吸气肌训练在慢性阻塞性肺疾病中的康复效果评价
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摘要
目的探讨吸气肌训练(IMT)对中重度慢性阻塞性肺疾病(COPD)患者的肺康复效果。方法选择2014年1月—2015年12月在苏州市吴江区第一人民医院就诊时处于稳定期的COPD患者50例,随机分为对照组和IMT组,每组25例。对照组吸入支气管扩张剂或糖皮质激素,IMT组在此基础上采取吸气肌训练。2组患者在入组时(0个月)及第12个月进行随访,检测最大吸气压力(PImax)、6 min步行距离、COPD评分(CAT)及住院次数,分析对比2组间上述指标的变化。结果通过12个月的观察,对照组的PImax下降[(80.12±17.94)cmH2O vs.(78.28±17.98)cmH2O,P<0.05],6 min步行距离缩短[(283.96±22.67)m vs.(278.12±21.12)m,P<0.05],第1秒用力呼气容积(FEV1)减少[(1.32±0.25)L vs.(1.27±0.24)L,P<0.05]。与对照组相比,IMT组PImax显著上升[(78.28±17.98)cmH2O vs.(95.48±19.36)cmH2O,P<0.05],6 min步行距离明显增加[(278.12±21.12)m vs.(320.32±28.71)m,P<0.05];通过训练,IMT组患者的CAT评分明显下降(15.36±5.20 vs. 11.76±2.79,P<0.05),而且因急性加重所致的住院次数明显减少[(1.40±0.91)次vs.(0.68±0.63)次,P<0.05];但2组FEV1及FEV1占预计值百分比(FEV1%)差异无统计学意义[(1.27±0.24)L vs.(1.40±0.28)L;49.56%±9.93%vs. 53.81%±13.66%,均P>0.05]。结论长期进行IMT可以改善COPD患者的活动耐量及生活质量,减少住院次数,为COPD患者生存带来益处。
Objective To investigate the effect of inspiratory muscle training(IMT) as a rehabilitation treatment for patients suffering from moderate to severe chronic obstructive pulmonary disease(COPD).MethodsFifty COPD patients in stable stage hospitalized in the First People's Hospital of Wu Jiang District,Suzhou from January 2014 to December 2015 were included and randomly divided into control group and IMT group. Patients in the control group inhaled bronchodilators or glucocorticoids,whereas those in IMT group took inspiratory muscle training in addition to inhaling bronchodilators or glucocorticoids. All patients were followed up for 12 months. Values of maximum inspiratory pressure(PImax),6-minute walking distance(6 MWD),COPD Assessment Test(CAT) score were analyzed. The number of hospitalizations within twelve months was also recorded in two groups of patients.ResultsAfter 12-month fellow-up,it was found that PImax was decreased[(80.12±17.94) cmH2 O vs.(78.28±17.98) cmH2 O,P<0.05)],6 MWD was shortened[(283.96±22.67) m vs.(278.12±21.12) m,P<0.05]and FEV1 was decreased[(1.32±0.25) L vs.(1.27±0.24) L,P<0.05]in control group.Compared with control group,PImax increased significantly in IMT group[(78.28±17.98) cmH2 O vs.(95.48±19.36) cmH2 O,P<0.05],6 MWD was also increased[(278.12±21.12) m vs.(320.32±28.71) m,P<0.05)]. While the CAT score was significantly reduced in patients of IMT group(15.36±5.20 vs. 11.76±2.79,P<0.05). The hospitalizations caused by acute exacerbation were significantly decreased(1.40±0.91 vs. 0.68±0.63,P<0.05),but there was no significant improvement in pulmonary function(P>0.05).ConclusionLong-term IMT can improve the activity tolerance and quality of life in COPD patients,and reduce hospitalizations,bring benefits to the survival of COPD patients.
