阶梯式肺康复运动在慢性阻塞性肺疾病急性加重住院患者中的应用效果

Application Effect of Stepwise Pulmonary Rehabilitation Exercise in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的探讨阶梯式肺康复运动在慢性阻塞性肺疾病急性加重(AECOPD)住院患者中的应用效果。方法采用非同期对照法,选取广西壮族自治区人民医院呼吸内科2021年6—9月收治的AECOPD患者40例为试验组,2021年10—12月收治的AECOPD患者39例为对照组。对照组患者接受常规治疗、健康教育、心理疏导及出院后肺康复运动指导;试验组患者在对照组基础上,于入院后24~48 h开始进行阶梯式肺康复运动直至出院。入院时(干预前)及出院前(干预后),采用COPD评估测试(CAT)评估患者生活质量,采用6 min步行试验评患者运动能力,采用Borg评分评价患者呼吸困难程度,测量患者第1秒用力呼气容积(FEV_(1))、第1秒用力呼气容积占预计值百分比(FEV_(1)%)、FEV_(1)/用力肺活量(FVC),记录患者住院时间,随访8周记录患者肺康复运动依从性。结果干预后,两组CAT评分、Borg评分分别较本组干预前降低,6 min步行距离分别较本组干预前延长(P<0.05);干预后,试验组CAT评分、Borg评分较对照组降低,6 min步行距离较对照组延长(P<0.05)。干预前及干预后,两组FEV_(1)、FEV_(1)%、FEV_(1)/FVC比较,差异无统计学意义(P>0.05);对照组干预前后FEV_(1)、FEV_(1)%、FEV_(1)/FVC比较,差异无统计学意义(P>0.05);观察组干预后FEV_(1)较干预前增大,FEV_(1)%、FEV_(1)/FVC较干预前升高(P<0.05)。试验组住院时间短于对照组(P<0.05)。随访8周,试验组肺康复运动依从率高于对照组(P<0.05)。结论阶梯式肺康复运动可提高AECOPD住院患者的生活质量、运动能力,减轻呼吸困难程度,提高肺功能,缩短住院时间,提高出院后肺康复运动依从性,对患者健康状况有积极影响。

Objective To investigate the application effect of stepwise pulmonary rehabilitation exercise in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Using the nonsimultaneous control method,40 patients with AECOPD admitted to Respiratory Medicine of the People's Hospital of Guangxi Zhuang Autonomous Region from June to September 2021 were selected as the experimental group,and 39 patients with AECOPD admitted from October to December 2021 were selected as the control group.Patients in the control group received conventional treatment,health education,psychological guidance and post-discharge pulmonary rehabilitation exercise instruction;patients in the experimental group started stepwise pulmonary rehabilitation exercise from 24 to 48 h after admission until discharge on the basis of the control group.The quality of life of patients was evaluated by COPD Assessment Test(CAT),the exercise ability was evaluated by 6 min walking test,the degree of dyspnea was evaluated by Borg score,the forced expiratory volume in the first second(FEV_(1)),percentage of forced expiratory volume in the first second in the predicted value(FEV_(1)%),and FEV_(1)/forced vital capacity(FVC)were measured at admission(before intervention)and before discharge(after intervention),the length of hospital stay was recorded,and the pulmonary rehabilitation exercise compliance was recorded at a follow-up of 8 weeks.Results After intervention,the CAT score and Borg score in the two groups were lower than those before intervention,respectively,and the 6 min walking distance was longer than that before intervention,respectively(P<0.05);after intervention,CAT score and Borg score in the experimental group were lower than those in the control group,and the 6 min walking distance was longer than that in the control group(P<0.05).Before and after intervention,there was no statistically significant difference in FEV_(1),FEV_(1)%,and FEV_(1)/FVC between the two groups(P>0.05);there was no statistically significant difference in FEV_(1),FEV_(1)%,and FEV_(1)/FVC in the control group before and after intervention(P>0.05);after intervention,FEV_(1) in the experimental group was bigger than that before intervention,FEV_(1)%and FEV_(1)/FVC in the experimental group were higher than those before intervention(P<0.05).The length of hospital stay in the experimental group was shorter than that in the control group(P<0.05).At 8 weeks of followup,the pulmonary rehabilitation exercise compliance rate in the experimental group was higher than that in the control group(P<0.05).Conclusion The stepwise pulmonary rehabilitation exercise can improve the quality of life and exercise ability,reduce the degree of dyspnea,improve the lung function,shorten the length of hospital stay,improve pulmonary rehabilitation exercise compliance in hospitalized patients with AECOPD,and have a positive impact on patient's health status.