作者：胡相悦，范耀菊

单位：

404000 重庆市，重庆大学附属三峡医院呼吸与危重症医学科

Units：

Department of Respiratory and Critical Care Medicine，Chongqing University Three Gorges Hospital，Chongqing 404000，China

关键词：

慢性阻塞性肺疾病；稳定期；指南；肺康复运动方案；运动耐力；衰弱；生活质量

Keywords：

Chronic obstructive pulmonary disease；Stable；Guidelines；Pulmonary rehabilitation exercise program；Exercise tolerance；Frailty；Quality of life

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.020

Funds：

重庆市卫生计生委医学科研计划面上项目（2018MSXM0595）

摘要：

背景　肺康复是以运动为核心的综合康复训练方法，可纠正慢性阻塞性肺疾病（COPD）患者低氧血症，增加运动耐力，但目前肺康复运动尚缺乏统一标准和方案。目的　探讨基于指南构建肺康复运动方案对 COPD 稳定期患者运动耐力、衰弱状况和生活质量的影响。方法　选择 2017 年 11 月—2019 年 12 月重庆大学附属三峡医院呼吸与危重症医学科收治的 246 例 COPD 稳定期患者为研究对象，采用随机数字表法分为常规组和指南组，每组 123 例。常规组患者采取常规肺康复运动方案，指南组患者基于指南构建肺康复运动方案，两组患者均干预 12 周。比较两组患者干预前后肺功能指标〔包括第 1 秒用力呼气容积（FEV 1 ）、FEV 1 与用力肺活量比值（FEV 1 /FVC）、FEV 1 占预计值百分比（FEV 1 %pred）、最大自主通气量（MVV）及 MVV 占预计值百分比（MVV%pred）〕、6 min 步行距离、Borg 劳累度评估量表评分、衰弱状况及 COPD 评估测试（CAT）评分。结果　干预后两组患者 FEV 1 、MVV 分别大于本组干预前，FEV 1 /FVC、FEV 1 %pred、MVV%pred 分别高于本组干预前（P ＜ 0.05）；干预后指南组患者 FEV 1 、MVV大于常规组，FEV 1 /FVC、FEV 1 %pred、MVV%pred 高于常规组（P ＜ 0.05）。干预后两组患者 6 min 步行距离分别长于本组干预前，Borg 劳累度评估量表评分分别低于本组干预前（P ＜ 0.05）；干预后指南组患者 6 min 步行距离长于常规组，Borg 劳累度评估量表评分低于常规组（P ＜ 0.05）。干预后指南组患者衰弱状况优于常规组（P ＜ 0.05）。干预后两组患者 CAT 评分分别低于本组干预前（P ＜ 0.05）；干预后指南组患者 CAT 评分低于常规组（P ＜ 0.05）。结论　基于指南构建肺康复运动方案可有效改善 COPD 稳定期患者肺功能，阻止衰弱进展，提高患者运动耐力和生活质量，其效果优于常规肺康复运动方案。

Abstract：

Background　Pulmonary rehabilitation is a comprehensive intervention training with exercise as the core，which can correct hypoxemia and increase exercise endurance for patients with chronic obstructive pulmonary diseas（COPD）.However，there is no unified standardized for pulmonary rehabilitation exercise program.Objective　To investigate the impact of guidelines-based pulmonary rehabilitation exercise program on exercise tolerance，frailty and quality of life in patients with stable COPD.Methods　From November 2017 to December 2019，a total of 246 patients with stable COPD admitted to the Department of Respiratory and Critical Care Medicine，Chongqing University Three Gorges Hospital were selected and randomly divided into conventional group（n=123，with routine pulmonary rehabilitation exercise program） and guidelinesgroup（n=123，with guidelines-based pulmonary rehabilitation exercise program）. Patients in both groups were intervened for 12 weeks. Statistic validity was accessed by pulmonary function indexes（including FEV 1 ，FEV 1 /FVC，FEV 1 %pred，MVV and MVV%pred），6-minute Walking Test distance（6MWD），Borg Fatigue Assessment Scale score，frailty status and COPD Assessment Test（CAT） score.Results　After intervention，FEV 1 and MVV of the two groups were larger thanthose before treatment，and FEV 1 /FVC，FEV 1 %pred and MVV%pred were higher than those before intervention，respectively（P ＜ 0.05）；after intervention，FEV 1 and MVV of the guidelines group were higher than those of the conventional group，while FEV 1 /FVC，FEV 1 %pred and MVV%pred were higher than those of the conventional group（P ＜ 0.05）.After intervention，the 6MWT of the two groups was longer than that before intervention，and the Borg Fatigue Assessment Scale score was lower than that before intervention，respectively（P ＜ 0.05）；after intervention，the 6MWT of the guidelines group was longer than that of the conventional group，and the Borg Fatigue Assessment Scale score was lower than that of the conventional group（P ＜ 0.05）.After intervention，the frailty status of the guidelines group was better than that of the conventional group（P ＜ 0.05）.After intervention，the CAT score of the two groups was lower than that before intervention，respectively（P＜0.05）；after intervention，the CAT score of the guidelines group was lower than that of the conventional group（P＜0.05）.Conclusion　Our findings might confirm the efficacy of guidelines-based pulmonary rehabilitation exercise program is superior for patients with COPD in the stable stage，which can improve pulmonary function，inhibit the process of weakness，improve exercise tolerance and quality of life.

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