上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (5): 620-.doi: 10.3969/j.issn.1674-8115.2011.05.020

• 论著（临床研究） • 上一篇    下一篇

不同严重度慢性阻塞性肺疾病患者肺康复策略比较

任 蕾1,2, 李庆云1, 杜井波2, 周均铭3, 翁秋霖2, 陈小虎2   

  1. 1.上海交通大学 |医学院附属瑞金医院呼吸科, 上海 200025； 2．上海市静安区老年医院呼吸科, 上海 200040； 3.上海市静安区曹家渡社区卫生服务中心, 上海 200042
  • 出版日期:2011-05-28 发布日期:2011-05-27
  • 通讯作者: 李庆云, 电子信箱: liqingyun68@yahoo.com.cn。
  • 作者简介:任 蕾（1971—）, 女, 主治医师, 硕士生；电子信箱: rl6249@hotmail.com。
  • 基金资助:

    上海市静安区十、百、千人才培养计划（200706B044）

Comparison of different strategies of pulmonary rehabilitation for patients with COPD of different severity

REN Lei1,2, LI Qing-yun1, DU Jing-bo2, ZHOU Jun-ming3, WENG Qiu-lin2, CHEN Xiao-hu2   

  1. 1.Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China； 2.Department of Respiratory Medicine, Shanghai Jing-an Geriatric Hospital, Shanghai 200040, China；3.Shanghai Caojiadu Community Health Service Center, Shanghai 200042, China
  • Online:2011-05-28 Published:2011-05-27
  • Supported by:

    Shanghai Jing-an talent cultivation plan, 200706B044

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摘要：

目的 探讨不同严重度慢性阻塞性肺疾病（COPD）患者如何选择肺康复策略。方法 将89例稳定期COPD患者按严重度分为中度COPD组（n=32）、重度COPD组（n=36）和极重度COPD组（n=21），每组再随机分为对照组和肺康复干预策略1组和策略2组，并进行20周的康复干预。比较干预前后及各组间患者BODE指数、6 min步行距离（6MWD）、呼吸困难程度评分（MMRC）、肺功能（FEV1）、体质量指数（BMI）及COPD急性加重次数的变化。结果 经过20周的肺康复干预，COPD中度、重度患者策略2疗效最好，干预前后6MWD比较差异有统计学意义（P<0.01），但BODE指数、MMRC、BMI和FEV1比较差异无统计学意义（P>0.05）。极重度COPD患者策略1组疗效最好，干预前后MMRC比较差异有统计学意义（P<0.05），但BODE指数、6MWD、BMI和FEV1比较差异无统计学意义（P>0.05）。重度COPD患者策略2组的BODE指数和6MWD改善效果最好（均P<0.000 1）；极重度COPD患者策略1组MMRC改善效果最好（P<0.01）。Poisson 回归分析显示，重度COPD患者在肺康复干预后急性加重次数明显减少（P<0.01）；其余不同干预组和不同严重度组间比较差异均无统计学意义（P>0.05）。结论 针对不同严重度COPD患者可采取不同的肺康复策略以取得最佳疗效。

关键词: 慢性阻塞性肺疾病, 肺康复, BODE指数, 6 min步行距离, 呼吸困难程度评分, 急性加重次数

Abstract:

Objective To investigate the strategies of pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD) of different severity. Methods Eighty-nine patients with COPD in stable stage were divided into moderate COPD group (n=32), severe COPD group (n=36) and very severe COPD group (n=21). Each group of patients were randomly subdivided into pulmonary rehabilitation strategy group 1, pulmonary rehabilitation strategy group 2 and  control group, and were intervened for 20 weeks. BODE index, 6 minute walking distance (6MWD), Modified Medical Research Council Scale (MMRC), pulmonary function(FEV1), body mass index (BMI) and acute exacerbation frequency of COPD were compared before and after intervention and among groups. Results After pulmonary rehabilitation intervention for 20 weeks, 6MWD in patients with moderate and severe COPD treated with strategy 2 significantly improved （P<0.01）, while BODE index, MMRC, BMI and FEV1 after intervention were not significantly different from those before intervention (P>0.05）. MMRC of patients with very severe COPD treated with strategy 1 significantly improved after intervention （P<0.05）, while BODE index, 6MWD, BMI and FEV1 after intervention were not significantly different from those before intervention (P>0.05）. BODE index and 6MWD of severe COPD group treated with strategy 2 improved significantly (P<0.000 1), and MMRC of very severe COPD group treated with strategy 1 improved significantly （P<0.01）. Poisson regression analysis revealed that acute exacerbation frequency of severe COPD patients significantly reduced by pulmonary rehabilitation （P<0.01）, while there was no significant change in the other groups (P>0.05). Conclusion Patients with different severity of COPD may take different pulmonary rehabilitation strategies to achieve the optimal effect.

Key words: chronic obstructive pulmonary disease, pulmonary rehabilitation, BODE index, 6 minute walking test, Modified Medical Research Council Scale, acute exacerbation frequency