慢性阻塞性肺疾病患者的姿势控制障碍原因及评估
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摘要
慢性阻塞性肺疾病(COPD)是一种常见的全身性疾病,以持续的气流受限为特征,其发病率和致残率高,给患者、家庭及社会带来极大的精神压力和经济压力。关于COPD的呼吸康复治疗在全球的指南中占有重要的地位,在患者、医生和治疗师中得到广泛的共识。传统的呼吸康复治疗大多集中在呼吸系统相关的功能障碍,主要包括肺清洁、呼吸肌肉的再教育和心肺耐力训练。但是关于姿势控制的评估和干预往往被忽略,而此方面的障碍会造成患者极大的功能障碍。姿势控制是指将身体重心控制在支持面的稳定极限内的能力,而姿势控制方面的障碍主要体现在个体跌倒风险增高,这极大地限制了COPD患者的活动能力,增加了总体的致残率和死亡率。关于COPD患者存在姿势控制障碍的现象在很多文献和临床报道中均可看到,但对其机制并未有明确而一致的解释。本文总结了近几年关于COPD患者姿势控制障碍的机制,并分析比较了临床上常用的几种评估方式。
Chronic obstructive pulmonary disease(COPD) is a kind of common systematic disease,characterized by continuous airflow obstruction.The high morbidity and disability caused by COPD bring the patients,their families and community huge psychological and economic pressures.The pulmonary rehabilitation(PR) weighs extremely high in the guidelines among the world and is widely accepted by patients,physicians and physiotherapists.Traditionally,the PR program focused on the respiratory related impairments,mainly consisted of pulmonary hygiene,respiratory muscle reduction and aerobic training,but the assessment and intervention of postural control were often neglected,which caused various functional limitations.Postural control means the ability to control the center of gravity into the limit of stability of the base of support.The deficit of postural control was characterized by highly risk of fall,which would cause high prevalence of morbidity and mortality.This kind of deficit was widely reported in several articles and case reports,but there was no common sense on the mechanism behind of it.Thus this article summarized the mechanism and the assessment of the deficit of postural control among COPD patients recent years.
Chronic obstructive pulmonary disease(COPD) is a kind of common systematic disease,characterized by continuous airflow obstruction.The high morbidity and disability caused by COPD bring the patients,their families and community huge psychological and economic pressures.The pulmonary rehabilitation(PR) weighs extremely high in the guidelines among the world and is widely accepted by patients,physicians and physiotherapists.Traditionally,the PR program focused on the respiratory related impairments,mainly consisted of pulmonary hygiene,respiratory muscle reduction and aerobic training,but the assessment and intervention of postural control were often neglected,which caused various functional limitations.Postural control means the ability to control the center of gravity into the limit of stability of the base of support.The deficit of postural control was characterized by highly risk of fall,which would cause high prevalence of morbidity and mortality.This kind of deficit was widely reported in several articles and case reports,but there was no common sense on the mechanism behind of it.Thus this article summarized the mechanism and the assessment of the deficit of postural control among COPD patients recent years.
引文
[1]RABE K F,HURD S,ANZUETO A,et al.Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary[J].Am J Respir Crit Care Med,2007,176(6):532-555.
[2]中华中医药学会.慢性阻塞性肺疾病诊疗指南[J].中国中医药现代远程教育,2011,9(12):115-116.
[3]AMBROSE A F,PAUL G,HAUSDORFF J M.Risk factors for falls among older adults:a review of the literature[J].Maturitas,2013,75(1):51-61.
[4]PAILLARD T.Effects of general and local fatigue on postural control:a review[J].Neurosci Biobehav Rev,2012,36(1):162-176.
[5]MAKI B E,MCILROY W E.Control of rapid limb movements for balance recovery:age-related changes and implications for fall prevention[J].Age Ageing,2006,35(Suppl 2):ii12-ii18.
[6]HORAK F B,MACPHERSON J M.Postural orientation and equilibrium[M]//Handbook of Physiology.New York:Oxford University Publisher,1996:255-292.
[7]ROIG M,ENG J J,ROAD J D,et al.Falls in patients with chronic obstructive pulmonary disease:a call for further research[J].Respir Med,2009,103(9):1257-1269.
[8]GANANCA F F,GAZZOLA J M,GANANCA C F,et al.Elderly falls associated with benign paroxysmal positional vertigo[J].Braz J Otorhinolaryngol,2010,76(1):113-120.
[9]GILLESPIE L D,ROBERTSON M C,GILLESPIE W J,et al.Interventions for preventing falls in older people living in the community[J].Cochrane Database Syst Rev,2012,12(9):CD007146.
[10]MORELLO R T,BARKER A L,HAINES T,et al.In-hospital falls and fall-related injuries:a protocol for a cost of fall study[J].Inj Prev,2013,19(5):363.
[11]ROIG M,ENG J J,MACINTYRE D L,et al.Falls in people with chronic obstructive pulmonary disease:an observational cohort study[J].Respir Med,2011,105(3):461-469.
