基于目标设置的多学科团队肺康复训练在慢性阻塞性肺疾病患者中的应用效果

Application Effect of Multidisciplinary Team Pulmonary Rehabilitation Based on Goal Setting in Patients with Chronic Obstructive Pulmonary Disease

目的探讨基于目标设置的多学科团队(MDT)肺康复训练(PR)在慢性阻塞性肺疾病(COPD)患者中的应用效果。方法本研究为一项前瞻性、单中心、单盲的随机对照研究。选取2022年6-12月河北省胸科医院呼吸与危重症医学科收治的COPD患者203例为研究对象。通过计算机生成随机序列,然后将患者分为试验组(102例)和对照组(101例),分组信息使用不透明的密封信封分发。对照组患者接受常规PR,试验组患者接受基于目标设置的MDT PR,两组患者均干预6个月。比较两组一般资料,干预前及干预1、2、4、6个月6分钟步行距离(6MWD)、圣乔治呼吸问卷(SGRQ)评分、第1秒用力呼气容积(FEV_(1))/用力肺活量(FVC)、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分,干预6个月内急性加重者占比及因急性加重再入院者占比。结果最终共196例患者完成本研究(试验组98例,对照组98例)。干预方法与时间在6MWD、SGRQ评分上存在交互作用(P<0.05);干预方法、时间在6MWD、SGRQ评分上主效应显著(P<0.05)。试验组干预1、2、4、6个月6MWD长于对照组,SGRQ评分低于对照组(P<0.05)。干预方法与时间在FEV_(1)/FVC上存在交互作用(P<0.05),在HAMA、HAMD评分上不存在交互作用(P>0.05);干预方法在FEV_(1)/FVC上主效应显著(P<0.05),在HAMA、HAMD评分上主效应不显著(P>0.05);时间在FEV_(1)/FVC及HAMA、HAMD评分上主效应显著(P<0.05)。试验组干预4、6个月FEV_(1)/FVC高于对照组(P<0.05)。两组干预6个月内急性加重者占比比较,差异无统计学意义(P>0.05)。两组干预6个月内均无患者因急性加重再入院。结论基于目标设置的MDT PR可以有效提高COPD患者运动耐力、生活质量,改善患者肺功能及短期预后,但尚未发现其可以有效减轻患者焦虑、抑郁情绪。

Objective To explore the application effect of multidisciplinary team(MDT)pulmonary rehabilitation(PR)based on goal setting in patients with chronic obstructive pulmonary disease(COPD).Methods This is a prospective,single-center,single-blind,randomized controlled study.A total of 203 COPD patients admitted to the Department of Respiratory and Critical Care Medicine,Hebei Chest Hospital from June to December in 2022 were selected as the study objects.Patients were divided into experimental group(102 cases)and control group(101 cases)using a computer generated random sequence,and the grouped information was distributed using an opaque sealed envelope.Patients in the control group received conventional PR,and patients in the experimental group received MDT PR based on goal setting.Both groups were intervened for 6 months.General information,6-minute walking distance(6MWD),St.George's Respiratory Questionnaire(SGRQ)score,forced expiratory volume in one second(FEV_(1))/forced vital capacity(FVC),Hamilton Anxiety Scale(HAMA)score and Hamilton Depression Scale(HAMD)score before intervention and at 1,2,4,and 6 months of intervention,the proportion of acute exacerbation and the proportion of readmission due to acute exacerbation within 6 months of intervention were compared between the two groups.Results A total of 196 patients completed the study(98 cases in the experimental group and 98 cases in the control group).There was interaction between intervention method and time on 6MWD and SGRQ score(P<0.05).The main effect of intervention method and time on 6MWD and SGRQ score was significant(P<0.05).At 1,2,4 and 6 months of intervention,6MWD of the experimental group was longer than that of the control group,and SGRQ score was lower than that of the control group(P<0.05).There was interaction between intervention method and time on FEV_(1)/FVC(P<0.05),but no interaction on HAMA and HAMD scores(P>0.05).The main effect of the intervention method was significant on FEV_(1)/FVC(P<0.05),but not significant on HAMA and HAMD scores(P>0.05).The main effect of time on FEV_(1)/FVC and HAMA and HAMD scores was significant(P<0.05).The FEV_(1)/FVC of the experimental group was higher than that of the control group at 4 and 6 months of intervention(P<0.05).There was no significant difference in the proportion of acute exacerbation between the two groups within 6 months of intervention(P>0.05).No patients in both groups were readmitted due to acute exacerbation within 6 months of intervention.Conclusion MDT PR based on goal setting can effectively improve exercise endurance,quality of life,lung function and short-term prognosis of COPD patients,but it has not been found to effectively reduce anxiety and depression in patients.