卧式功率车踏车训练在极重度慢性阻塞性肺疾病急性加重住院患者呼吸康复中的应用

Application of horizontal power bicycle training in respiratory rehabilitation of inpatients with extremely severe acute exacerbation of chronic obstructive pulmonary disease

目的 研究卧式功率车踏车训练在极重度慢性阻塞性肺疾病急性加重(AECOPD)住院患者呼吸康复中的应用价值。方法 选取2019年8月至2021年7月在上海健康医学院附属嘉定区中心医院住院治疗且符合纳入和排除标准的80例极重度AECOPD患者为研究对象,采用随机数表法分为研究组和对照组,每组40例。从入院第3天开始,对照组患者给予常规药物治疗和呼吸康复训练,研究组患者在此基础上以卧式功率车踏车康复训练,1次/d,每次25 min,直至出院。比较两组患者的康复时间,以及入院第3天和出院当天的股四头肌肌力、1 min坐立试验(1-min STST)、改良版英国医学研究委员会(mMRC)呼吸困难问卷、慢性阻塞性肺疾病患者自我评估测试(CAT)评分。结果 研究组和对照组患者的康复时间分别为(11.09±2.67) d,(10.70±2.81) d,差异无统计学意义(P>0.05);出院时,研究组患者的股四头肌肌力为(267.77±68.92) N,明显高于对照组的(204.69±68.84) N,1-min STST为(23.14±3.68)次,明显多于对照组的(18.08±2.55)次,差异均有统计学意义(P<0.05);出院时,研究组患者的mMRC评分为(3.05±0.38)分,明显低于对照组的(3.42±0.50)分,差异有统计学意义(P<0.05),而CAT评分为(13.14±4.03)分,与对照组的(15.00±3.24)分比较差异无统计学意义(P>0.05);出院时,对照组患者的1-min STST、CAT评分为(18.08±2.55)次、(15.00±3.24)分,明显低于入院第3天的(19.79±1.71)次、(22.46±3.97)分,差异均有统计学意义(P<0.05),出院时对照组患者的股四头肌肌力、mMRC评分为(204.69±68.84) N、(3.42±0.50)分,与入院第3天的(213.60±71.85) N、(3.58±0.50)分比较差异均无统计学意义(P>0.05);出院时,研究组患者的股四头肌肌力、1-min STST为(267.77±68.92) N、(23.14±3.68)次,明显高于入院第3天的(224.09±83.38) N、(18.67±3.41)次,差异均有统计学意义(P<0.05),出院时研究组患者的mMRC评分、CAT评分为(3.05±0.38)分、(13.14±4.03)分,明显低于入院第3天的(3.57±0.51)分、(21.52±4.18)分,差异均有统计学意义(P<0.05)。结论 极重度AECOPD患者在住院期间进行卧式功率车踏车康复训练,可以增加患者股四头肌肌力,改善mMRC评分,从而增加患者下肢活动能力,提高生活质量,值得临床推广。

Objective To investigate the application value of horizontal power bicycle training in respiratory rehabilitation of inpatients with extremely severe acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods Eighty patients with extremely severe AECOPD hospitalized in Jiading District Central Hospital Affiliated to Shanghai University of Medicine & Health Sciences in compliance with the inclusion and exclusion criteria from August 2019 to July 2021 were selected as the research objects. They were randomly divided into a control group and a study group by random number table method, with 40 patients in each group. From the third day of hospitalization, the patients in the control group were treated with conventional drugs and respiratory rehabilitation training, and the patients in the study group were given horizontal power bicycle training on the basis of the control group, once a day, for 25 minutes, until discharge. The rehabilitation time, quadriceps muscle strength, 1 min sit-to-stand test(1-min STST), modified British Medical Research Council(mMRC) dyspnea questionnaire, and self-assessment test(CAT) score of patients with chronic obstructive pulmonary disease were compared between the two groups on the third day of admission and the day of discharge. Results The rehabilitation time in the study group and the control group were(11.09 ± 2.67) days and(10.70±2.81) days, respectively, and the difference was not statistically significant(P>0.05). At discharge, the quadriceps muscle strength in the study group was(267.77±68.92) N, which was significantly higher than(204.69±68.84) N in the control group, and the number of 1-minSTST in the study group was(23.14±3.68) times, significantly higher than(18.08±2.55) times in the control group(P<0.05). At discharge, the mMRC score in the study group was(3.05±0.38) points, which was significantly lower than(3.42±0.50) points in the control group(P<0.05), while the CAT score showed no significant difference between the study group and the control group:(13.14±4.03) points vs(15.00±3.24) points(P>0.05). At discharge, the 1-minSTST and CAT scores in the control group were(18.08±2.55) times and(15.00±3.24) points, which were significantly lower than(19.79±1.71) times and(22.46±3.97) points on the third day of admission, while the quadriceps muscle strength and mMRC score were(204.69±68.84) N and(3.42±0.50) points, which showed no significant difference with(213.60±71.85) N and(3.58±0.50) points on the third day of admission(P>0.05).At discharge, the quadriceps muscle strength and 1-minSTST in the study group were(267.77±68.92) N and(23.14±3.68) times, which were significantly higher than(224.09±83.38) N and(18.67±3.41) times on the third day of admission(P<0.05), while the score of mMRC and CAT were(3.05±0.38) points and(13.14±4.03) points, which were significantly lower than(3.57±0.51) points and(21.52±4.18) points on the third day of admission(P<0.05). Conclusion The horizontal power bicycle training for patients with extremely severe AECOPD during hospitalization can increase the quadriceps muscle strength and improve the mMRC score, thus improve the lower limb mobility and quality of life of patients, which is worthy of clinical promotion.