主被动踏车结合作业疗法对稳定期慢性阻塞性肺疾病患者的影响
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摘要
目的:探析上下肢主被动康复踏车结合作业疗法在稳定期慢性阻塞性肺疾病(COPD)患者中的运用效果。方法:92例COPD患者被随机分作业疗法组和踏车+作业疗法组,各46例。两组患者均接受常规临床护理和治疗,以及综合康复治疗,作业疗法组还接受作业治疗,踏车+作业疗法组在作业疗法组基础上增加上下肢主被动踏车训练,治疗8周后,对比分析两组患者肺功能、运动功能、日常生活能力及生活质量。结果:与治疗前比较,治疗后两组患者肺功能、运动功能、日常生活活动能力评分(ADL)、生活质量圣·乔治呼吸问卷(St·George respiratory questionnaire, SGRQ)均有明显改善(P<0.05或<0.01);与作业疗法组比较,治疗后踏车+作业疗法组改良的英国MRC呼吸困难指数(mMRC)[(2.7±0.4)级比(2.4±0.6)级]显著降低,6min步行距离[(291.4±28.9)m比(307.8±30.4) m]及ADL评分[(56.0±11.4)分比(62.0±10.9)分]均显著增加(P<0.05或<0.01),但肺功能指标和生活质量(SGRQ),无显著差异(P均>0.05)。结论:上下肢主被动踏车训练结合作业疗法能明显提高慢性阻塞性肺疾病患者的肺功能、运动功能和日常生活活动能力。
Objective: To explore therapeutic effect of upper and lower extremity active and passive rehabilitation treadmill combined occupational therapy on patients with chronic obstructive pulmonary disease(COPD) during stable period. Methods:A total of 92 COPD patients were randomly and equally divided into occupational therapy group and treadmill + occupational therapy group. Both groups received routine nursing care, treatment and comprehensive rehabilitation therapy, occupational therapy group also received occupational therapy, while treadmill + occupational therapy group received upper and lower extremity active and passive treadmill training based on occupational therapy group. After eight-week treatment, pulmonary function, exercise function, daily living capacity and quality of life were analyzed and compared between two groups. Results:Compared with before treatment, after treatment, there were significant improvements in pulmonary function, exercise function, score of activity of daily living scale(ADL) and quality of life(SGRQ) in two groups, P<0.05 or <0.01. Compared with occupational therapy group after treatment, there was significant reduction in modified Medical Research Council dyspnea scale(mMRC) [(2.7±0.4) grade vs.(2.4±0.6) grade], and significant rise in 6 min walking distance [(291.4±28.9)m vs.(307.8±30.4) m] and ADL score [(56.0±11.4) scores vs.(62.0±10.9) scores] in treadmill + occupational therapy group(P<0.05 or <0.01), but there were no significant differences in pulmonary function indexes and quality of life(SGRQ) between two groups, P>0.05 all. Conclusion:Upper and lower extremity active and passive treadmill training combined occupational therapy can significantly improve pulmonary function and exercise function and daily living capacity in patients with chronic obstructive pulmonary disease.
Objective: To explore therapeutic effect of upper and lower extremity active and passive rehabilitation treadmill combined occupational therapy on patients with chronic obstructive pulmonary disease(COPD) during stable period. Methods:A total of 92 COPD patients were randomly and equally divided into occupational therapy group and treadmill + occupational therapy group. Both groups received routine nursing care, treatment and comprehensive rehabilitation therapy, occupational therapy group also received occupational therapy, while treadmill + occupational therapy group received upper and lower extremity active and passive treadmill training based on occupational therapy group. After eight-week treatment, pulmonary function, exercise function, daily living capacity and quality of life were analyzed and compared between two groups. Results:Compared with before treatment, after treatment, there were significant improvements in pulmonary function, exercise function, score of activity of daily living scale(ADL) and quality of life(SGRQ) in two groups, P<0.05 or <0.01. Compared with occupational therapy group after treatment, there was significant reduction in modified Medical Research Council dyspnea scale(mMRC) [(2.7±0.4) grade vs.(2.4±0.6) grade], and significant rise in 6 min walking distance [(291.4±28.9)m vs.(307.8±30.4) m] and ADL score [(56.0±11.4) scores vs.(62.0±10.9) scores] in treadmill + occupational therapy group(P<0.05 or <0.01), but there were no significant differences in pulmonary function indexes and quality of life(SGRQ) between two groups, P>0.05 all. Conclusion:Upper and lower extremity active and passive treadmill training combined occupational therapy can significantly improve pulmonary function and exercise function and daily living capacity in patients with chronic obstructive pulmonary disease.
引文
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[9]冯平.慢阻肺评估测试、6min步行试验和肺功能检测在老年中重度慢性阻塞性肺疾病稳定期患者病情诊断中的意义[J].国际老年医学杂志,2017,38(1):18-21.