[12]KELSEY J L,PROCTER-GRAY E,BERRY S D,et al.Reevaluating the implications of recurrent falls in older adults:location changes the inference[J].J Am Geriatr Soc,2012,60(3):517-524.
[13]LAWLOR D A,PATEL R,EBRAHIM S.Association between falls in elderly women and chronic diseases and drug use:cross sectional study[J].BMJ,2003,327(7417):712-717.
[14]BEAUCHAMP M K,HILL K,GOLDSTEIN R S,et al.Impairments in balance discriminate fallers from non-fallers in COPD[J].Respir Med,2009,103(12):1885-1891.
[15]ROCCO C C,SAMPAIO L M,STIRBULOV R,et al.Neurophysiological aspects and their relationship to clinical and functional impairment in patients with chronic obstructive pulmonary disease[J].Clinics(Sao Paulo),2011,66(1):125-129.
[16]BEAUCHAMP M K,BROOKS D,GOLDSTEIN R S.Deficits in postural control in individuals with COPD-emerging evidence for an important secondary impairment[J].Multidiscip Respir Med,2010,5(6):417-421.
[17]BUTCHER S J,MESHKE J M,SHEPPARD M S.Reductions in functional balance,coordination,and mobility measures among patients with stable chronic obstructive pulmonary disease[J].J Cardiopulm Rehabil,2004,24(4):274-280.
[18]HUNG W W,WISNIVESKY J P,SIU A L,et al.Cognitive decline among patients with chronic obstructive pulmonary disease[J].Am J Respir Crit Care Med,2012,180(2):134-137.
[19]BERNARD S,LEBLANC P,WHITTOM F,et al.Peripheral muscle weakness in patients with chronic obstructive pulmonary disease[J].Am J Respir Crit Care Med,2012,158(2):629-634.
[20]BEAUCHAMP M K,O'HOSKI S,GOLDSTEIN R S,et al.Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease[J].Arch Phys Med Rehabil,2010,91(9):1460-1465.
[21]BEAUCHAMP M K,SIBLEY K M,LAKHANI B,et al.Impairments in systems underlying control of balance in COPD[J].Chest,2012,141(6):1496-1503.
[22]CHANG A T,SEALE H,WALSH J,et al.Static balance is affected following an exercise task in chronic obstructive pulmonary disease[J].J Cardiopulm Rehabil Prev,2008,28(2):142-145.
[23]SMITH M D,CHANG A T,SEALE H E,et al.Balance is impaired in people with chronic obstructive pulmonary disease[J].Gait Posture,2010,31(4):456-460.
[24]JANSSENS L,BRUMAGNE S,MCCONNELL A K,et al.Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease[J].PLo S One,2013,8(3):e57949.
[25]CLEGG A,YOUNG J,ILIFFE S,et al.Frailty in elderly people[J].Lancet,2013,381(9868):752-762.
[26]ROBINOVITCH S N,FELDMAN F,YANG Y,et al.Video capture of the circumstances of falls in elderly people residing in long-term care:an observational study[J].Lancet,2013,381(9860):47-54.
[27]LAJOIE Y,GALLAGHER S P.Predicting falls within the elderly community:comparison of postural sway,reaction time,the Berg balance scale and the Activities-specific Balance Confidence(ABC)scale for comparing fallers and non-fallers[J].Arch Gerontol Geriatr,2004,38(1):11-26.
[28]PICONE E N.The timed up and go test[J].Am J Nurs,2013,113(3):56-59.
[29]MESQUITA R,WILKE S,SMID D,et al.Measurement properties of the Timed Up&Go test in patients with COPD[J].Chron Respir Dis,2016,pii:1479972316647178,[Epub ahead of print].
[30]MANCINI M,HORAK F B.The relevance of clinical balance assessment tools to differentiate balance deficits[J].Eur J Phys Rehabil Med,2010,46(2):239-248.
[31]JAYAKARAN P,JOHNSON G M,SULLIVAN S J,et al.Instrumented measurement of balance and postural control in individuals with lower limb amputation:a critical review[J].Int J Rehabil Res,2012,35(3):187-196.
[2]中华中医药学会.慢性阻塞性肺疾病诊疗指南[J].中国中医药现代远程教育,2011,9(12):115-116.
[3]AMBROSE A F,PAUL G,HAUSDORFF J M.Risk factors for falls among older adults:a review of the literature[J].Maturitas,2013,75(1):51-61.
[4]PAILLARD T.Effects of general and local fatigue on postural control:a review[J].Neurosci Biobehav Rev,2012,36(1):162-176.
[5]MAKI B E,MCILROY W E.Control of rapid limb movements for balance recovery:age-related changes and implications for fall prevention[J].Age Ageing,2006,35(Suppl 2):ii12-ii18.
[6]HORAK F B,MACPHERSON J M.Postural orientation and equilibrium[M]//Handbook of Physiology.New York:Oxford University Publisher,1996:255-292.
