三球式呼吸训练器在老年慢性阻塞性肺疾病急性加重期患者早期肺康复中的应用价值
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摘要
目的探讨三球式呼吸训练器在慢性阻塞性肺疾病急性加重期(AECOPD)患者中的应用价值。方法入选2017年6月至2018年6月南京市高淳人民医院呼吸科收治的86例AECOPD患者,按随机数表法分为观察组与对照组,各组43例。对照组进行缩唇腹式呼吸训练,观察组采用三球式呼吸训练器进行呼吸训练。比较2组治疗前后肺功能指标[第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、FEV1/预计值]、动脉血气分析指标[血二氧化碳分压(PaCO_2)与血氧分压(PaO_2)]、6分钟步行距离(6MWD)及COPD自我评估测试问卷(CAT)评分。采用SPSS 16.0统计软件进行分析。根据数据类型,组间比较采用t检验或χ~2检验。结果训练前后比较,2组患者肺功能、血气分析、6MWD及CAT评分均有显著改善(P<0.01)。训练后,观察组患者较对照组PaO_2[(63.98±2.61)vs(62.12±1.69)mmHg]、PaCO_2[(47.47±3.17)vs(48.88±3.00)mmHg]、6MWD[(229.67±46.38)vs(222.23±46.31)m]、CAT[(19.53±4.44)vs(20.19±4.48)score]改善更显著,差异有统计学意义(P<0.05)。结论采用三球式呼吸训练器对老年AECOPD患者进行早期肺康复训练,能及时恢复呼吸功能、改善生活质量。
Objective To investigate the application value of Tri-Ball respiratory exerciser in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A total of 86 AECOPD patients admitted in Gaochun People′s Hospital of Nanjing from June 2017 to June 2018 were recruited in this study. They were randomly divided into observation group(n=43) and control group(n=43). The observation group underwent breathing training with Tri-Ball respiratory exerciser device, while the control group accepted conventional pursed lips ventral breathing training. The pulmonary function indices [forced expiratory volume in the first second(FEV1), FEV1/forced vital capacity(FEVI/FVC), and FEV1/expected], blood gas parameters [arterial partial pressure of oxygen(PaO_2) and arterial partial pressure of carbon dioxide(PaCO_2)], 6-minute walking distance(6 MWD) and results of COPD assessment test(CAT) were compared between 2 groups. SPSS statistics 16.0 was used for analysis. According to the data type, Student′s t test or Chi-square test was used for intergroup comparison. Results After the treatment, significant improvements were achieved in pulmonary function, results of blood gas analysis, 6 MWD and CAT scores in both groups(P<0.01). But the observation group obtained significantly greater improvements in PaO_2 [(63.98±2.61) vs(62.12±1.69)mmHg], PaCO_2 [(47.47±3.17) vs(48.88±3.00)mmHg], 6 MWD[(229.67±46.38) vs(222.23±46.31)m] and CAT scores [(19.53±4.44) vs(20.19±4.48)] when compared with control group(all P<0.05). Conclusion Tri-Ball respiratory exerciser is helpful to restore respiratory function and improve the quality of life in early pulmonary rehabilitation for elderly AECOPD patients.
Objective To investigate the application value of Tri-Ball respiratory exerciser in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A total of 86 AECOPD patients admitted in Gaochun People′s Hospital of Nanjing from June 2017 to June 2018 were recruited in this study. They were randomly divided into observation group(n=43) and control group(n=43). The observation group underwent breathing training with Tri-Ball respiratory exerciser device, while the control group accepted conventional pursed lips ventral breathing training. The pulmonary function indices [forced expiratory volume in the first second(FEV1), FEV1/forced vital capacity(FEVI/FVC), and FEV1/expected], blood gas parameters [arterial partial pressure of oxygen(PaO_2) and arterial partial pressure of carbon dioxide(PaCO_2)], 6-minute walking distance(6 MWD) and results of COPD assessment test(CAT) were compared between 2 groups. SPSS statistics 16.0 was used for analysis. According to the data type, Student′s t test or Chi-square test was used for intergroup comparison. Results After the treatment, significant improvements were achieved in pulmonary function, results of blood gas analysis, 6 MWD and CAT scores in both groups(P<0.01). But the observation group obtained significantly greater improvements in PaO_2 [(63.98±2.61) vs(62.12±1.69)mmHg], PaCO_2 [(47.47±3.17) vs(48.88±3.00)mmHg], 6 MWD[(229.67±46.38) vs(222.23±46.31)m] and CAT scores [(19.53±4.44) vs(20.19±4.48)] when compared with control group(all P<0.05). Conclusion Tri-Ball respiratory exerciser is helpful to restore respiratory function and improve the quality of life in early pulmonary rehabilitation for elderly AECOPD patients.
