作者：陈秋婷，钟美容，覃松梅，莫丽，陆艳兰，黎景徽

单位：

1.广西中医药大学2.广西中医药大学附属瑞康医院护理部3.广西医学科学院广西壮族自治区人民医院呼吸与危重症医学科4.广西医学科学院广西壮族自治区人民医院重症医学科

Units：

1.GuangxiUniversityofChineseMedicine,Nanning530001,China2.NursingDepartment,RuikangHospitalAffiliatedtoGuangxiUniversityofChineseMedicine,Nanning530011,China3.DepartmentofRespiratoryandCriticalCareMedicine,GuangxiAcademyofMedicalSciences/thePeople'sHospitalofGuangxiZhuangAutonomousRegion,Nanning530021,China4.IntensiveCareUnit,GuangxiAcademyofMedicalSciences/thePeople'sHospitalofGuangxiZhuangAutonomousRegion,Nanning530021,China

关键词：

肺疾病,慢性阻塞性; 慢性阻塞性肺疾病急性加重; 阶梯式肺康复运动; 生活质量; 肺功能;

Keywords：

Pulmonarydisease,chronicobstructive;Acuteexacerbationofchronicobstructivepulmonarydisease;Stepwisepulmonaryrehabilitationexercise;Qualityoflife;Lungfunction

CLC：

R563.9

DOI：

10.12114/j.issn.1008-5971.2023.00.047

Funds：

广西重点实验室建设项目( ZZH2020013?)；广西卫建委自筹课题( Z20170395?)

摘要：

目的 探讨阶梯式肺康复运动在慢性阻塞性肺疾病急性加重(AECOPD)住院患者中的应用效果。方法 采用非同期对照法，选取广西壮族自治区人民医院呼吸内科2021年6—9月收治的AECOPD患者40例为试验组，2021年10—12月收治的AECOPD患者39例为对照组。对照组患者接受常规治疗、健康教育、心理疏导及出院后肺康复运动指导；试验组患者在对照组基础上，于入院后24～48 h开始进行阶梯式肺康复运动直至出院。入院时(干预前)及出院前(干预后)，采用COPD评估测试(CAT)评估患者生活质量，采用6 min步行试验评患者运动能力，采用Borg评分评价患者呼吸困难程度，测量患者第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占预计值百分比(FEV1%)、FEV1/用力肺活量(FVC)，记录患者住院时间，随访8周记录患者肺康复运动依从性。结果 干预后，两组CAT评分、Borg评分分别较本组干预前降低，6 min步行距离分别较本组干预前延长(P<0.05)；干预后，试验组CAT评分、Borg评分较对照组降低，6 min步行距离较对照组延长(P<0.05)。干预前及干预后，两组FEV1、FEV1%、FEV1/FVC比较，差异无统计学意义(P>0.05)；对照组干预前后FEV1、FEV1%、FEV1/FVC比较，差异无统计学意义(P>0.05)；观察组干预后FEV1较干预前增大，FEV1%、FEV1/FVC较干预前升高(P<0.05)。试验组住院时间短于对照组(P<0.05)。随访8周，试验组肺康复运动依从率高于对照组(P<0.05)。结论 阶梯式肺康复运动可提高AECOPD住院患者的生活质量、运动能力，减轻呼吸困难程度，提高肺功能，缩短住院时间，提高出院后肺康复运动依从性，对患者健康状况有积极影响。

Abstract：

ObjectiveToinvestigatetheapplicationeffectofstepwisepulmonaryrehabilitationexerciseinhospitalizedpatientswithacuteexacerbationofchronicobstructivepulmonarydisease(AECOPD).MethodsUsingthenon-simultaneouscontrolmethod,40patientswithAECOPDadmittedtoRespiratoryMedicineofthePeople'sHospitalofGuangxiZhuangAutonomousRegionfromJunetoSeptember2021wereselectedastheexperimentalgroup,and39patientswithAECOPDadmittedfromOctobertoDecember2021wereselectedasthecontrolgroup.Patientsinthecontrolgroupreceivedconventionaltreatment,healtheducation,psychologicalguidanceandpost-dischargepulmonaryrehabilitationexerciseinstruction;patientsintheexperimentalgroupstartedstepwisepulmonaryrehabilitationexercisefrom24to48hafteradmissionuntildischargeonthebasisofthecontrolgroup.ThequalityoflifeofpatientswasevaluatedbyCOPDAssessmentTest(CAT),theexerciseability wasevaluatedby6minwalkingtest,thedegreeofdyspneawasevaluatedbyBorgscore,theforcedexpiratoryvolumeinthefirstsecond(FEV1),percentageofforcedexpiratoryvolumeinthefirstsecondinthepredictedvalue(FEV1%),andFEV1/forcedvitalcapacity(FVC)weremeasuredatadmission(beforeintervention)andbeforedischarge(afterintervention),thelengthofhospitalstaywasrecorded,andthepulmonaryrehabilitationexercisecompliancewasrecordedatafollow-upof8weeks.ResultsAfterintervention,theCATscoreandBorgscoreinthetwogroupswerelowerthanthosebeforeintervention,respectively,andthe6minwalkingdistancewaslongerthanthatbeforeintervention,respectively(P<0.05);afterintervention,CATscoreandBorgscoreintheexperimentalgroupwerelowerthanthoseinthecontrolgroup,andthe6minwalkingdistancewaslongerthanthatinthecontrolgroup(P<0.05).Beforeandafterintervention,therewasnostatisticallysignificantdifferenceinFEV1,FEV1%,andFEV1/FVCbetweenthetwogroups(P>0.05);therewasnostatisticallysignificantdifferenceinFEV1,FEV1%,andFEV1/FVCinthecontrolgroupbeforeandafterintervention(P>0.05);afterintervention,FEV1intheexperimentalgroupwasbiggerthanthatbeforeintervention,FEV1%andFEV1/FVCintheexperimentalgroupwerehigherthanthosebeforeintervention(P<0.05).Thelengthofhospitalstayintheexperimentalgroupwasshorterthanthatinthecontrolgroup(P<0.05).At8weeksoffollow-up,thepulmonaryrehabilitationexercisecompliancerateintheexperimentalgroupwashigherthanthatinthecontrolgroup(P<0.05).ConclusionThestepwisepulmonaryrehabilitationexercisecanimprovethequalityoflifeandexerciseability,reducethedegreeofdyspnea,improvethelungfunction,shortenthelengthofhospitalstay,improvepulmonaryrehabilitationexercisecomplianceinhospitalizedpatientswithAECOPD,andhaveapositiveimpactonpatient'shealthstatus.

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