[7]ROIG M,ENG J J,ROAD J D,et al.Falls in patients with chronic obstructive pulmonary disease:a call for further research[J].Respir Med,2009,103(9):1257-1269.
[8]GANANCA F F,GAZZOLA J M,GANANCA C F,et al.Elderly falls associated with benign paroxysmal positional vertigo[J].Braz J Otorhinolaryngol,2010,76(1):113-120.
[9]GILLESPIE L D,ROBERTSON M C,GILLESPIE W J,et al.Interventions for preventing falls in older people living in the community[J].Cochrane Database Syst Rev,2012,12(9):CD007146.
[10]MORELLO R T,BARKER A L,HAINES T,et al.In-hospital falls and fall-related injuries:a protocol for a cost of fall study[J].Inj Prev,2013,19(5):363.
[11]ROIG M,ENG J J,MACINTYRE D L,et al.Falls in people with chronic obstructive pulmonary disease:an observational cohort study[J].Respir Med,2011,105(3):461-469.
[12]KELSEY J L,PROCTER-GRAY E,BERRY S D,et al.Reevaluating the implications of recurrent falls in older adults:location changes the inference[J].J Am Geriatr Soc,2012,60(3):517-524.
[13]LAWLOR D A,PATEL R,EBRAHIM S.Association between falls in elderly women and chronic diseases and drug use:cross sectional study[J].BMJ,2003,327(7417):712-717.
[14]BEAUCHAMP M K,HILL K,GOLDSTEIN R S,et al.Impairments in balance discriminate fallers from non-fallers in COPD[J].Respir Med,2009,103(12):1885-1891.
[15]ROCCO C C,SAMPAIO L M,STIRBULOV R,et al.Neurophysiological aspects and their relationship to clinical and functional impairment in patients with chronic obstructive pulmonary disease[J].Clinics(Sao Paulo),2011,66(1):125-129.
[16]BEAUCHAMP M K,BROOKS D,GOLDSTEIN R S.Deficits in postural control in individuals with COPD-emerging evidence for an important secondary impairment[J].Multidiscip Respir Med,2010,5(6):417-421.
[17]BUTCHER S J,MESHKE J M,SHEPPARD M S.Reductions in functional balance,coordination,and mobility measures among patients with stable chronic obstructive pulmonary disease[J].J Cardiopulm Rehabil,2004,24(4):274-280.
[18]HUNG W W,WISNIVESKY J P,SIU A L,et al.Cognitive decline among patients with chronic obstructive pulmonary disease[J].Am J Respir Crit Care Med,2012,180(2):134-137.
[19]BERNARD S,LEBLANC P,WHITTOM F,et al.Peripheral muscle weakness in patients with chronic obstructive pulmonary disease[J].Am J Respir Crit Care Med,2012,158(2):629-634.
[20]BEAUCHAMP M K,O'HOSKI S,GOLDSTEIN R S,et al.Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease[J].Arch Phys Med Rehabil,2010,91(9):1460-1465.
[21]BEAUCHAMP M K,SIBLEY K M,LAKHANI B,et al.Impairments in systems underlying control of balance in COPD[J].Chest,2012,141(6):1496-1503.
[22]CHANG A T,SEALE H,WALSH J,et al.Static balance is affected following an exercise task in chronic obstructive pulmonary disease[J].J Cardiopulm Rehabil Prev,2008,28(2):142-145.
[23]SMITH M D,CHANG A T,SEALE H E,et al.Balance is impaired in people with chronic obstructive pulmonary disease[J].Gait Posture,2010,31(4):456-460.
[24]JANSSENS L,BRUMAGNE S,MCCONNELL A K,et al.Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease[J].PLo S One,2013,8(3):e57949.
[25]CLEGG A,YOUNG J,ILIFFE S,et al.Frailty in elderly people[J].Lancet,2013,381(9868):752-762.
[26]ROBINOVITCH S N,FELDMAN F,YANG Y,et al.Video capture of the circumstances of falls in elderly people residing in long-term care:an observational study[J].Lancet,2013,381(9860):47-54.
[27]LAJOIE Y,GALLAGHER S P.Predicting falls within the elderly community:comparison of postural sway,reaction time,the Berg balance scale and the Activities-specific Balance Confidence(ABC)scale for comparing fallers and non-fallers[J].Arch Gerontol Geriatr,2004,38(1):11-26.
[28]PICONE E N.The timed up and go test[J].Am J Nurs,2013,113(3):56-59.
[29]MESQUITA R,WILKE S,SMID D,et al.Measurement properties of the Timed Up&Go test in patients with COPD[J].Chron Respir Dis,2016,pii:1479972316647178,[Epub ahead of print].
[30]MANCINI M,HORAK F B.The relevance of clinical balance assessment tools to differentiate balance deficits[J].Eur J Phys Rehabil Med,2010,46(2):239-248.
[31]JAYAKARAN P,JOHNSON G M,SULLIVAN S J,et al.Instrumented measurement of balance and postural control in individuals with lower limb amputation:a critical review[J].Int J Rehabil Res,2012,35(3):187-196.