引文
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[12] Levine S,Bashir MH,Clanton TL,et al.COPD elicits remodeling of the diaphragm and vastus lateralis muscles in humans[J].J Appl Physiol(1985),2013,114(9):1235-1245.DOI:10.1152/japplphysi01.01121.2012.
[13] Basso-Vanelli RP,Di Lorenzo VA,Labadessa IG,et al.Effects of inspiratory muscle training and calisthenics-and-breathingexercises in COPD with and without respiratory muscle weak-ness[J].Respir Care,2016,61(1):50-60.DOI:10.4187/respcare.03947.
[14] Dellweg D,Reissig K,Hoehn E,et al.Inspiratory muscle training during rehabilitation in successfully weaned hypercapnic patients with COPD[J].Respir Med,2017,2(3):116-123.DOI:10.1016/j.rmed.2016.12.006.
[15] Araujo CL,Karloh M,Reis CM,et al.Pursed-lips breathing reduces dynamic hyperinflation induced by activities of daily living test in patients with chronic obstructive pulmonary disease:a randomized cross-over study[J].J Rehabil Med,2015,47(10):957-962.DOI:10.2340/16501977-2008.
[16] Cahalin LP,Braga M,Matsuo Y,et al.Efficacy of diaphragmatic breathing in persons with chronic obstructive pulmonary disease:a review of the literature[J].J Cardiopulm Rehabil,2002,22(1):7-21.DOI:10.1097/00008483-200201000-00002.
[17] Fernandes M,Cukier A,Feltrim IZ.Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease[J].Chron Respir Dis,2011,8(4):237-244.DOI:10.1177/1479972311424296.
[18] 姜艳,石天奇,韩军,等.三球式呼吸训练器对老年COPD病人肺功能的影响[J].护理研究,2015,29(11):4210-4212.DOI:10.3969/j.issn.1009-6493.2015.33.044.Jiang Y,Shi TQ,Han J,et al.Influence of three-ball breathing training apparatus on lung function of elderly patients with chronic obstructive pulmonary disease[J].Chin Nur Res,2015,29(11):4210-4212.DOI:10.3969/j.issn.1009-6493.2015.33.044.
[19] 高天敏,周全昌,黄仕聪,等.三球式呼吸训练器在慢性阻塞性肺疾病患者肺康复中的应用研究[J].重庆医学,2015,44(32):4514-4516.DOI:10.3969/j.issn.1671-8348.2015.32.018.Gao TM,Zhou QC,Huang SC,et al.The application of respiratory exerciser tri-ball in pulmonary rehabilitation patients with chronic obstructive pulmonary disease[J].Chongqing Med,2015,44(32):4514-4516.DOI:10.3969/j.issn.1671-8348.2015.32.018.
[2] 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 J Respir Crit Care Med,2013,188(8):e13-64.DOI:10.1164/rccm.201309-1634ST.
[3] Bolton CE,Bevan-Smith EF,Blakey JD,et al.British Thoracic Society guideline on pulmonary rehabilitation in adults[J].Thorax,2013,68(Suppl 2):ii1-30.DOI:10.1136/thoraxjnl-2013-203808.
[4] Zainuldin R,Sasiadek KM,Abdul Raub NA,et al.An evaluation on the effects of inpatient pulmonary rehabilitation following acute exacerbation of chronic obstructive pulmonary disease in a Singapore Hospital[J].Ann Acad Med Singapore,2016,45(4):169-171.
[5] 中华医学会呼吸病学会分会慢性阻塞性肺疾病学.慢性阻塞性肺疾病诊治指南(2013修订版)[J].中华结核与呼吸杂志,2013,36(4):255-264.DOI:10.3760/cma.j.issn.10010939.2013.04.007.Chronic Obstructive Pulmonary Disease Group of Chinese Respiratory Diseases Society.Guideline for chronic obstructive pulmonary disease (revised 2013)[J].Chin J Tuberc Respir Dis,2013,36(4):255-264.DOI:10.3760/cma.j.issn.1001-0939.2013.04.007.
