分级运动肺康复对慢性阻塞性肺疾病患者肺功能、血气指标及6MWD的影响

The effect of graded exercise lung rehabilitation on pulmonary function,blood gas index and 6-minute walking distance in patients with chronic obsrtuctive pulmonary disease

目的探讨分级运动肺康复对慢性阻塞性肺疾病(COPD)患者肺功能、血气指标及6分钟步行距离(6MWD)的影响。方法本研究为病例对照研究。采用随机抽样法,选取攀枝花市中心医院2021年3月至2022年3月呼吸与危重症医学科收治的200例COPD患者,分为观察组和对照组,每组100例。对照组采用常规治疗和健康教育,观察组在对照组的基础上进行分级运动康复训练。比较2组患者治疗前后肺功能指标[第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)、用力肺活量占预计值百分比(FVC%pred)、FEV_(1)/FVC],比较2组患者治疗前后血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))],比较2组患者治疗前后6MWD、COPD评估测试(CAT)评分、圣乔治呼吸问卷(SGRQ)评分,比较2组患者并发症发生情况。结果观察组治疗后FEV_(1)%pred[(66.75±1.68)%比(65.68±1.71)%],FVC%pred[(79.73±4.33)%比(78.52±4.28))%],FEV_(1)/FVC[(64.13±3.41)%比(62.58±3.37)%],PaO_(2)[(87.22±4.23)mmHg比(72.41±3.62)mmHg](1 mmHg=0.133 kPa),6MWD[(589.67±12.76)m比(507.93±12.46)m]均高于对照组(t值分别为4.46、1.99、3.23、26.60、45.83,均P<0.05),PaCO_(2)[(48.63±2.57)mmHg比(69.16±3.11)mmHg],CAT评分[(10.36±1.54)分比(12.41±1.65)分],SGRQ评分[(25.35±3.67)分比(29.87±4.12)分]均低于对照组(t值分别为50.89、9.08、8.19,均P<0.05);2组并发症发生率分别为4.00%(4/100)与15.00%(15/100),差异有统计学意义(χ^(2)=7.04,P<0.01)。结论分级运动肺康复能够提高COPD患者肺功能、增加运动耐力、改善血气指标。

Objective To investigate the effect of graded exercise pulmonary rehabilitation on pulmonary function,blood gas index and 6-minute walking distance(6MWD)in patients with chronic obstructive pulmonary disease(COPD).Methods This was a case control study.A total of 200 COPD patients admitted to the Department of Respiratory and Critical Care Medicine of Panzhihua Central Hospital from March 2021 to March 2022 were selected by random sampling method.They were randomly assigned into the observation group and the control group,with 100 patients in each group.COPD patients in the control group were managed by routine treatment and health education,while those in the observation group additionally received graded exercise rehabilitation training.Pulmonary function indexes,including FEV_(1)%pred,FVC%pred,FEV_(1)/FVC in patients of both groups before and after treatment were compared.Moreover,blood gas indexes(PaO_(2),PaCO_(2)),6MWD,COPD assessment test(CAT)score,St George′s Respiratory Questionnaire(SGRQ)score and complications between groups were compared.Results FEV_(1)%pred([66.75±1.68]%vs[65.68±1.71]%),FVC%pred([79.73±4.33]%vs[78.52±4.28]%),FEV_(1)/FVC([64.13±3.41]%vs[62.58±3.37]%),PaO_(2)([87.22±4.23]mmHg vs[72.41±3.62]mmHg,1 mmHg=0.133 kPa)and 6MWD([589.67±12.76]m vs[507.93±12.46]m)were significantly higher in the observation group after treatment than those of control group(t values were 4.46,1.99,3.23,26.60,and 45.83,respectively,all P<0.05).PaCO_(2)([48.63±2.57]mmHg vs[69.16±3.11]mmHg),CAT score([10.36±1.54]points vs[12.41±1.65]points)and SGRQ score([25.35±3.67]points vs[29.87±4.12]points)were significantly lower in the observation group after treatment than those of control group(t values were 50.89,9.08 and 8.19,respectively,all P<0.05).A significantly lower rate of complication was detected in the observation group than that of control group(4.00%vs 15.00%,χ^(2)=7.04,P<0.01).Conclusions Graded exercise lung rehabilitation can improve the lung function,exercise endurance and blood gas index of COPD patients.