基于康复前移理念的早期康复方案在尘肺并发慢性阻塞性肺疾病中的应用

Application of early rehabilitation program based on concept of rehabilitation forward in pneumoconiosis with chronic obstructive pulmonary disease

目的 了解基于康复前移理念的早期康复方案用于尘肺并发慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的效果。方法 选取2019年3—12月天津中医药大学第二附属医院收治的116例尘肺并发COPD急性加重期患者,随机分为对照组和观察组,每组58例。对照组采用常规康复方案干预,观察组采用基于康复前移理念的早期康复方案干预,比较两组干预效果差异。结果 干预后,观察组肺功能指标(第1秒用力呼气容积量、第1秒用力呼气容积/用力肺活量百分比、每分钟静息通气量)和营养指标(血清白蛋白、血清总蛋白、前白蛋白)分别为(1.62±0.18)L、(68.27±6.35)%、(12.83±1.26)L/min、(35.68±3.42)g/L、(62.85±5.16)g/L和(263.58±20.64)mg/L,优于对照组[(1.53±0.25)L、(62.82±6.78)%、(12.24±1.37)L/min、(30.91±3.67)g/L、(57.37±5.59)g/L、(254.27±21.81)mg/L],差异均有统计学意义(均P<0.05)。观察组改良呼吸困难指数评分、6 min步行试验和慢性阻塞性肺疾病评估测试评分分别为(1.21±0.32)分、(416.49±33.07)m、(11.87±3.06)分,优于对照组[(1.78±0.53)分、(327.37±34.59)m、(15.65±4.57)分],差异均有统计学意义(均P<0.05)。出院后1年内,观察组的急性加重发作次数、急诊就诊次数和再住院次数分别为(0.76±0.45)、(0.31±0.15)和(0.55±0.27)次,少于对照组[(1.28±0.59)、(0.64±0.28)、(0.92±0.36)次],差异均有统计学意义(均P<0.05)。结论 基于康复前移理念的早期康复方案用于尘肺并发COPD急性加重期干预能有效改善患者肺功能和营养状况,提高运动耐量和生活质量,减少急性加重发生率。

Objective To explore the application effect of early rehabilitation program based on the concept of rehabilitation forward in pneumoconiosis with chronic obstructive pulmonary disease(COPD).Methods 116 patients of pneumoconiosis with acute exacerbation of COPD in the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine were collected and randomly divided into the control group and the experimental group,58 patients in each group.The control group was intervened with conventional rehabilitation program,and the experimental group was intervened with early rehabilitation program based on the concept of rehabilitation forward.The difference of intervention effect between the two groups was compared.Results After the intervention,the indexes of lung function(forced expiratory volume in the first second,forced expiratory volume in the first second/forced vital capacity,ventilation per minute) and nutritional indexes(serum albumin,serum total protein,prealbumin) of the experimental group were respectively(1.62 ±0.18)L,(68.27 ±6.35)%,(12.83 ±1.26)L/min,(35.68 ±3.42)g/L,(62.85 ±5.16)g/L and(263.58±20.64)mg/L,which were better than those of the control group[(1.53±0.25)L,(62.82±6.78)%,(12.24±1.37)L/min,(30.91±3.67)g/L,(57.37±5.59)g/L and(254.27±21.81)mg/L],and the differences were statistically significant(all P<0.05).The modified medical British research council score,six minute walking distance and COPD assessment test score of the experimental group were respectively(1.21 ±0.32)points,( 416.49 ± 33.07) m and( 11.87 ± 3.06) points,which were better than those of the control group [(1.78 ±0.53)points,(327.37 ±34.59)m and(15.65 ±4.57)points],and the differences were statistically significant(all P<0.05).After one year after discharge,the number of acute exacerbation,emergency visits and hospitalization in the experimental group were respectively(0.76±0.45),(0.31±0.15) and(0.55±0.27) times,which were less than those in the control group[(1.28±0.59),(0.64±0.28) and(0.92 ±0.36)times],and the differences were statistically significant(all P<0.05).Conclusion The early rehabilitation program based on the concept of rehabilitation forward used in pneumoconiosis with acute exacerbation of COPD can effectively improve the pulmonary function and nutritional status of patients,improve the exercise ability and quality of life,and reduce the incidence of acute exacerbation.