营养和心理干预联合肺康复训练操对慢阻肺患者的疗效  

Clinical effect of nutritional and psychological intervention combined with pulmonary rehabilitation exercise on patients with chronic obstructive pulmonary disease

作　　者：张继华[1] 张丽琼[1] 杨耀鹏[1] 李晓[1] 张毅[1] 王丽英[1] 石红 姜华[1] 郭巍 沐黎 曾勇[1] Zhang Jihua;Zhang Liqiong;Yang Yaopeng;Li Xiao;Zhang Yi;Wang Liying;Shi Hong;Jiang Hua;Guo Wei;Mu Li;Zeng Yong(Department of Pulmanory and Critical Care Medicine,the Sixth Affiliated Hospital of Kunming Medical University,Yuxi 653100,China)

机构地区：[1]昆明医科大学第六附属医院呼吸与危重症医学科,玉溪653100

出　　处：《中华医学杂志》2020年第2期110-115,共6页National Medical Journal of China

基　　金：云南省科技计划项目(2014FZ049)。

摘　　要：目的探讨以营养补充和心理干预联合肺康复训练操为主的综合管理对慢性阻塞性肺疾病(简称慢阻肺)患者的疗效。方法选择昆明医科大学第六附属医院2014年10月至2017年10月就诊的260例慢阻肺稳定期患者,依据肺功能分轻、中、重、极重度,各组按随机数字表法再分成对照组和综合管理组。对照组予劝导戒烟、疫苗接种、氧疗、规范药物使用等常规治疗,综合管理组在此基础上增加营养补充、心理干预、肺康复训练操。12个月后对比分析两组患者的第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1%预计值)、FEV1与用力肺活量(FVC)的比值(FEV1/FVC)、动脉血氧分压(PaO2)及二氧化碳分压(PaCO2)、体质指数(BMI)、血清白蛋白(ALB)水平、营养风险筛查(NRS2002)评分、上臂围、6 min步行距离(6MWD)、改良版英国医学研究委员会呼吸困难量表(mMRC)评分、慢阻肺评估测试(CAT)评分、中文版医院焦虑抑郁量表(HADS)评分、圣乔治呼吸问卷(SGRQ)评分、急性加重次数等。结果综合管理组PaO2显著高于对照组[(51.1±7.2)比(47.0±9.1)mmHg](1 mmHg=0.133 kPa);NRS2002评分[(1.1±1.1)比(2.2±1.0)分]、焦虑评分[(4.1±2.2)比(5.6±2.7)分]、抑郁评分[(4.1±2.0)比(5.5±2.6)分]、SGRQ总分[(36.8±20.8)比(48.6±19.5)分]均显著低于对照组;6MWD显著长于对照组[(368.4±72.0)比(343.4±75.0)m](P<0.05);轻、中、重度患者急性加重次数显著低于对照组(均P<0.05);FEV1%预计值、FEV1/FVC、PaCO2、BMI、ALB、上臂围、mMRC及CAT评分差异无统计学意义。结论营养干预、心理干预联合肺康复训练操的综合肺康复管理措施可降低慢阻肺患者的营养风险,改善焦虑抑郁,提高生活质量,减少轻、中、重度患者急性加重次数。Objective To explore the clinical effect of nutritional and psychological intervention combined with pulmonary rehabilitation exercise on patients with chronic obstructive pulmonary disease(COPD).Methods A total of 260 patients with COPD admitted to the Sixth Affiliated Hospital of Kunming Medical University from October 2014 to October 2017 were included.They were divided into mild,moderate,severe and extremely severe groups according to forced expiratory volume in one second predicted(FEV1%prep)of pulmonary function.The patients were divided into control group and comprehensive management group according to the random number table method.The control group was given routine treatment including smoking quitting persuasion,vaccination,oxygen therapy and standardized medication.The comprehensive management group was given additional nutritional support,psychological intervention and pulmonary rehabilitation exercise.The data of the lung function indexes(FEV1%prep,FEV1/FVC,PaO2,PaCO2),nutritional indexes[body mass index(BMI),albumin(ALB),nutrition risk screening(NRS)2002],anxiety and depression scores,6-minute walking distance(6MWD),modified medical research council(mMRC)dyspnea scale,COPD assessment test(CAT),St.George′s score,and frequency of acute exacerbations were compared between two groups after 12 months of treatment.Results After 12 months′treatment,PaO2 in the comprehensive management group was significantly higher than that in the control group[(51.1±7.2)vs(47.0±9.1)mmHg](1 mmHg=0.133 kPa);Nutritional risk(NRS2002)decreased obviously[(1.1±1.1)vs(2.2±1.0)];anxiety score[(4.1±2.2)vs(5.6±2.7)];depression score[(4.1±2.0)vs(5.5±2.6)]and St.George′s score[(36.8±20.8)vs(48.6±19.5)]decreased significantly(P<0.05).And the 6MWD was significantly farther[(368.4±72.0)vs(343.4±75.0)m]in management group.The frequency of acute exacerbations was significantly reduced in the mild,moderate and severe groups(P<0.05).But there was no significant difference in FEV1%prep,FEV1/FVC,PaCO2,BMI,ALB,mMRC score and

关 键 词：肺疾病 慢性阻塞性 康复 营养疗法 心理疗法 治疗结果 

分 类 号：R563[医药卫生—呼吸系统]