慢性支气管炎和慢性阻塞性肺疾病患者运动能力和运动中呼吸困难及焦虑、抑郁状态研究  

Study on the Exercise Capacity,Dyspnea,Status of Anxiety and Depression in the Patients with Chronic Bronchitis and COPD

作　　者：刘广杰[1] 胥杰[1] 王扬[1] 罗秀芳[1] 

机构地区：[1]首都医科大学附属北京同仁医院呼吸内科,100730

出　　处：《医学研究杂志》2015年第6期28-30,共3页Journal of Medical Research

基　　金：教育部留学回国科研基金资助项目(2005546)

摘　　要：目的慢性阻塞性肺疾病(chronic obstructive pulmonary,COPD)是一肺部疾病,也是周身的系统性疾病,提倡采用4方面评价的BODE评价标准,包括运动能力和呼吸困难评价因子。中重度COPD患者活动时呼吸困难常是门诊就医时的主诉,也是轻度COPD和慢性支气管炎(CB)病程进展的结果,本文目的是观察慢性支气管炎和COPD患者的运动能力和运动中呼吸困难及焦虑抑郁状态,以便加深对COPD的认知。方法慢性支气管炎患者21例;COPD诊断标准符合中华医学会诊断标准,Ⅱ级稳定期COPD患者18例;Ⅲ级稳定期COPD患者12例,Ⅳ级稳定期COPD患者5例。运动方案应用6分钟步行试验,呼吸困难评价采用勃氏分级(Borg scale,BS),焦虑、抑郁状态评价采用HAD评价方法。结果慢性支气管炎患者的6分钟步行距离为410±65m,Ⅱ级COPD患者的6分钟步行距离为368±46m。Ⅲ+Ⅳ级COPD患者的6分钟步行距离为238±55m,与慢性支气管炎和中度COPD患者的6分钟步行距离差异明显(P<0.01)。慢性支气管炎患者和Ⅱ级COPD患者运动过程中无明显呼吸困难,Ⅲ+Ⅳ级COPD患者运动中呼吸困难明显,有些患者运动过程中需要休息方完成6分钟的步行。Ⅲ+Ⅳ级COPD患者BS运动初始为4.0±1.0,2分钟时为6.2±2.0,4分钟时为5.0±2.0,6分钟时为6.6±2.0,与慢性支气管炎和Ⅱ级COPD患者的BS差异明显(P<0.01)。经HAD评价在慢性支气管炎患者,没有焦虑或抑郁状态,COPDⅡ级患者抑郁1例,COPDⅢ+Ⅳ级患者焦虑5例,抑郁3例,焦虑和抑郁5例,共计13例,与COPDⅡ级和慢性支气管炎患者比较,明显增多(P<0.01)。结论重度和极重度COPD患者的平地运动能力下降,运动中呼吸困难明显,一些患者存在着焦虑、抑郁状态。Objective Chronic obstructive pulmonary disease （COPD） is a type of obstructive lung disease, with chronic systemic inflammation syndrome. It is proposed a criteria, known as BODE, by which composed of four aspects to evaluate including the exercise eapacity and dyspnea. Dyspnea is one of the most major complain in the moderate - severe COPD at out - patient treatment, also it is the outcome of the progression in mild COPD or chronic broniehitis（ CB）. The purpose of this study is to investigate the exercise capacity and the status of dyspnea during exercise, anxiety and depression in the patients with ehronie bronchitis or with COPD. Methods 21 CB pa- tients and 18 COPD Ⅱ patients,12 COPD m and 5COPD Ⅳ patients were recruited. The diagnostic criteria of COPD is dependent on Chinese thoracic soeiety standard, All COPD patients were in stable phase. Six minute walking test was used for exercise test. Dyspnea e- valuation was according to Borg scale （BS）. Evaluation of the status of anxiety and depression was used by HAD evaluation method. Results Six minutes walking distance was 410 ± 65m in CB patients, while, in the patients of COPD Ⅱ and COPD Ⅲ ＋ Ⅳ. Six minutes walking distance was 368 ±46m and 238 ± 55m, separately. Six minutes walking distance was significantly decreased in COPD Ⅲ ＋ Ⅳ patients compare with COPD Ⅱ patients and CB patients （ P 〈 0.01 ） , respectively. Dyspnea evaluation by Borg scale in exercise test showed that there was no obvious dyspenea in patients with CB or in the patients with COPD H , but dyspenea was significant increase by observation in the patients with COPD Ⅲ＋ Ⅳ, some of them needed stop to rest during the exercise test. BS was examined during exer- cise test at a series of time point （0, 2, 4, 6 minutes）. BS of COPD Ⅲ＋Ⅳ patients were 4.0±1.0at 0min, 6.2±2.0 at 2min, 5.0± 2.0 at 4min, 6.6 ± 2.0 at 6min, respectively. The BS was significantly increased in COPD Ⅲ＋Ⅳ, patients compare with CB patients and COPD Ⅱ patie

关 键 词：慢性阻塞性肺疾病 运动 呼吸困难 焦虑 抑郁 

分 类 号：R563[医药卫生—呼吸系统]