[6] Zhong N,Wang C,Yao W,et al.Prevalence of chronic obstructive pulmonary disease in China:a large,population based survey[J].Am J Respir Crit Care Med,2007,176(8):753-760.DOI:10.31164/rccm.200612-1749OC.
[7] He M,Yu S,Wang L,et al.Efficiency and safety of pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease[J].Med Sci Monit,2015,21:806-812.DOI:10.12659/MSM.892769.
[8] 姚文飞,屠春林,付玉华,等.肺康复对慢性阻塞性肺疾病急性加重期住院患者的疗效[J].中国康复理论与实践,2017,23(1):101-105.DOI:10.3969/j.issn.1006-9771.2017.01.024.Yao WF,Tu CL,Fu YH,et al.Effect of pulmonary rehabilitation on acute exacerbation of chronic obstructive pulmonary disease[J].Chin J Rehabil Theory Pract,2017,23(1):101-105.DOI:10.3969/j.issn.1006-9771.2017.01.024.
[9] Clini EM,Crisafulli E,Costi S,et al.Effects of early inpatient rehabilitation after acute exacerbation of COPD[J].Respir Med,2009,103(10):1526-1531.DOI:1016/j.rmed.2009.04.011.
[10] Puhan MA,Spaar A,Frey M,et al.Early versus late pulmonary rehabilitation in obstructive pulmonary disease patients with acute exacerbations:a randomized trial[J].Respiration,2012,83(6):499-506.DOI:10.1159/000329884.
[11] Ali MS,Talwar D,Jain SK.The effect of a short-term pulmonary rehabilitation on exercise capacity and quality of life in patients hospitalised with acute exacerbation of chronic obstructive pulmonary disease[J].Indian J Chest Dis Allied Sci,2014,56(1):13-19.
[12] Levine S,Bashir MH,Clanton TL,et al.COPD elicits remodeling of the diaphragm and vastus lateralis muscles in humans[J].J Appl Physiol(1985),2013,114(9):1235-1245.DOI:10.1152/japplphysi01.01121.2012.
[13] Basso-Vanelli RP,Di Lorenzo VA,Labadessa IG,et al.Effects of inspiratory muscle training and calisthenics-and-breathingexercises in COPD with and without respiratory muscle weak-ness[J].Respir Care,2016,61(1):50-60.DOI:10.4187/respcare.03947.
[14] Dellweg D,Reissig K,Hoehn E,et al.Inspiratory muscle training during rehabilitation in successfully weaned hypercapnic patients with COPD[J].Respir Med,2017,2(3):116-123.DOI:10.1016/j.rmed.2016.12.006.
[15] Araujo CL,Karloh M,Reis CM,et al.Pursed-lips breathing reduces dynamic hyperinflation induced by activities of daily living test in patients with chronic obstructive pulmonary disease:a randomized cross-over study[J].J Rehabil Med,2015,47(10):957-962.DOI:10.2340/16501977-2008.
[16] Cahalin LP,Braga M,Matsuo Y,et al.Efficacy of diaphragmatic breathing in persons with chronic obstructive pulmonary disease:a review of the literature[J].J Cardiopulm Rehabil,2002,22(1):7-21.DOI:10.1097/00008483-200201000-00002.
[17] Fernandes M,Cukier A,Feltrim IZ.Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease[J].Chron Respir Dis,2011,8(4):237-244.DOI:10.1177/1479972311424296.
[18] 姜艳,石天奇,韩军,等.三球式呼吸训练器对老年COPD病人肺功能的影响[J].护理研究,2015,29(11):4210-4212.DOI:10.3969/j.issn.1009-6493.2015.33.044.Jiang Y,Shi TQ,Han J,et al.Influence of three-ball breathing training apparatus on lung function of elderly patients with chronic obstructive pulmonary disease[J].Chin Nur Res,2015,29(11):4210-4212.DOI:10.3969/j.issn.1009-6493.2015.33.044.
[19] 高天敏,周全昌,黄仕聪,等.三球式呼吸训练器在慢性阻塞性肺疾病患者肺康复中的应用研究[J].重庆医学,2015,44(32):4514-4516.DOI:10.3969/j.issn.1671-8348.2015.32.018.Gao TM,Zhou QC,Huang SC,et al.The application of respiratory exerciser tri-ball in pulmonary rehabilitation patients with chronic obstructive pulmonary disease[J].Chongqing Med,2015,44(32):4514-4516.DOI:10.3969/j.issn.1671-8348.2015.32.018.