Objective To investigate the effect of inspiratory muscle training(IMT) as a rehabilitation treatment for patients suffering from moderate to severe chronic obstructive pulmonary disease(COPD).MethodsFifty COPD patients in stable stage hospitalized in the First People's Hospital of Wu Jiang District,Suzhou from January 2014 to December 2015 were included and randomly divided into control group and IMT group. Patients in the control group inhaled bronchodilators or glucocorticoids,whereas those in IMT group took inspiratory muscle training in addition to inhaling bronchodilators or glucocorticoids. All patients were followed up for 12 months. Values of maximum inspiratory pressure(PImax),6-minute walking distance(6 MWD),COPD Assessment Test(CAT) score were analyzed. The number of hospitalizations within twelve months was also recorded in two groups of patients.ResultsAfter 12-month fellow-up,it was found that PImax was decreased[(80.12±17.94) cmH2 O vs.(78.28±17.98) cmH2 O,P<0.05)],6 MWD was shortened[(283.96±22.67) m vs.(278.12±21.12) m,P<0.05]and FEV1 was decreased[(1.32±0.25) L vs.(1.27±0.24) L,P<0.05]in control group.Compared with control group,PImax increased significantly in IMT group[(78.28±17.98) cmH2 O vs.(95.48±19.36) cmH2 O,P<0.05],6 MWD was also increased[(278.12±21.12) m vs.(320.32±28.71) m,P<0.05)]. While the CAT score was significantly reduced in patients of IMT group(15.36±5.20 vs. 11.76±2.79,P<0.05). The hospitalizations caused by acute exacerbation were significantly decreased(1.40±0.91 vs. 0.68±0.63,P<0.05),but there was no significant improvement in pulmonary function(P>0.05).ConclusionLong-term IMT can improve the activity tolerance and quality of life in COPD patients,and reduce hospitalizations,bring benefits to the survival of COPD patients.
引文
[1]Global Executive Committee.Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease(2018 report)[EB/OL].(2017-12-05)[2018-11-30].https://goldcopd.org/archived-reports/.
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[5]Spruit MA,Singh SJ,Garvey C,et al.An official American Thoracic Society/European Respiratory Society statement:key concepts and advances in pulmonary rehabilitation[J].Am JRespir Crit Care Med,2013,188(8):e13-64.doi:10.1164/rccm.201309-1634ST.
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[8]陈亚红.2018年GOLD慢性阻塞性肺疾病诊断、治疗及预防全球策略解读[J].中国医学前沿杂志(电子版),2017,9(12):15-22.Chen YH.Interpretation of global initiative for chronic obstructive lung disease global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease 2018 report[J].Chinese Journal of the Frontiers of Medical Science(Electronic Version),2017,9(12):15-22.doi:10.12037/YXQY.2017.12-05.
[9]Gosselink R,De Vos J,van den Heuvel SP,et al.Impact of inspiratory muscle training in patients with COPD:what is the evidence?[J].Eur Respir J,2011,37(2):416-425.doi:10.1183/09031936.00031810.
[10]Gea J,Pascual S,Casadevall C,et al.Muscle dysfunction in chronic obstructive pulmonary disease:update on causes and biological findings[J].J Thorac Dis,2015,7(10):E418-438.doi:10.3978/j.issn.2072-1439.2015.08.04.
[11]Schultz K,Jelusic D,Wittmann M,et al.Inspiratory muscle training does not improve clinical outcomes in 3-week COPD rehabilitation:results from a randomized controlled trial[J].Eur Respir J,2018,51(1).pii:1702000.doi:10.1183/13993003.02000-2017.
[12]Ringbaek T,Martinez G,Lange P.A comparison of the assessment of quality of life with CAT,CCQ,and SGRQ in COPD patients participating in pulmonary rehabilitation[J].COPD,2012,9(1):12-15.doi:10.3109/15412555.2011.630248.
[13]Beaumont M,Forget P,Couturaud F,et al.Effects of inspiratory muscle training in COPD patients:A systematic review and metaanalysis[J].Clin Respir J,2018,12(7):2178-2188.doi:10.1111/crj.12905.
[14]Weiner P,Magadle R,Beckerman M,et al.Maintenance of inspiratory muscle training in COPD patients:one year follow-up[J].Eur Respir J,2004,23(1):61-65.
