肺康复对长期家庭氧疗的老年慢性阻塞性肺疾病患者的临床疗效及安全性

Clinical efficacy and safety of pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease treated with long-term home oxygen therapy

目的探讨肺康复对于长期家庭氧疗的老年慢性阻塞性肺疾病(慢阻肺)患者的临床疗效及安全性。方法纳入2021年11月至2022年10月于山西医科大学第一医院就诊后顺利出院的老年稳定期慢阻肺患者60例,运用前瞻性研究方法,将入组患者按照随机数字表法分为肺康复组和对照组各30例,肺康复组患者进行为期12周的肺康复训练,对照组患者进行肺康复健康宣教及营养宣教,比较两组患者一般资料,干预前后的肺功能[第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、1秒率(FEV_(1)/FVC)、第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)]、血气分析[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))]、6 min步行距离(6MWD)、握力、5次起立-坐下时间(5R-STST)、改良版英国医学研究委员会呼吸困难问卷(mMRC)、慢阻肺患者自我评估测试(CAT)、闭目单足站立时间(CCT)、Berg平衡量表(BBS)及安全性。结果最终肺康复组29例、对照组28例患者完成了本研究,两组患者一般资料差异均无统计学意义(均P>0.05)。干预后肺康复组患者FEV_(1)/FVC、PaO_(2)、PaCO_(2)、SaO_(2)、6MWD、握力、5R-STST、CAT、CCT、BBS均较干预前好转(t=-2.242、-4.630、W=-3.439、t=-6.512、-10.563、-6.197、W=-3.968、t=10.847、-7.334、W=-4.189,均P<0.05),对照组干预前和干预后各项指标比较差异均无统计学意义(均P>0.05);两组间比较结果显示,干预后肺康复组6MWD、CAT、CCT较对照组改善明显(t=-2.104、2.183、2.106,均P<0.05),余指标两组间比较差异均无统计学意义(均P>0.05)。研究过程中未出现与训练相关的不良反应。结论为期12周的肺康复对于长期家庭氧疗的老年COPD患者有效,有助于改善患者呼吸功能和全身症状,提高运动耐力、四肢肌力及平衡功能;本套肺康复方案能在保证简单易行的前提下,改善患者的临床症状,安全性及依从性良好,值得推广应用。

ObjectiveTo investigate the clinical efficacy and safety of pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease(COPD)who are undergoing long-term home oxygen therapy.MethodsThe study included a total of 60 elderly patients with COPD who were successfully discharged after receiving treatment at the First Hospital of Shanxi Medical University from November 2021 to October 2022.The enrolled patients were randomly divided into two groups:the pulmonary rehabilitation group and the control group,with 30 patients in each group.The allocation was determined using a random number table and prospective research methods.Patients in the pulmonary rehabilitation group underwent a 12-week pulmonary rehabilitation training program,while patients in the control group received pulmonary rehabilitation education and nutrition education.The general data of the two groups of patients were compared,including lung function parameters[forced expiratory volume in one second(FEV_(1)),forced vital capacity(FVC),forced expiratory volume in one second to forced vital capacity ratio(FEV_(1)/FVC),and percentage of predicted forced expiratory volume in one second(FEV_(1)%pred)],blood gas analysis[partial pressure of arterial oxygen(PaO_(2)),partial pressure of arterial carbon dioxide(PaCO_(2)),arterial oxygen saturation(SaO_(2))],6-minute walking distance(6MWD),grip strength,5-round sit to stand test(5R-STST),modified British medical research council(mMRC)score,COPD assessment test(CAT)score,closed cycles test(CCT),Berg balance scale(BBS),and safety measures.These parameters were assessed before and after the intervention.ResultsA total of 29 patients in the pulmonary rehabilitation group and 28 patients in the control group completed the study.The general data between the two groups showed no significant difference(all P>0.05).After the intervention,patients in the pulmonary rehabilitation group showed improvements in FEV_(1)/FVC,PaO_(2),PaCO_(2),SaO_(2),6MWD,grip strength,5R-STST,CAT,CCT,and BBS(t=-2.242,-4.630,W=-3.439,t=-6.512,-10.563,-6.197,W=-3.968,t=10.847,-7.334,W=-4.189,all P<0.05).Additionally,6MWD,CAT,and CCT showed significant improvement after the intervention compared to the control group(t=-2.104,2.183,2.106,all P<0.05).No training-related adverse effects were observed during the study.ConclusionsThe 12-week pulmonary rehabilitation program is shown to be effective for elderly patients with COPD who are undergoing long-term home oxygen therapy.This program helps to improve respiratory function,systemic symptoms,exercise endurance,muscle strength,and balance function.It is designed to be simple and easy to implement,allowing patients to achieve their training goals and improve their clinical symptoms.Additionally,the program has been found to be safe and well-tolerated by patients,making it a valuable intervention that should be promoted and widely applied.