作者：王丽1，2 ，张文博 1，2 ，毕冰茜 1，2 ，李娟 1，2

单位：

1.250062 山东省济南市，山东省职业卫生与职业病防治研究院；2.250062 山东省济南市，山东第一医科大学（山东省医学科学院）；通信作者：李娟，E-mail：liw2018nj@163.com

Units：

1.Shandong Academy of Occupational Health and Occupational Diseases，Jinan 250062，China；2.Shandong First Medical University（Shandong Academy of Medical Sciences），Jinan 250062，China；Corresponding author：LI Juan，E-mail：liw2018nj@163.com

关键词：

慢性阻塞性肺疾病；跨理论模型；肺康复；家庭护理；可行性研究

Keywords：

Chronic obstructive pulmonary disease；Transtheoretical Model；Pulmonary rehabilitation；Homenursing；Feasibility studies

CLC：

R 563.9

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.017

Funds：

山东省医学科学院医药卫生科技创新工程项目

摘要：

目的　探讨基于跨理论模型（TTM）的居家肺康复方案在慢性阻塞性肺疾病（COPD）患者中的可行性和有效性。方法　选取 2016 年 8 月—2019 年 2 月山东省职业卫生与职业病防治研究院呼吸内科收治的 COPD 患者116 例，采用抛硬币法分为对照组和试验组，每组 58 例。对照组患者接受居家肺康复方案，试验组患者接受基于 TTM的居家肺康复方案；两组患者均持续干预 24 周。比较两组患者居家运动依从性及干预前后运动行为、肺功能指标〔包括第 1 秒用力呼气容积占预计值百分比（FEV 1 %）、第 1 秒用力呼气容积与用力肺活量比值（FEV 1 /FVC）〕、6 分钟步行距离（6MWD）、慢性阻塞性肺疾病评估测试（CAT）评分，并比较两组患者干预期间不良事件发生情况。结果　（1）试验组患者居家运动总体依从率、完全依从率高于对照组（P<0.05）。（2）两组患者干预前运动行为比较，差异无统计学意义（P>0.05）；试验组患者干预后运动行为优于对照组（P<0.05）。（3）两组患者干预前 FEV 1 %、FEV 1 /FVC、6MWD、CAT 评分及干预后 FEV 1 %、FEV 1 /FVC 比较，差异无统计学意义（P>0.05）；试验组患者干预后6MWD 长于对照组，CAT 评分低于对照组（P<0.05）。（4）两组患者干预期间均未发生严重不良事件。结论　基于TTM 的居家肺康复方案在 COPD 患者中安全可行，其可有效提高患者运动依从性及运动耐力，改善患者生活质量，但并未明显改善患者肺功能。

Abstract：

Objective　To investigate the feasibility and effectiveness of Transtheoretical Model（TTM） guidedhome-based pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease（COPD）. Methods　From August 2016 to February 2019，a total of 116 patients with COPD were selected in the Department of RespiratoryMedicine，Shandong Academy of Occupational Health and Occupational Diseases，and they were divided into control group andexperiment group by coin tossing method，with 58 cases in each group. Patients in control group received home-based pulmonaryrehabilitation program，while patients in experiment group received TTM guided home-based pulmonary rehabilitationprogram；patients in the two groups were continuously intervened for 24 weeks. Exercise behavior，exercise compliance，index of pulmonary function（including FEV 1 % and FEV 1 /FVC），6-minute walking distance（6MWD）and CAT score werecompared between the two groups before and after intervention，moreover incidence of adverse events was observed duringintervention. Results　（1）Overall exercise compliance rate and complete exercise compliance rate in experiment group werestatistically significantly higher than those in control group（P<0.05）.（2）There was no statistically significant differencein exercise behavior between the two groups before intervention（P>0.05），while exercise behavior in experiment group wasstatistically significantly better than that in control group after intervention（P<0.05）.（3）No statistically significant differenceof FEV 1 %，FEV 1 /FVC，6MWD or CAT score was found between the two groups before intervention，nor was FEV 1 % or FEV 1 /FVC after intervention（P>0.05）；6MWD in experiment group was statistically significantly longer than that in control groupafter intervention，while CAT score in experiment group was statistically significantly lower than that in control group（P<0.05）.（4）No one in the two groups occurred any serious adverse events during intervention. Conclusion　TTM guided home-based pulmonary rehabilitation program is safe and effective in patients with COPD，which can effectively improve the exercisecompliance，exercise tolerance and quality of life，but it can not effectively improve the pulmonary function.

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