呼吸功能锻炼对慢性阻塞性肺疾病患者肋间肌质量及肺功能的影响

Effect of Respiratory Function Exercise on Intercostal Muscle Mass and Pulmonary Function in Patients with Chronic Obstructive Pulmonary Disease

目的:探讨呼吸功能锻炼对慢性阻塞性肺疾病(COPD)患者肋间肌质量、肺功能及生存质量的影响。方法:选择抚州市第一人民医院2021年3月-2022年5月收治的90例经治疗后病情稳定的COPD患者。采用随机数字表法分为对照组和观察组,每组45例。对照组给予常规干预,观察组在常规干预基础上进行呼吸功能锻炼。比较两组干预前及干预6周后肺功能、6分钟步行试验距离、肋间肌质量、生存质量评分及临床总满意度。结果:干预前,两组肺功能指标[第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)、FEV_(1)占用力肺活量百分比(FEV_(1)/FVC%)、最大呼吸中段流量(MMEF)及最大呼吸峰流速(PEF)]、6分钟步行试验距离、肋间肌横截面积(CSA)指数、CT值指数、St George's呼吸疾病问卷评估量表(SGRQ)(症状、活动能力、疾病影响)评分比较,差异均无统计学意义(P>0.05)。干预6周后,观察组FEV_(1)%pred(57.53±4.23)%、FEV_(1)/FVC%(64.24±4.15)%、MMEF(0.37±0.07)L/s、PEF(0.48±0.11)L/s、6分钟步行试验距离(332.53±39.57)m、肋间内肌CSA指数(5.44±1.28)mm^(2)·m^(2)/kg、肋间外肌CSA指数(5.11±1.07)mm^(2)·m^(2)/kg、肋间最内肌CSA指数(5.08±1.07)mm^(2)·m^(2)/kg、肋间内肌CT值指数(5.57±1.26)HU·m^(2)/kg、肋间外肌CT值指数(5.24±1.32)HU·m^(2)/kg、肋间最内肌CT值指数(5.11±1.30)HU·m^(2)/kg,均高于对照组的(52.47±4.34)%、(58.61±4.67)%、(0.29±0.07)L/s、(0.39±0.10)L/s、(289.34±41.58)m、(4.31±1.48)mm^(2)·m^(2)/kg、(4.28±1.11)mm^(2)·m^(2)/kg、(4.16±1.06)mm^(2)·m^(2)/kg、(4.40±1.20)HU·m^(2)/kg、(4.22±1.13)HU·m^(2)/kg、(4.21±1.20)HU·m^(2)/kg,观察组生活质量症状(40.56±6.67)分、活动能力(38.89±6.23)分、疾病影响(21.46±4.89)分,均低于对照组的(48.64±7.26)、(45.61±6.56)、(27.55±5.31)分(P<0.05);观察组满意度97.78%,高于对照组的84.44%(P<0.05)。结论:呼吸功能锻炼可有效改善COPD患者肺功能,提高肋间肌质量及生存质量,康复锻炼效果显著,临床满意度高。

Objective:To investigate the effects of respiratory function exercise on intercostal muscle mass,pulmonary function and quality of life in patients with chronic obstructive pulmonary disease(COPD).Method:A total of 90 COPD patients with stable condition after treatment who admitted to the First People's Hospital of Fuzhou from March 2021 to May 2022 were selected.The patients were divided into the control group and the observation group by random number table method,with 45 cases in each group.The control group received routine intervention,the observation group received respiratory function exercise on the basis of routine intervention.The pulmonary function,6 min walking test distance,intercostal muscle mass,quality of life score and total clinical satisfaction were compared between the two groups before intervention and after 6 weeks of intervention.Result:Before intervention,there were no significant differences in pulmonary function indexes[the percentage of forced expiratory volume in the first second to the expected value(FEV_(1)%pred),FEV_(1)/forced vital capacity(FEV_(1)/FVC%),maximal midexpiratory flow(MMEF)and peak respiratory flow rate(PEF)],6 min walking test distance,CSA index,CT value index,St George's respiratory disease questionnaire(SGRQ)assessment scale score(symptoms,activity ability,disease impact)between the two groups(P>0.05).After 6 weeks of intervention,FEV_(1)%pred(57.53±4.23)%,FEV_(1)/FVC%(64.24±4.15)%,MMEF(0.37±0.07)L/s,PEF(0.48±0.11)L/s,6 min walking distance was(332.53±39.57)m,intercostal muscle CSA index was(5.44±1.28)mm^(2)·m^(2)/kg,intercostal external muscle CSA index was(5.57±1.26)mm^(2)·m^(2)/kg,intercostal innermost muscle CSA index was(5.11±1.30)mm^(2)·m^(2)/kg,intercostal muscle CT value index(5.11±1.30)HU·m^(2)/kg,intercostal external muscle CT value index(5.24±1.32)HU·m^(2)/kg,intercostal innermost muscle CT value index(5.08±1.07)HU·m^(2)/kg in the observation group were higher than(52.47±4.34)%,(58.61±4.67)%,(0.29±0.07)L/s,(0.39±0.10)L/s,(289.34±41.58)m,(4.31±1.48)mm^(2)·m^(2)/kg,(4.28±1.11)mm^(2)·m^(2)/kg,(4.16±1.06)mm^(2)·m^(2)/kg,(4.40±1.20)HU·m^(2)/kg,(4.22±1.13)HU·m^(2)/kg,(4.21±1.20)HU·m^(2)/kg in the control group(P<0.05).Quality of life symptom(40.56±6.67)points,activity ability(38.89±6.23)points and disease impact(21.46±4.89)points in the observation group were lower than(48.64±7.26),(45.61±6.56)and(27.55±5.31)points in the control group(P<0.05).The satisfaction of the observation group was 97.78%,which was higher than 84.44%of the control group(P<0.05).Conclusion:Respiratory function exercise can effectively improve pulmonary function,improve intercostal muscle quality and quality of life in patients with COPD.Rehabilitation exercise has significant effect and high clinical satisfaction.