肺康复对中重度慢性阻塞性肺疾病患者轻度认知功能障碍的影响  

Effect of pulmonary rehabilitation on mild cognitive impairment in patients with moderate to severe chronic obstructive pulmonary disease

作　　者：郭雨平[1] 李乐 柯正华[1] 龙升华 GUO Yu-ping;LI Le;KE Zheng-hua;LONG Sheng-hua(Department of Respiratory Critical Care Medicine,Huangshi Central Hospital of Edong Healthcare Group(the Affiliated Hospital of Hubei Polytechnic University),Huangshi,Hubei 435000,China)

机构地区：[1]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)呼吸危重症医学科,湖北黄石435000

出　　处：《临床肺科杂志》2023年第4期558-562,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析中重度慢性阻塞性肺疾病(COPD)患者合并轻度认知功能障碍(MCI)的危险因素并探讨肺康复对中重度COPD患者认知功能的影响。方法将80例中重度COPD患者,随机分为康复组和对照组,收集年龄、文化程度、身体质量指数(BMI)、吸烟指数、病程,以及实验前后6分钟步行试验(6MWT)距离、第一秒用力呼气容积占预计值百分比(FEV 1%pred)、第一秒用力呼气容积与用力肺活量比值(FEV 1/FVC)、慢性阻塞性肺疾病评估测试(CAT)评分、匹兹堡睡眠质量指数(PSQI)评分、蒙特利尔认知评估量表(MoCA)评分,并统计分析。结果80例患者中合并MCI为64例,年龄(OR=1.295,95%CI=1.007~1.666,P<0.05)、CAT评分(OR=2.035,95%CI=1.026~4.039,P<0.05)、PSQI评分(OR=2.508,95%CI=1.104~5.698,P<0.05)是COPD合并MCI的独立危险因素,PSQI评分与MoCA评分呈负相关(r=-0.503,P<0.05),CAT评分与MoCA评分呈负相关(r=-0.609,P<0.05)。经肺康复后康复组较之前MoCA评分提高(P<0.05),PSQI评分下降(P<0.05),CAT评分下降(P<0.05),6MWT距离提升(P<0.05),FEV 1%pred提升(P<0.05)。结论肺康复可以改善中重度COPD患者认知功能,这可能与患者睡眠质量和CAT评分的改善相关。Objective To analyze the risk factors of mild cognitive impairment(MCI)in patients with moderate to severe chronic obstructive pulmonary disease(COPD)and to explore the effect of pulmonary rehabilitation on cognitive function in patients with moderate to severe COPD.Methods 80 patients with moderate to severe COPD were randomly divided into the rehabilitation group and the control group.Age,education level,body mass index(BMI),smoking index,and duration of disease were collected.Before and after the experiment,6-minute walking test(6MWT)distance,forced expiratory volume in 1 second to predicted value(FEV 1%PRED),forced expiratory volume in 1 second to forced vital capacity ratio(FEV 1/FVC),chronic obstructive pulmonary disease assessment test(CAT)score,Pittsburgh Sleep Quality index(PSQI)score,and Montreal Cognitive Assessment Scale(MoCA)score were statistically analyzed.Results 64 of the 80 patients were complicated with MCI.Age(OR=1.295,95%CI=1.007~1.666,P<0.05),CAT score(OR=2.035,95%CI=1.026~4.039,P<0.05)and PSQI score(OR=2.508,95%CI=1.104~5.698,P<0.05)were independent factors for COPD combined with MCI,and PSQI score was negatively correlated with MoCA score(R=-0.503,P<0.05).CAT score was negatively correlated with MoCA score(r=-0.609,P<0.001).After pulmonary rehabilitation,MoCA score,PSQI score,CAT score,6MWT distance and FEV 1%pred were improved in the rehabilitation group(P<0.05).Conclusion Pulmonary rehabilitation improves cognitive function in patients with moderate to severe COPD,which may be associated with improved sleep quality and CAT score.

关 键 词：慢性阻塞性肺疾病 轻度认知功能障碍 危险因素 肺康复 

分 类 号：R563.9[医药卫生—呼吸系统] R493[医药卫生—内科学]