重度和极重度COPD患者急性加重后早期院内肺康复的效果  

Effects of Early Inpatient Pulmonary Rehabilitation during Acute Exacerbation of Severe and Very Severe COPD

作　　者：王鑫[1] 郝志芳[1] 李莉[1] 宋适恒[2] 龙雪娟[1] 李宁[1] 

机构地区：[1]河北省胸科医院 [2]河北医科大学第一附属医院,河北石家庄050000

出　　处：《昆明医科大学学报》2013年第1期71-75,共5页Journal of Kunming Medical University

基　　金：河北省医学科学研究重点研究计划资助项目(20110021)

摘　　要：目的观察重度和极重度COPD患者急性加重期院内早期应用以无创正压通气(NPPV)下运动锻炼为基础的肺康复(pulmonary rehabilitation,PR)后的疗效.方法将2010年7月至2012年6月因急性加重(acute exacerbation of COPD,AECOPD)住院治疗的67名重度和极重度COPD患者随机分成单纯药物治疗组(非PR组)和药物治疗联合PR组(PR组);PR组除常规药物治疗外,早期院内NPPV下的运动锻炼,每天1～2次、每次10～15 min,共5～7 d;比较2组患者住院期间转入ICU的比例以及肺康复前后6 min步行距离(six-minute walk distance,6MWD)和6MWD后的Brog评分.结果(1)住院期间非PR组转入ICU的比例(25.7%)明显高于PR组(9.3%),(P<0.05).(2)2组患者出院时的6MWD(PR组和PR组分别为248.1 m和260.5 m,P>0.05)无差异.PR组出院时6MWD后Brog评分低于非PR组(非PR组和PR组分别为5.3和3.3,P>0.05).(3)出院时2组患者6MWD的变化值(非PR组和PR组分别为27.5 m和26.2 m)均小于最小临床显著差异值(54米)(P<0.05),但PR组出院时6MWD后Brog评分的变化值(3.7)要大于非PR组(1.3),P<0.05).结论重度和极重度COPD患者急性加重期院内早期肺康复是可行的,且短期肺康复治疗虽不能改善患者的运动能力,但可降低患者的呼吸困难程度.Objective To observe the clinical effects of early inpatient pulmonary rehabilitation（PR） program based on simultaneous exercise training and non-invasive positive pressure ventilation（NPPV） during acute exacerbation of severe and very severe chronic obstructive pulmonary disease（COPD）.Methods Sixty-seven patients,hospitalized because of acute exacerbation of COPD（AECOPD） from July 2010 to June 2012,with severe（GOLD stage Ⅲ） or very severe（GOLD stageⅣ） COPD were randomly distributed into 2 groups： one group（non-PR group） performing pharmacotherapy alone and the other group（PR group） performing PR combined with pharmacotherapy.In addition to conventional pharmacotherapy,the PR group executed simultaneously exercise training and NPPV 10-15 minutes every time,twice-thrice per day for 5-7 days.The pro-post changes in six-minute walk distance（6MWD） test,Brog score and the percentage of patients admitted to intensive care unit in the duration of hospital stay were compared.Results Compared with the PR group,the percentage of patients admitted to intensive care unit in the duration of hospital stay（25.7% vs 9.3%,P0.05） was higher in the non-PR group.On the discharge no differences were found between two groups in 6MWD（248.1m vs 260.5m,P0.05）,while post-6MWD Brog score of the PR group was lower than the non-PR group（3.3 vs 5.3,P 0.05）.Absolute changes of the all two groups in 6MWD（27.5 m and 26.2m,respectively） were significantly lower than the minimum clinically significant difference（54 m）（P0.05）.Absolute changes of the PR groups in post-6MWD Brog score（3.7） were higher than the minimum clinically significant difference（1）（P0.05）,but the non-PR group（1.3） was not（P 0.05）.Conclusions Early inpatient PR during acute exacerbation of severe（GOLD stage Ⅲ） or very severe（GOLD stage Ⅳ） COPD is fesiable.Although the short-term inpatient PR can not improve exercise tolerance,it can ameliorate the severity of dyspnoea in the patient

关 键 词：肺康复 慢性阻塞性肺疾病 慢性阻塞性肺病急性加重 无创正压通气 运动锻炼 

分 类 号：R563[医药卫生—呼吸系统]