[15]Dellweg D,Reissig K,Hoehn E,et al.Inspiratory muscle training during rehabilitation in successfully weaned hypercapnic patients with COPD[J].Respir Med,2017,123:116-123.doi:10.1016/j.rmed.2016.12.006.2018-12-032019-04-30
[2]Wang C,Xu JY,Yang L,et al.Prevalence and risk factors of chronic obstructive pulmonary disease in China(the China Pulmonary Health[CPH]study):a national cross-sectional study[J].Lancet,2018,391(10131):1706-1717.doi:10.1016/S0140-6736(18)30841-9.
[3]Petrovic M,Reiter M,Zipko H,et al.Effects of inspiratory muscle training on dynamic hyperinflation in patients with COPD[J].Int JChron Obstruct Pulmon Dis,2012,7:797-805.doi:10.2147/COPD.S23784.
[4]Charususin N,Gosselink R,McConnell A,et al.Inspiratory muscle training improves breathing pattern during exercise in COPDpatients[J].Eur Respir J,2016,47(4):1261-1264.doi:10.1183/13993003.01574-2015.
[5]Spruit MA,Singh SJ,Garvey C,et al.An official American Thoracic Society/European Respiratory Society statement:key concepts and advances in pulmonary rehabilitation[J].Am JRespir Crit Care Med,2013,188(8):e13-64.doi:10.1164/rccm.201309-1634ST.
[6]McLean S,Hoogendoorn M,Hoogenveen RT,et al.Projecting the COPD population and costs in England and Scotland:2011 to 2030[J].Sci Rep,2016,6:31893.doi:10.1038/srep31893.
[7]Neves LF,Reis MH,Plentz RD,et al.Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD:systematic review[J].Respir Care,2014,59(9):1381-1388.doi:10.4187/respcare.02793.
[8]陈亚红.2018年GOLD慢性阻塞性肺疾病诊断、治疗及预防全球策略解读[J].中国医学前沿杂志(电子版),2017,9(12):15-22.Chen YH.Interpretation of global initiative for chronic obstructive lung disease global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease 2018 report[J].Chinese Journal of the Frontiers of Medical Science(Electronic Version),2017,9(12):15-22.doi:10.12037/YXQY.2017.12-05.
[9]Gosselink R,De Vos J,van den Heuvel SP,et al.Impact of inspiratory muscle training in patients with COPD:what is the evidence?[J].Eur Respir J,2011,37(2):416-425.doi:10.1183/09031936.00031810.
[10]Gea J,Pascual S,Casadevall C,et al.Muscle dysfunction in chronic obstructive pulmonary disease:update on causes and biological findings[J].J Thorac Dis,2015,7(10):E418-438.doi:10.3978/j.issn.2072-1439.2015.08.04.
[11]Schultz K,Jelusic D,Wittmann M,et al.Inspiratory muscle training does not improve clinical outcomes in 3-week COPD rehabilitation:results from a randomized controlled trial[J].Eur Respir J,2018,51(1).pii:1702000.doi:10.1183/13993003.02000-2017.
[12]Ringbaek T,Martinez G,Lange P.A comparison of the assessment of quality of life with CAT,CCQ,and SGRQ in COPD patients participating in pulmonary rehabilitation[J].COPD,2012,9(1):12-15.doi:10.3109/15412555.2011.630248.
[13]Beaumont M,Forget P,Couturaud F,et al.Effects of inspiratory muscle training in COPD patients:A systematic review and metaanalysis[J].Clin Respir J,2018,12(7):2178-2188.doi:10.1111/crj.12905.
[14]Weiner P,Magadle R,Beckerman M,et al.Maintenance of inspiratory muscle training in COPD patients:one year follow-up[J].Eur Respir J,2004,23(1):61-65.
[15]Dellweg D,Reissig K,Hoehn E,et al.Inspiratory muscle training during rehabilitation in successfully weaned hypercapnic patients with COPD[J].Respir Med,2017,123:116-123.doi:10.1016/j.rmed.2016.12.006.2018-12-032019-04-30
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