天灸疗法联合康复训练对南宁市社区慢性阻塞性肺疾病稳定期患者生命质量的影响

Effect of crude herb moxibustion combined with rehabilitation training on life quality of patients ;with stable-stage chronic obstructive pulmonary diseases in Nanning communities

目的：了解天灸疗法联合康复训练对南宁市社区慢性阻塞性肺疾病（COPD）稳定期患者肺功能的恢复情况以及对其生命质量的影响。方法抽取南宁市社区200例COPD稳定期患者做为本次研究对象。采用随机数字表法分为对照组和试验组，每组各100例，对照组患者接受常规药物治疗及社区健康教育指导；试验组患者在此基础上，于每年三伏、三九天，用天灸药饼准确地贴于选定的穴位上，并在药饼上行艾炷灸。1个疗程为1年6次，连续完成2个疗程，并联合康复训练。以上研究对象均在本次试验干预前和进行2个疗程结束后6个月时进行肺功能检测及圣乔治呼吸问卷评分研究对比。结果试验组患者干预前的用力肺活量、第1秒用力呼气容积、第1秒用力呼气容积与用力肺活量的百分比分别为（2.27±0.36）L、（1.56±0.30）L、（44.81±5.35）%，干预后6个月分别为（3.36±0.42）L、（2.25±0.27）L、（65.38±8.08）%，差异有统计学意义（t=18.90、16.40、20.36，P＜0.01）；对照组干预前分别为（2.28±0.43）L、（1.58±0.33）L、（45.17±4.97）%，干预后6个月分别为（2.57±0.57）L、（1.71±0.35）L、（46.94±8.42）%，差异无统计学意义（t=1.81、2.04、1.70，P＞0.05）；2组间干预前比较差异无统计学意义（t=0.17、0.43、0.47，P＞0.05)，2组间干预后比较差异有统计学意义（t=10.62、11.62、14.99，P＜0.01）。试验组患者的圣乔治呼吸问卷得分其症状部分、活动能力部分、疾病影响部分、总分在干预前分别为（16.56±1.76）、（10.44±1.57）、（18.55±2.17）、（45.73±2.53）分，干预后6个月分别为（10.77±1.56）、（7.28±1.23）、（14.33±1.66）、（32.98±2.35）分，差异有统计学意义（t=14.82～35.50，P＜0.01）；对照组干预前分别为（16.47±1.81）、（10.39±1.66）、（18.52±2.16）、（45.79±2.49）分，干预后6个月分别为（16.12±1.36）、（9.89±1.38）、（16.96±1.58）、（42.15±2.34）分，差异无统计学意义（t=1.45～2.17，P＞0.05）；2组间干预前比较差异无统计学意义（t=0.09～0.34，P＞0.05），2组间干预后比较差异有统计学意义（t=10.88~26.22，P＜0.01）。结论天灸疗法联合康复训练对延缓COPD稳定期患者肺功能下降，减少并发症，提高患者生命质量有一定的临床意义。

Objective To learn the effects of crude herb moxibustion combined with rehabilitation training on the recovery of pulmonary functions and quality of life of patients with stable-stage chronic obstructive pulmonary diseases (COPD) in Nanning communities. Methods Two hundred patients with stable-stage COPD, sampled from Nanning communities and used as the subjects of this study, were divided into the experiment group and the control group by the random number table method. Patients in&nbsp;the control group were given conventional medication and community health care education and guides;Patients in the experiment group were not only offered the same treatment as mentioned above, but treated during dog days and the coldest days of winter with moxibustion medicine cakes which were applied accurately on selected acupuncture points, together with moxibustion with moxa cone done on the cakes. Treatment was done 6 times in each course of treatment, and 2 courses were given, combined with rehabilitation training. Examination of pulmonary functions was conducted for all patients before and after the treatment and St. George′s Respiratory Questionnaires (SGRQ) were distributed to them. Results Forced vital capacity patients, forced expiratory volume in first second, the percentage of forced expiratory volume in first second and forced vital capacity of experimental group before the intervention were (2.27 ± 0.36) L, (1.56 ± 0.30) L, (44.81 ± 5.35) %, while six months after the intervention were (3.36 ± 0.42) L, (2.25 ± 0.27) L, (65.38 ±8.08)%. The difference was statistically significant (t=18.90, 16.40, 20.36, P<0.01);The above indexes of control group respectively before intervention were (2.28±0.43) L, (1.58±0.33) L, (45.17 ± 4.97) %, while six months after the intervention were (2.57 ± 0.57) L, (1.71 ± 0.35) L, (46.94 ± 8.42)%. Difference was not statistically significant (t = 1.81, 2.04, 1.70, P > 0.05). Differences between two groups before intervention had no statistical significance (t = 0.17, 0.43, 0.47, P > 0.05), and differences between two groups after the intervention were statistically significant (t=10.62, 11.62, 14.99, P < 0.01). In the experimental group,before intervention the total score of SGRQ and the part scores of symptom, the activity ability and the influence of the disease were (16.56 ± 1.76) points, (10.44 ± 1.57) points, (18.55±2.17) points, (45.73 ± 2.53) points, 6 months after the intervention the scores were (10.77 ± 1.56) points, (7.28±1.23) points, (14.33 ±1.66) points, (32.98 ± 2.35) points. The difference was significant (t=14.82-35.50, P<0.01);In the control group before intervention the total scores of SGRQ and the part score of symptom, the activity ability and the influence of the disease were (16.47 ±1.81) points, (10.39 ± 1.66) points, (18.52 ± 2.16) points, (45.79 ± 2.49) points, 6 months after the intervention the scores were (16.12 ±1.36) points, (9.89 ±1.38) points, (16.96 ±1.58) points, (42.15±2.34) points. The lower score was not obvious, there was no statistically significant difference (t=1.45-2.17, P > 0.05). Intervention before comparing differences between two groups had no statistical significance (t=0.09-0.34, P > 0.05). Intervention after comparing differences between two groups was statistically significant (t=10.88-26.22, P<0.01). Conclusions Clinically, crude herb moxibustion combined with rehabilitation training is to some extent conducive to delaying the decrease in pulmonary functions, reducing complications, and improving the quality of life of patients with stable-stage COPD.