心肺康复在重度支气管扩张症患者中的应用价值

Application value of cardiopulmonary rehabilitation on severe bronchiectasis in patients

目的探讨应用简易器材进行系统的心肺康复在重度稳定期支气管扩张症患者中的应用价值。方法本研究为前瞻性队列研究。采用单纯随机抽样法选取2019年6月至10月就诊于济南市第八人民医院和济南市莱芜人民医院呼吸科的支气管扩张症患者125例,采用随机数字表法分为常规治疗组(n=58)和心肺康复组(n=67)。应用简易器材为患者实施系统的心肺康复训练。分别于治疗前、治疗后3个月和治疗后6个月,采用重复测量方差分析比较2组患者6分钟步行测试(6MWT)、第一秒用力呼气容积占预计值百分比(FEV1%Pred)、FVC%pred、第一秒用力呼气容积与用力肺活量比值(FEV1/FVC)%、BSI评分、慢性阻塞性肺疾病评分(CAT)、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、T淋巴细胞亚群计数的变化。结果随着干预时间的延长,心肺康复组6MWT逐渐延长、FEV1%pred、FVC%pred、CD3%、CD4%,CD4/CD8均逐渐升高,BSI评分、CAT评分、SAS评分和SDS评分均逐渐降低,常规治疗组6MWT逐渐下降。2组6MWT、FEV1%pred、FVC%pred、BSI、CAT、SAS、CD4%、CD8%、CD4/CD8在组间、时点间以及组间和时点间交互作用差异均有统计学意义,FEV1/FVC和SDS在时点间和组间和时点间交互作用差异有统计学意义,CD3%只在组间差异有统计学意义,分别为6MWT(F组间=59.20,P<0.01,F时点间=895.88,P<0.01,F组间·时点间=1553.81,P<0.001)、FEV1%pred(F组间=3.90,P=0.05,F时点间=173.23,P<0.001,F组间·时点间=124.61,P<0.001)、FVC%Pred(F组间=15.53,P<0.001,F时点间=114.23,P<0.01,F组间·时点间=105.37,P<0.01)、BSI评分(F组间=61.62,P<0.001,F时点间=259.79,P<0.01,F组间·时点间=428.18,P<0.01)、CAT评分(F组间=13.11,P<0.001,F时点间=321.60,P<0.01,F组间·时点间=110.98,P<0.01)、SAS评分(F组间=13.13,P<0.001,F时点间=336.26,P<0.01,F组间·时点间=140.11,P<0.01)、CD4%(F组间=8.68,P<0.01,F时点间=10.43,P<0.01,F组间·时点间=6.39,P<0.01)、CD8%(F组间=18.31,P<0.01,F时点间=13.11,P<0.01,F组间·时点间=4.12,P<0.05)、CD4/CD8(F组间=39.20,P<0.01,F时点间=24.59,P<0.01,F组间·时点间=41.59,P<0.01)、SDS(F时点间=338.29,P<0.01,F组间·时点间=395.51,P<0.01)、CD3%(F组间=14.37,P<0.01)。结论应用简易器材进行心肺康复能提高重度稳定期支气管扩张症患者的运动耐力和肺通气功能,提升免疫功能,缓解焦虑与抑郁。

Objective To explore the application value of systematic cardiopulmonary rehabilitation using simple medical device on severe bronchiectasis at stable phase in patients.Methods This prospective cohort study included 125 patients with bronchiectasis who came from the Eighth People′s Hospital of Jinan city and Laiwu People′s Hospital of Jinan from June through October 2019,those patients were divided into control group(n=58)and cardiopulmonary rehabilitation group(n=67)by random number table.A systematic cardiopulmonary rehabilitation were perfromed using simple medical device.Contrast analysis in repeated measures analysis of variance were performed between groups,the 6-minutes walk test(6MWT),the first second forced expiratory volume(FEV1)and a percentage of the predicted value(FEV1%pred),a lower baseline%predicted forced vital capacity(FVC%pred),the change in the ratio of the forced expiratory volume in the first second to the forced vital capacity(FEV1/FVC)%,bronchiectasis severity index(BSI)score,chronic obstructive pulmonary assessment test(CAT)score,self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score,and T lymphocyte subsets before treatment and on month 3,and month 6 were compared.Results Over the intervention time,had gradually increased 6MWT,gradually increased FEV1%pred,FVC%pred,CD3%,CD4%,CD4/CD8,as well as gradually decreased BSI score,CAT score,SAS score,SDS score were found in cardiopulmonary rehabilitation group;while gradually decreased 6MWT was found in control group.There were statistically significant differences in 6MWT,FEV1%pred,FVC%pred,BSI,CAT,SAS,CD4%,CD8%,CD4/CD8 in intergroup,intertime and intertime interaction between groups.FEV1/FVC and SDS have statistically significant differences in intergroup,intertime and intertime interaction between groups.While CD3 showed statistically significant differences only between groups,the differences were 6MWT(F group=59.20,P<0.01,F time point=895.88,P<0.01,F group·time point=1553.81,P<0.01);FEV1%pred(F group=3.90,P=0.05,F time point=173.23,P<0.001,F group·time point=124.61,P<0.001);FVC%pred(F group=15.53,P<0.001,F time point=114.23,P<0.01,F group·time point=105.37,P<0.01);BSI score(F group=61.62,P<0.001,F time point=259.79,P<0.01,F group·time point=428.18,P<0.01);CAT score(F group=13.11,P<0.001,F time point=321.60,P<0.01,F group·time point=110.98,P<0.01);SAS score(F group=13.13,P<0.001,F time point=336.26,P<0.01,F group·time point=140.11,P<0.01);CD4%(F group=8.68,P<0.01,F time point=10.43,P<0.01,F group·time point=6.39,P<0.01);CD8%(F group=18.31,P<0.01,F time point=13.11,P<0.01,F group·time point=4.12,P<0.05);CD4/CD8(F group=39.20,P<0.01,F time point=24.59,P<0.01,F group·time point=41.59,P<0.01)respectively.SDS score(F time point=338.29,P<0.01,F group·time point=395.51,P<0.01),CD3%(F group=14.37,P<0.01).Conclusions Cardiopulmonary rehabilitation with simple equipment is capable of improving exercise endurance and pulmonary ventilation function,improving immune function and relieving anxiety and depression for patients with severe bronchiectasis at stable phase.