kg^(-1)·min^(-1)]、VO_(2)/kg@AT[(14.43±3.25)ml·kg^(-1)·min^(-1)比(11.04±2.40)ml·kg^(-1)·min^(-1)]、Peak W[(97.42±9.74)W比(78.32±11.18)W]均升高,差异均有统计学意义(t值分别为2.54、2.30、2.01、2.35、2.90、3.13,P值均<0.05);观察组CAT评分[(20.62±9.87)分比(26.65±7.95)分]、mMRC评分[(2.53±1.16)分比(3.09±0.83)分]均降低,差异均有统计学意义(t值分别2.06、0.31,P值均<0.05)。结论体外膈肌起搏治疗可以改善稳定期COPD患者的静态肺功能,提高心肺运动耐量及日常生活质量,具有较好的康复使用价值。

Objective To observe the effects of external diaphragm pacing on cardiopulmonary function and quality of daily life in patients with stable chronic obstructive pulmonary disease(COPD).Methods This was a case-control study.A total of 68 stable COPD patients admitted to the Cardiopulmonary Rehabilitation department and Respiratory deparement of Kunshan Rehabilitation Hospital from January 2019 to April 2021 were selected as the subjects by simple random sampling method.They were divided into observation group and control group by random number table method,with 34 cases in each group.Patients in both groups received 12 weeks of routine treatment for COPD and cardiopulmonary rehabilitation,including lower limb power treadmill training and warm needle therapy.The observation group was supplemented with external diaphragm pacing therapy.Before and after treatment,forced expiratory volume in the first second(FEV_(1)),ratio of forced expiratory volume in the first second to forced vital capacity(FEV_(1)/FVC),forced expiratory volume in the first second in percent predicted values(FEV_(1)%pred),peak oxygen uptake per kilogram(Peak VO_(2)/kg),oxygen uptake per kilogram at anaerobic threshold(VO_(2)/kg@AT),Peak power(Peak W),COPD assessment test(CAT),modified Medical Research Council(mMRC)scores were tested and recorded.Paired T-test was used to compare before and after treatment,and group designed T-test was used for comparison between groups.χ^(2)test was used for classification data.Non-parametric test was used for grade data.Mann-whitney U test and Wilcoxon test were used for inter-group and intra-group comparison of non-normal distribution measurement data.Results After 12 weeks of treatment,FEV_(1)[(1.82±0.56)L vs(1.43±0.58)L],FEV_(1)/FVC[(65.47±10.94)%vs(59.79±6.68)%],FEV_(1)%pred[(60.91±20.19)%vs(51.97±16.28)%],Peak VO_(2)/kg[(24.43±4.21)ml·kg^(-1)·min^(-1)vs(17.33±2.62)ml·kg^(-1)·min^(-1)],VO_(2)/kg@AT[(14.43±3.25)ml·kg^(-1)·min^(-1)vs(11.04±2.40)ml·kg^(-1)·min^(-1)],and Peak W[(97.42±9.74)W vs(78.32±11.18)W]of observation group increased compared with the control group(t values were 2.54,2.30,2.01,2.35,2.90,and 3.13,respectively,all P<0.05).CAT score[(20.62±9.87)vs(26.65±7.95)]and mMRC score[(2.53±1.16)vs(3.09±0.83)]of observation group were lower than control group(t values were 2.06,and 0.31,respectively,both P<0.05).Conclusions Extracorporeal diaphragmatic pacing therapy can improve static lung function,cardiopulmonary exercise tolerance and daily life quality of stable COPD patients,with good rehabilitation value.