观察反馈式抗阻吸气肌训练对脊髓损伤患者呼吸功能的影响

目的观察反馈式抗阻吸气肌训练对脊髓损伤(SCI)患者吸气肌力量、呼吸困难程度和呼吸系统并发症发生率的影响。方法66例SCI患者随机分为对照组和试验组,每组各33例,对照组给予常规康复训练加腹式呼吸训练,试验组予以常规康复训练加反馈式抗阻吸气肌训练,治疗前、治疗4周后评估最大吸气压(MIP)、吸气流速峰值(PIF)、呼吸困难程度及呼吸系统并发症发生率,比较两组患者呼吸功能的改善情况。结果治疗4周后两组MIP、PIF均高于治疗前(P<0.05);且试验组MIP、PIF高于对照组(P<0.05);治疗4周后两组呼吸困难程度评分低于治疗前(P<0.05),且试验组低于对照组(P<0.05);两组呼吸系统并发症发生率比较,差异无统计学意义(χ^2=0.64,P>0.05)。结论反馈式抗阻吸气肌训练可明显改善SCI患者的吸气肌力量、减轻呼吸困难程度。

慢性气道疾病稳定期吸入药物能力与肺功能相关性

目的干粉吸入剂(DPI)的吸气流速是否达到最佳与药物疗效密切相关。本研究希望通过测定最大吸气峰值流速(PIF)来评估患者吸入药物能力,寻找PIF与肺功能指标之间相关性,指导患者选择有效的吸入装置。方法纳入慢性气道疾病稳定期患者。采用In-check Dial G16■装置记录PIF数值。同日完成肺功能或记录半年内稳定期肺功能数值。结果本研究共纳入168名稳定期慢性气道疾病患者,平均年龄(66.48±10.77)岁,平均BMI(23.56±3.75)kg/m^(2)。以PIF 60 L/min为界分两组,显示年龄、肺功能指标(VT、IRV、IC、VC_(max)、FVC、FEV_(1)、FEV_(1)/FVC、PEF、MEF_(75)、MEF_(50)、MEF_(25)、MEF_(75/25)、DLCO、TLC)组间比较,P<0.05;性别、BMI、肺功能指标(MV、ERV、RV、RV/TLC、FRC)组间比较,P>0.05。PIF与IC相关系数r=0.326,P<0.001,两者线性回归分析R^(2)值0.106,P<0.001。PIF<60 L/min时,IC对应AUC值为0.814,最佳界值1.27L,敏感度76.2%,特异度83.0%。结论本研究发现IC是影响PIF的因素之一,当IC<1.27L时,可能出现PIF达不到最佳的情况。需关注这类人群DPI使用情况,评估吸入药物能力,改善疾病预后。

Effect of breathing and Daoyin exercises on the quality of life in patients with chronic obstructive pulmonary disease

Objective： To observe the effect of breathing and Daoyin exercises on the quality of life in patients with stable chronic obstructive pulmonary disease（COPD） due to deficiency of the lung and kidney（grade II-III）.Methods： A total of 60 eligible cases were randomly allocated into a treatment group（n=30） and a control group（n=30） by random number table. Cases in the control group received routine Western medical treatment, whereas cases in the treatment group conducted breathing and Daoyin exercises in addition to routine Western medical treatment. Patients in both groups were treated for a total of 3 months. Then the observation was made on changes in pulmonary ventilation function, major clinical symptoms, modified Medical Research Council scale（m MRC）, distance in 6-minute walk test（6-MWT）, COPD assessment test（CAT） and efficacy satisfaction questionnaire for COPD（ESQ-COPD） before and after treatment. Results： After treatment, the total effective rate was 80.0% in the treatment group, versus 66.7% in the control group, showing a statistical difference（P〈0.05）. Patients in the treatment group obtained more significant improvement in coughing, sputum production, dyspnea and shortness of breath than those in the control group（P〈0.05）. Patients in the treatment group obtained more significant elevation in the forced expiratory volume in 1 second percentage of predicted value（FEV1%） and peak expiratory flow rate（PEF%） than those in the control group（P〈0.05）. Patients in the treatment group obtained lower m MRC score than those in the control group（P〈0.05）. Patients in the treatment group obtained longer 6-MWT distance than those in the control group（P〈0.05）. Patients in the treatment group obtained lower CAT score（P〈0.01） and higher ESQ-COPD score（P〈0.05） than those in the control group. Conclusion： Breathing and Daoyin exercises combined with routine Western medical treatment are effective for stable COPD（grade II-III） due to deficiency of the lung and kidney and can improve the patients＇ quality of life.