Valsalva动作在慢性阻塞性肺疾病患者肺功能康复治疗中应用价值研究

Study on the application value of Valsalva movement in pulmonary function rehabilitation of patients with chronic obstructive pulmonary disease

目的探讨Valsalva动作对中、重度慢性阻塞性肺疾病(COPD)稳定期患者肺功能、运动耐量及生活质量的影响。方法将106例COPD稳定期患者按照随机数字表法分为对照组(稳定期药物治疗+全身呼吸操组)与观察组(稳定期药物治疗+Valsalva动作融入全身呼吸操康复组),各53例。分别于研究开始前、第30天、第90天记录肺功能(FEV1、FVC、IC等)、6分钟步行距离(6MWD),分别于研究开始前、第90天记录圣乔治呼吸疾病问卷(SGRQ)评分。结果肺功能检查提示第90天时,观察组FEV1(1.29±0.03)L明显高于对照组(1.14±0.14)L,差异有统计学意义(P<0.05),观察组FVC(2.36±0.20)L明显高于对照组(2.21±0.37)L,差异有统计学意义(P<0.05);观察组IC在第90天时优于对照组,差异有统计学意义(P<0.05);两组比较,FEV1、FVC、IC在第90天谷值反应差异均有统计学意义(P<0.05),观察组均优于对照组。6分钟步行试验显示,观察组在第30天和第90天谷值反应分别为(29.42±5.16)m和(79.36±17.28)m,两者差异有统计学意义(P<0.05)。SGRQ评分比较,第90天两组SGRQ评分对比治疗前均有改善(P<0.05),观察组SGRQ评分(40.33±3.07)明显低于对照组SGRQ评分(47.53±10.01),差异有统计学意义(P<0.05)。结论Valsalva动作融入全身呼吸操康复组在改善肺功能、提高运动耐量、改善生活质量方面优于全身呼吸操组。

Objective To investigate the effects of Valsalva maneuver on pulmonary function,exercise tolerance and quality of life in patients with moderate and severe chronic obstructive pulmonary disease(COPD)in stable phase.Methods 106 patients with COPD in stable phase were divided into control group(stable phase drug therapy+whole body breathing exercise group)and observation group(stable phase drug therapy+Valsalva maneuver into whole body breathing exercise rehabilitation group),with 53 cases in each group.Pulmonary function(FEV1,FVC,IC,etc.)and 6-minute walking distance(6MWD)were recorded before the study began,on the 30th day and on the 90th day,respectively.St.George's respiratory questionnaire(SGRQ)scores were recorded before the study began and on the 90th day,respectively.Results Pulmonary function examination showed that on the 90th day,FEV1 in the observation group was(1.29±0.03)L,The results showed a pronounced increase in the experimental group's measurements compared to the control group's(1.14±0.14)L,This disparity was found to be statistically noteworthy(P<0.05);FVC in the observation group was(2.36±0.20)L,The experimental data surpassed the control group's measurements(2.21±0.37)L,The disparity between the groups was deemed to be statistically meaningfu(P<0.05);By the 90th day,the observation group demonstrated a superior IC value compared to the control group,and this improvement was accompanied by a statistically discernible difference(P<0.05);FEV1,FVC,IC in the two groups were compared,and the differences were statistically significant on the 90th day(P<0.05),and the observation group was better than the control group.The 6-minute walking test showed that the trough value responses of the observation group on the 30th day and the 90th day were(29.42±5.16)m and(79.36±17.28)m,respectively,with statistically significant difference(P<0.05).SGRQ scores of the two groups were improved after 90 days of treatment(P<0.05),furthermore,on comparison,the SGRQ scores for the observation group were markedly reduced in comparison to the control group's scores[(40.33±3.07)vs.(47.53±10.01)],with statistically significant difference(P<0.05).Conclusion The combination of Valsalva maneuver and whole body breathing exercises is superior to whole body breathing exercises in improving pulmonary function,exercise toler ance and quality of life.