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[12]张敏,徐桂华,李峰,等.健身气功易筋经促进慢性阻塞性肺疾病稳定期患者康复[J].中国运动医学杂志,2016,35(4):339-343.
[13]蒋雪莲,钟萍,黄成亮,等.稳定期慢性阻塞性肺疾病患者营养状况和氧化应激能力与肺功能的关系[J].中华结核和呼吸杂志,2017,40(1):40-45.
[14]潘明鸣,张洪胜,孙铁英,等.老年男性支气管哮喘-慢性阻塞性肺疾病重叠综合征患者肺功能特征分析[J].中华老年医学杂志,2017,36(2):146-150.
[15]舒李慧,王锐英,许建英,等.肺功能对稳定期慢性阻塞性肺疾病患者疗效评估的研究[J].山西医药杂志,2016,45(8):886-889.
[16]赵寅滢,邹黎菲,范晓东,等.COPD稳定期患者前白蛋白与C反应蛋白水平、肺功能的相关性分析[J].现代仪器与医疗,2016,22(6):103-105.
[17]Frisk B,Espehaug B,Hardie JA,et al.Physical activity and longitudinal change in 6-min walk distance in COPD patients[J].Respir Med,2014,108(1):86-94.
[18]陈静华,肖惠,江涵,等.呼吸运动锻炼康复法对稳定期COPD患者肺功能及生活质量的影响[J].南昌大学学报(医学版),2017,57(2):8-10.
[2]张叶钦,胡晓芸,侯飞飞,等.早期慢性阻塞性肺疾病诊治进展[J].临床肺科杂志,2018,23(3):547-550.
[3]Nakken N,Janssen DJ,van den Bogaart EH,et al.Patient versus proxy-reported problematic activities of daily life in patients with COPD[J].Respirology,2017,22(2):307-314.
[4]谢斌,鲍晓,李伟玲,等.康复训练对稳定期慢阻肺患者生活质量和运动功能的影响[J].中国康复,2016,31(4):277-279.
[5]雷丽,李馨,胡相悦,等.综合康复训练对稳定期慢性阻塞性肺疾病患者的疗效观察[J].中国医药导报,2017,14(13):175-178.
[6]李亮,曾明,王月丽,等.肺功能训练仪用于治疗稳定期慢性阻塞性肺疾病患者的疗效观察[J].中国康复医学杂志,2016,31(10):1117-1120.
[7]Ahmed S,Sawatzky R,Levesque JF,et al.Minimal evidence of response shift in the absence of a catalyst[J].Qual Life Res,2014,23(9):2421-2430.
[8]伏冉,郑玉龙,王贻,等.全面肺康复治疗对中、重度慢性阻塞性肺疾病患者稳定期肺功能和血气指标的影响[J].中华物理医学与康复杂志,2016,38 (8):594-597.
[9]冯平.慢阻肺评估测试、6min步行试验和肺功能检测在老年中重度慢性阻塞性肺疾病稳定期患者病情诊断中的意义[J].国际老年医学杂志,2017,38(1):18-21.
[10]Sunde S,Walstad RA,Bentsen SB,et al.The development of an integrated care model for patients with severe or very severe chronic obstructive pulmonary disease (COPD):the COPD-Home model[J].Scand J Caring Sci,2014,28(3):469-477.
[11]赵建君,蔡盈盈.益肺胶囊联合肺康复训练对老年慢性阻塞性肺疾病稳定期患者肺功能的影响[J].实用医院临床杂志,2017,14(6):80-83.
[12]张敏,徐桂华,李峰,等.健身气功易筋经促进慢性阻塞性肺疾病稳定期患者康复[J].中国运动医学杂志,2016,35(4):339-343.
[13]蒋雪莲,钟萍,黄成亮,等.稳定期慢性阻塞性肺疾病患者营养状况和氧化应激能力与肺功能的关系[J].中华结核和呼吸杂志,2017,40(1):40-45.
[14]潘明鸣,张洪胜,孙铁英,等.老年男性支气管哮喘-慢性阻塞性肺疾病重叠综合征患者肺功能特征分析[J].中华老年医学杂志,2017,36(2):146-150.
[15]舒李慧,王锐英,许建英,等.肺功能对稳定期慢性阻塞性肺疾病患者疗效评估的研究[J].山西医药杂志,2016,45(8):886-889.
[16]赵寅滢,邹黎菲,范晓东,等.COPD稳定期患者前白蛋白与C反应蛋白水平、肺功能的相关性分析[J].现代仪器与医疗,2016,22(6):103-105.
[17]Frisk B,Espehaug B,Hardie JA,et al.Physical activity and longitudinal change in 6-min walk distance in COPD patients[J].Respir Med,2014,108(1):86-94.
[18]陈静华,肖惠,江涵,等.呼吸运动锻炼康复法对稳定期COPD患者肺功能及生活质量的影响[J].南昌大学学报(医学版),2017,57(2):8-10.